LAUSR

Dear Editor, In order to advance trauma care in lowand middle-income countries (LMIC), innovative approaches must be utilized that build capacity and allow for successful implementation and dissemination of strategies. Recently, in the World Journal of Trauma, Dasari et al. [1] published a qualitative study about the implementation process of an innovative electronic surgery registry in Paraguay. The experience of Paraguay, an upper-middle-income country, is crucial for other Latin-American countries to understand potential barriers for the implementation of electronic registries in the region. The authors analyzed the hospital infrastructure and healthcare staff perspectives of the implementation process, but a missing component in the discussion was the historical local surveillance strategies. Therefore, experiences from LMIC provide a new perspective about the implementation process of injury prevention tools. The case of Jamaica, Cali-Colombia and Honduras is relevant to understand the evolution and the different pathways of injury prevention/surveillance systems. In Jamaica, in 1998 a trauma registry (TR) was created at the University Hospital of the West Indies to document detailed information on all trauma admissions, and the Violence-Related Injury Surveillance System (VRISS, in 1999 expanded to all injuries in the Jamaica Injury Surveillance System, JISS) to register all cases of injuries in the hospital emergency departments [2]. In Colombia, in 1995, Dr. Rodrigo Guerrero established in Cali a Violence Surveillance System (VSS) to capture city-wide injury information [3]. Through an initiative by the Center for Disease Control and Prevention (CDC), the Pan-American Health Organization (PAHO) and the Cisalva Institute at the Universidad del Valle, a paperbased trauma surveillance system (TSS) was created in 2000 to register all injuries in Cali’s hospital emergency departments. This TSS was also implemented in other Latin-American countries, including El Salvador, Peru, Jamaica and Honduras [2, 4]. Most recently, the International TR of the Pan-American Trauma Society was implemented in Cali [5]. Honduras created a surveillance system similar to the VSS in Cali called the University Institute on Democracy, Peace and Security (IUDPAS, http://www.iudpas.org/ index.php). There have been few international initiatives to work on trauma care improvement in Honduras, including collaborations with Harvard University and the International Committee of the Red Cross (ICRC). However, Honduras’ initiatives have been largely overlooked because the country lacks an organized trauma system and does not have the capacity to carry out significant trauma research. It also offers few opportunities for public health scientists and surgeons to collaborate, which is necessary for comprehensive trauma systems, contrary to the situation in Jamaica or Cali, or the new situation in Paraguay [1], where they have been collaborating actively [2, 5]. The NIH and the Fogarty International Center created new funding opportunities to develop ‘‘eCapacity’’ through training grants that combine innovative electronic health & Francisco J. Bonilla-Escobar [email protected]