4. The Other Side of the Story: Evaluating Global Surgery Partnerships From All Perspectives

Background: Technologic advances have led to increasing collaboration in global surgery. With increasing data on perceptions from High Income Countries (HIC), little has been written about perceptions from Low and Middle Income Countries (LMIC). We hypothesized that collaborations have increased in diversity but lack long term structure. This survey provides a snapshot of perspectives from LMIC surgeons. Methods: A survey was distributed to surgeons from LMIC worldwide to assess the nature and perception of collaborations, funding, benefits, communication, and the effects of Covid-19 on partnerships. Results: We received responses from LMIC representatives in 12 countries on 3 continents. The majority (83%) had participated in collaborations within the past 5 years. 39% of collaborations were facilitated virtually. Clinical and educational partnerships (39% each) were ranked most important by LMIC respondents. Sustainability of the partnership was most achieved in domains of education/training (78%) and research (61%). 77% of LMIC respondents reported expressing their needs before HIC team arrival. However, 54% of respondents were the ones to initiate the conversation. Only 47% said HIC partners understood the overall environment well at arrival to LMIC. The majority, 95%, of participants felt a formal process of collaboration/ structured partnership would benefit all parties in assessing needs. During the Covid-19 pandemic, 87% reported continued collaborations. 44% of partners felt that relationships were weaker, 31% felt relationships were stronger, and 25% felt they were unchanged. Conclusion: Our study provides a worldwide snapshot of LMIC surgeon’s perspectives on collaboration in global surgery. Independent of location, LMIC partners cite inadequate structure for long-term collaborations. We propose a formal pathway and initiation process to assess resources and needs at the outset of a partnership.