A model for humanitarian outreach in today's world.

The traditional model for humanitarian work for surgeons has been a few long-term people and a larger number of volunteers on short-term missions to needy places for one or two weeks with limited opportunity for follow-up. While a great deal of good has resulted from these efforts, in the long term not much has changed. Recent studies like the U.N. Millennium Development Goals and the Lancet Commission Report, Surgery 2030, have pointed out that the burden of surgical disease is the major public health issue in the world, such that an estimated five billion people worldwide do not have access to safe surgery and anesthesia, with the largest number being in Africa where almost half of the population is less than age 18years. These and other reports related to essential surgery conclude that the key element in this problem is an extreme shortage of a capable, well-trained physician workforce, without which none of the Millennium Goals can be accomplished. For these reasons, we have directed our efforts to the development of a humanitarian model that meets the modern day need to expand the surgeon and anesthesia workforces using a Western university model adapted to locoregional African needs. The goal is to train the trainers in order to magnify the physician output rapidly over wide geographical areas and to train teams of surgeons and anesthesiologists who will work together. Although we have worked primarily in East Africa, particularly in Kenya, we feel that this model is widely applicable. While this effort is in its early stages, resident trainees from the home program in Kenya are now in Uganda, Rwanda, Ethiopia, Sierra Leone, Cameroon, and Madagascar, and they are in the process of developing their own residency training programs. It is our vision that with the expansion of the surgeon-anesthesiologist workforce, more people will have access to safe surgery and anesthesia, including obstetrical care, a humanitarian model in today's context.