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Accountability in global surgery missions
  1. Elena Zitzman1,
  2. Holly Berkley2,
  3. Rahul M Jindal1
  1. 1 USU-Walter Reed Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
  2. 2 Department of Obstetrics and Gynecology, Naval Medical Center San Diego, San Diego, California, USA
  1. Correspondence to Dr Rahul M Jindal; jindalr{at}

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Summary box

  • Supervisory systems regulating outcomes after global surgical missions are limited.

  • With a few notable exceptions, most global surgical missions garner low (if any) follow-up rates and thus outcomes reporting is scarce.

  • Obstacles include logistical difficulties, surgeon and non-governmental organisation non-compliance, journalistic coverage (both positive and negative), and economics.

  • We suggest a multifaceted solution, including buy-in and direction from global surgical leadership, web-based and tax-incentivised reporting, and a cross-disciplinary cooperation with journalists and social media.

  • We believe that the implementation of outcomes reporting during the development of surgical systems in low-income and middle-income countries is both an efficient way to promote safe surgery worldwide and vital to our professional ethic.


There are limited supervisory systems, if any, regulating poor outcomes after medical and surgical missions in low and middle-income countries (LMICs). Even in the environment of close legal and academic oversight,1 2 the medical community fights the perception that only ‘good’ outcomes are reported in medical journals.3 The nature of global surgery poses significant additional barriers to oversight and outcomes reporting, some of which are more self-evident than others. The void of oversight may encourage untrained teams to embark on missions beyond their abilities4; despite the best of intentions, global surgeons may be doing more harm than good. We owe it to our Oath as medical professionals and to the populations we serve to evaluate the care we are providing, not just in our own countries, but in the countries to which we travel as non-governmental organisations (NGOs) and other humanitarian or global surgical missions. Our aim in this commentary is to (1) survey the current climate of outcomes reporting in global surgery, (2) identify obstacles and (3) propose concrete solutions.

Current climate of outcomes reporting in global surgery

First, it is essential for us to acknowledge the role of outcomes and our reasons for …

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