Decolonizing Global Surgery

Abstract

Background: Trauma remains a leading cause of child mortality and disability worldwide, taking the lives of 1 million children annually. Of all deaths from pediatric trauma, 95% occur in low-and middle-income countries (LMICs). To improve quality of care, the Royal College of Physicians and Surgeons of Canada has developed and validated the Trauma Resuscitation in Kids (TRIK) course. While initially designed for North American settings, TRIK has potential for global educational utility, yet the costs of required adaptation and international instructor training impede its globalization. Our objective was to describe the process of designing a feasible and sustainable global training course for pediatric trauma, using a limited budget and respecting key ethical principles. Methods: Stakeholders from high-income countries and LMICs were assembled to pilot a TRIK course in Brazil, designed using a nominal group technique. Cost-effectiveness analysis was undertaken, comparing virtual and in-person instructor training options. Results: Three main phases were considered essential for this TRIK course: (1) selection and training of Brazilian champions as instructors to maintain the course, (2) course adaptation to local trauma epidemiology and resources, and (3) accurate translation of all material. Estimated instructor training budgets were CAD $5800 using an in-person modality and CAD $1800 using virtual training. Conclusion: Adaptation of a training course to a lower-income country presents several challenges. Our panel of experts identified key steps for an effective Brazilian course adaptation: involvement of local experts, adaptation to local context and resources while maintaining overall course effectiveness, and translation of course materials. In view of the cost barriers to broader globalization, virtual training of local champions may be a feasible option to cost-effectively increase the number of local course instructors. Equitable training adapted to local provider-directed needs is crucial to addressing disparities in pediatric trauma care worldwide while promoting the decolonization of global health.