title: Strategic design for pediatric neurosurgery missions across the Western Hemisphere.
abstract: BACKGROUND
  With growing interest in global health, surgeons have created outreach missions to improve health care disparities in less developed countries. These efforts are mainly episodic with visiting surgeons performing the operations and minimal investment in local surgeon education. To create real and durable advancement in surgical services in disciplines that require urgent patient care, such as pediatric neurosurgery, improving the surgical armamentarium of the local surgeons must be the priority.
  
  
  METHODS
  We propose a strategic design for extending surgical education missions throughout the Western Hemisphere in order to transfer modern surgical skills to local neurosurgeons. A selection criteria and structure for targeted missions is a derivative of logistical and pedagogical lessons ascertained from previous missions by our teams in Peru and Ukraine.
  
  
  RESULTS
  Outreach programs should be applied to hospitals in capital cities to serve as a central referral center for maximal impact with fiscal efficiency. The host country should fulfill several criteria, including demonstration of geopolitical stability in combination with lack of modern neurosurgical care and equipment. The mission strategy is outlined as three to four 1-week visits with an initial site evaluation to establish a relationship with the hospital administration and host surgeons. Each visit should be characterized by collaboration between visiting and host surgeons on increasingly complex cases, with progressive transfer of skills over time.
  
  
  CONCLUSIONS
  A strategic approach for surgical outreach missions should be built on collaboration and camaraderie between visiting and local neurosurgeons, with the mutual objective of cost-effective targeted renovation of their surgical equipment and skill repertoire.
authors.affiliation: NYU School of Medicine, 550 First Avenue, New York, NY 10016, USA.
authors.forename: Amanda
authors.initials: A
authors.lastname: Hambrecht
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Duenas
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Hahn
authors.forename: Henry E
authors.initials: HE
authors.lastname: Aryan
authors.forename: Samuel A
authors.initials: SA
authors.lastname: Hughes
authors.forename: Dawn
authors.initials: D
authors.lastname: Waters
authors.forename: Michael L
authors.initials: ML
authors.lastname: Levy
authors.forename: Rahul
authors.initials: R
authors.lastname: Jandial
keywords: Central and South America; missions; neurosurgery; pediatric neurosurgery; targeted renovation