title: The Role of International Volunteers in the Growth of Surgical Capacity in Post-earthquake Haiti.
abstract: BACKGROUND
  The 2010 Haiti earthquake severely strained local healthcare infrastructure. In the wake of this healthcare crisis, international organizations provided volunteer support. Studies demonstrate that this support improved short-term recovery; however, it is unclear how long-term surgical capacity has changed and what role volunteer surgical relief efforts have played. Our goal was to investigate the role of international surgical volunteers in the increase of surgical capacity following the 2010 Haiti earthquake.
  
  
  METHODS
  We retrospectively analyzed the operative reports of 3208 patients at a general, trauma and critical care hospital in Port-au-Prince from June 2010 through December 2013. We collected data on patient demographics and operation subspecialty. Surgeons and anesthesiologists were categorized by subspecialty training and as local healthcare providers or international volunteers. We performed analysis of variance to detect changes in surgical capacity over time and to estimate the role volunteers play in these changes.
  
  
  RESULTS
  Overall number of monthly operations increased over the 2.5 years post-earthquake. The percentage of orthopedic operations declined while the percentage of other subspecialty operations increased (p = 0.0003). The percentage of operations performed by international volunteer surgeons did not change (p = 0.51); however, the percentage of operations staffed by volunteer anesthesiologists declined (p = 0.058). The percentage of operations performed by matching specialty- and subspecialty-trained international volunteers has not changed (p = 0.54).
  
  
  CONCLUSIONS
  Haitian post-earthquake local and overall surgical capacity has steadily increased, particularly for provision of subspecialty operations. Surgical volunteers have played a consistent role in the recovery of surgical capacity. An increased focus on access to surgical services and resource-allocation for long-term surgical efforts particularly in the realm of subspecialty surgery may lead to full recovery of surgical capacity after a large and devastating natural disaster.
authors.affiliation: Hospital Bernard-Mevs, Blvd Toussaint Louverture, Village Solidarite #2, Port-au-Prince, Haiti. maxherbyd@gmail.com.
authors.forename: Max Herby
authors.identifier: http://orcid.org/0000-0001-6445-5977
authors.initials: MH
authors.lastname: Derenoncourt
authors.affiliation: Hospital Bernard-Mevs, Blvd Toussaint Louverture, Village Solidarite #2, Port-au-Prince, Haiti.
authors.forename: Roselaine
authors.initials: R
authors.lastname: Carré
authors.affiliation: Division of Plastic Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Condé-Green
authors.affiliation: Hospital Bernard-Mevs, Blvd Toussaint Louverture, Village Solidarite #2, Port-au-Prince, Haiti.
authors.forename: Alain
authors.initials: A
authors.lastname: Rodnez
authors.affiliation: Division of Trauma and Surgical Critical Care, Rutgers New Jersey Medical School, Newark, NJ, USA.
authors.forename: Ziad C
authors.initials: ZC
authors.lastname: Sifri
authors.affiliation: Division of Trauma and Surgical Critical Care, Rutgers New Jersey Medical School, Newark, NJ, USA.|Department of Surgery, St. Barnabas Hospital, Bronx, NY, USA.
authors.forename: Gerard A
authors.initials: GA
authors.lastname: Baltazar
mesh_terms: D000776:Anesthesiology; D004190:Disasters; D055866:Earthquakes; D013502:General Surgery; D006205:Haiti; D006296:Health Services / Q000600:supply & distribution*; D006297:Health Services Accessibility; D006761:Hospitals; D006801:Humans; D009938:Organizations; D012189:Retrospective Studies; D013043:Specialties, Surgical; D014838:Volunteers