Humanitarian plastic surgery for São Tomé and Príncipe
Situation:
São Tomé and Príncipe is a small, remote island republic off the coast of West Africa with a population of around 210,000. Medical care is severely limited. The central and almost only care facility is the public hospital, Hospital Dr. Ayres de Menezes (H.A.M.), in the capital. There are around 850 beds and only two regularly usable operating rooms available for the entire population. Due to staff and material shortages, these can often only be used for absolute emergencies.
Specialized surgical services are hardly available locally. Highly complex procedures are performed—if at all—as part of temporary international aid missions. There is no independent plastic and reconstructive care. Patients with severe burn injuries, scar contractures, or congenital malformations therefore often remain untreated. Children are particularly affected, resulting in long-term limitations in mobility, educational opportunities, and social participation.
The structural deficits are exacerbated by a pronounced shortage of skilled workers. Political instability and easier labor migration, especially to Portugal, have led to a continuous exodus of medical personnel in recent years. This affects nursing staff as well as medical personnel and has a direct negative impact on the health care of the population.
Objectives:
The aim of the project is to bring about a lasting improvement in plastic and reconstructive care in São Tomé and Príncipe. The focus is not on short-term aid, but on sustainable impact.
This is to be achieved through a combination of direct surgical assistance, structural capacity building, and close cooperation with the local healthcare system. Surgical procedures, with a particular focus on the treatment of complex and chronic wounds, are specifically linked to training and further education in order to strengthen existing structures and build up local expertise.
The central approach is not only to provide surgical knowledge on a temporary basis, but to anchor it in the long term. Repeated missions, year-round telemedical availability, practical training, networking between various actors locally and in Germany, and the continuous strengthening of cooperation enable the development of local resources and promote independence beyond the duration of the project.
The number of plastic surgeries performed by specialists—with a benchmark of at least 30 procedures per mission on average—is the key indicator for the sub-goal of providing direct surgical care to the local population. At least two missions per year are planned.
The number of training procedures, training courses conducted, and the degree of surgical independence are decisive for the sub-goal of competence development. A key indicator of success is the number of local physicians who can perform skin transplants independently. These measures are ongoing.
The number of trained users, proof of proper use and maintenance, and documented handover protocols are the indicators for the sub-goal of sustainable integration of medical devices and techniques into everyday clinical practice. The handover will take place gradually and depend on the learning success of the local staff.
Surgical missions
A central component of the project is two to three plastic surgery missions per year in São Tomé and Príncipe at the Hospital Dr. Ayres de Menezes (H.A.M.). The interdisciplinary team consists of plastic and reconstructive surgeons, anesthesiologists, and surgical and anesthesia nurses. The surgical focus is on functional restoration, including scar contractures, malformations, syndactyly, and chronic wounds, with the aim of improving mobility, participation, and quality of life. Due to the unstable supply situation, all necessary materials are brought entirely from Germany.
Patient acquisition and outpatient consultations
Patients are selected through daily consultations at H.A.M. and mobile consultations in remote health stations (pt.: "postos"). These are carried out together with local staff and also serve as training in wound care and aftercare. Our local project manager Dra. Carvalho is responsible for the continuous identification of potential cases between missions. There are plans to expand outpatient activities to the neighboring island of Príncipe in the future.
Training and knowledge transfer
Knowledge transfer takes place in a practical manner through one-on-one training during operations and structured training courses in surgery, anesthesia, hygiene, and wound care. The goal is to gradually build local independence.
Telemedical follow up care
Between assignments, structured telemedical care is provided for follow-up treatment and expert advice. This enables continuous monitoring of postoperative progress and supports the sustainable development of expertise on site.
The project aims to establish permanent structures for plastic and reconstructive care in São Tomé and Príncipe. The focus is on building local expertise, gradually transferring surgical tasks to local staff, and ensuring the reliable use of medical equipment.
Repeated missions, practical training, and ongoing support ensure that knowledge and responsibility are firmly anchored locally. Close cooperation with the public health system raises awareness of the issues among key players and promotes the continuation of established structures, particularly in the field of specialized wound care, even after the project has ended.
The goal is to establish local plastic and reconstructive care that can function in the long term with significantly reduced external support.
