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Clinical Outcome, Social Impact and Patient Expectation: a Purposive Sampling Pilot Evaluation of Patients in Benin Seven Years After Surgery

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Abstract

Background

Access to affordable and timely surgery is not equitable around the world. Five billion people lack access, and while non-governmental organizations (NGOs) help to meet this need, long-term surgical outcomes, social impact or patient experience is rarely reported.

Method

In 2016, Mercy Ships, a surgical NGO, undertook an evaluation of patients who had received surgery seven years earlier with Mercy Ships in 2009 in Benin. Using purposive sampling, patients who had received maxillofacial, plastics or orthopedic surgery were invited to attend a surgical evaluation day. In this pilot study, we used semi-structured interviews and questionnaire responses to assess patient expectation, surgical and social outcome.

Results

Our results show that seven years after surgery 35% of patients report surgery-related pain and 18% had sought further care for a clinical complication of their condition. However, 73% of patients report gaining social benefit from surgery, and overall patient satisfaction was 89%, despite 35% of patients saying that they were unclear what to expect after surgery indicating a mismatch of doctor/patient expectations and failure of the consent process.

Conclusion

In conclusion, our pilot study shows that NGO surgery in Benin provided positive social impact associated with complication rates comparable to high-income countries when assessed seven years later. Key areas for further study in LMICs are: evaluation and treatment of chronic pain, consent and access to further care.

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Author information

Authors and Affiliations

  1. M/V Africa Mercy, Mercy Ships, Port Au Cotonou, Benin

    Michelle C. White, Kirsten Randall, Esther Avara, Jenny Mullis, Gary Parker & Mark G. Shrime

  2. Great Ormond Street Children’s Hospital, London, UK

    Michelle C. White

  3. Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA

    Mark G. Shrime

  4. Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA

    Mark G. Shrime

Authors
  1. Michelle C. White
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  2. Kirsten Randall
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  3. Esther Avara
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  4. Jenny Mullis
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  5. Gary Parker
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  6. Mark G. Shrime
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Contributions

MW and KR conceived and designed the study. EA, JM and GP acquired the data. MW, KR and MGS contributed to data interpretation and analysis. MW wrote the first draft of the manuscript, and all authors were involved in critical revision of the article and approved the final version for publication.

Corresponding author

Correspondence to Michelle C. White.

Ethics declarations

Conflict of interests

Mark G. Shrime receives funds from the Damon Runyon Cancer Research Foundation and from the GE Safe Surgery 2020 project. The other authors have no conflicts of interest to declare.

Appendices

Appendix 1

The following 10 questions formed basis for the semi-structured interview:

  1. 1.

    Do you/your child have pain related to your surgery?

    1. a.

      If yes, how bad is the pain?*

  2. 2.

    Have you/your child had any open wounds (slow/poor healing) since discharge?

  3. 3.

    Did you have to seek further care for the condition?

  4. 4.

    Did you feel like you knew what to expect after the surgery?

  5. 5.

    How satisfied are you with the results of the surgery?**

  6. 6.

    Were you expecting a better result?**

  7. 7.

    Were you/or your child made to feel isolated or teased before your surgery?**

    1. a.

      Do you or your child feel isolated or get teased now?**

  8. 8.

    After the surgery did it improve your/your child’s ability to go to work or school?**

  9. 9.

    What do you remember most about your stay on the ship?

    1. a.

      The best memories

    2. b.

      The worst memories

  10. 10.

    Describe some of the ways your/your child’s life has changed since the surgery?

*Question 1a was measured using the Wong and Baker 6 faces scale for children and a 0–5 scale for adults.

**Questions 5–8 were measured using the 6-point Smiley Face Assessment Scale (SFAS).

Appendix 2

Details of thematic analysis

Five themes on the perceptions of care received by patients (number of responses)

  1. 1.

    Loving and compassionate care (64)

  2. 2.

    Food [15]

  3. 3.

    Spiritual aspect to holistic care [13]

  4. 4.

    Freedom from fear [12]

  5. 5.

    That the surgery was free [9]

Four themes on the impact of surgery on patient’s lives

  1. 1.

    Improved self-esteem and hope [34]

  2. 2.

    Improved function [31]

  3. 3.

    Improved ability to work or go to school [18]

  4. 4.

    Improved speech [11]*

*This was maxillofacial patients only

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White, M.C., Randall, K., Avara, E. et al. Clinical Outcome, Social Impact and Patient Expectation: a Purposive Sampling Pilot Evaluation of Patients in Benin Seven Years After Surgery. World J Surg 42, 1254–1261 (2018). https://doi.org/10.1007/s00268-017-4296-9

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  • DOI: https://doi.org/10.1007/s00268-017-4296-9

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