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Free Online Training for Cleft Care - Analysis of Global Market Penetration
Derek M. Culnan, MD1, Aaron Oliker, MS2, Court B. Cutting, MD2, Roberto L. Flores, MD2.
1Indiana University, Indianapolis, IN, USA, 2New York University, New York, NY, USA.

PURPOSE:
We have produced a free, web-based, multimedia surgical simulator partnered with Smile Train, which demonstrates the cardinal procedures of cleft surgery. The intent is to help surgeons in developing countries care for their local populations. We report on the international utilization of the world’s first internet-based cleft simulator.
METHODS:
User IP-addresses were tracked to their originating countries over one-year. The countries were analyzed based upon economic factors and health metrics such as health expenditures and underweight children to determine the served populations.
RESULTS:
849 novel users from 78 countries were recorded representing 6.28 billion persons or 88.5% of the global population. 54 countries were classified as developing economies; representing 5.3-billion people with an average GDP of \.4-billion and PCI \,281. The poorest developing countries accessing the Simulator in terms of PCI were Congo(\), Ethiopia(\,200), and Nepal(\,300) or by population below the poverty line were Haiti(80%) Congo(71%) and Nigeria(70%). Surprisingly, the simulator was used in 21 countries with active armed conflicts and 28 where the US State Department advises against travel including Yemen, Iraq and Nigeria.
CONCLUSION:
The Simulator has quickly gained global use including in the poorest countries. Projects directed towards international education in the developing world should strongly consider using free web-based digital technology to immediately access and educate caregivers, particularly in countries with economic or political constraints.


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