Pediatric Surgical Care as a Model for Equity, Education, and Development: The Separation of Conjoined Twins In Haiti

Author(s):
Jamie Golden; Allison Linden; Michelle Morse; Vanessa Rouzier; Aaron Jensen; Peggy Han; Jerry Bitar; Marlon Bitar; James Stein; Henri Ford

Background:

Equitable surgical care for children is an essential component of basic human rights, but has largely been forgotten among the priorities of global surgery. The delivery of pediatric surgical care is inadequate in many low- and middle-income countries (LMICs) due to lack of specialty trained providers, health care resources, and infrastructure. Our team has worked closely with Haitian practitioners for 8 years to provide advanced pediatric surgical care and to establish a collaboration to improve self-sufficient management of complex pediatric surgical patients.

Hypothesis:

Building pediatric surgical capacity through multinational partnerships concentrating on education of local practitioners is essential for sustainable, self-sufficient healthcare in Haiti.

Methods:

We discuss the successful delivery of advanced pediatric surgical and critical care in Haiti during the separation of conjoined twins as an example of an effective partnership.

Results:

In September 2014 in Mirebalais, Haiti, a triplet pregnancy was diagnosed with two of the fetuses identified as omphalopagus conjoined twins. The three girls were delivered via cesarean section at 36 weeks gestation. As the conjoined twins grew and met their developmental milestones, a multinational interdisciplinary team of Haitian and US pediatricians, intensivists, surgeons, and anesthesiologists formulated a plan to separate the twins in Haiti at six months of age.

Through meticulous pre-operative planning, intraoperative communication and teaching, and post-operative intensive care, the conjoined twin separation was performed in Mirebalais in May 2015. Our teams worked side by side with direct transfer of knowledge and skills during a 7 hour operation that was a success for the girls and a unique chance for Haitian practitioners to work alongside their American colleagues in an operation rarely performed in the most advanced hospitals in the world.

Conclusions:

We illustrate the capacity to deliver safe, advanced surgical care and achieve the highest attainable standard of health within the constraints of a low-resource setting. The success of this operation was a great source of pride and symbolized the advancement of healthcare in a nation that had to rebuild itself from significant damage. It reflects the culmination of 8 years of capacity building and education to provide advanced pediatric surgical care in a country that has limited resources and lacks specialty trained pediatric surgeons.