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Surgical skills needed for humanitarian missions in resource-limited settings

Surgical skills needed for humanitarian missions in resource-limited settings. Evan G. Wong, Miguel Trelles, Lynette Dominguez, Shailvi Gupta, Gilbert Burnham, Adam L.Kushner. A four year audit of MSF data from 21 countries. Background.

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Surgical skills needed for humanitarian missions in resource-limited settings

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  1. Surgical skills needed for humanitarian missions in resource-limited settings Evan G. Wong, Miguel Trelles, Lynette Dominguez, Shailvi Gupta, Gilbert Burnham, Adam L.Kushner A four year audit of MSF data from 21 countries

  2. Background Surgeons from high-income countries are interested in global surgery and humanitarian missions.

  3. Background Knowledge of the surgical skills needed to respond to humanitarian missions is essential to: • Guide recruitment. • Build capacity of surgeons. • Plan for interventions.

  4. MSF and surgery • MSF is providing surgical care for more than 40 years; and between 2008 and 2013, 46 projects in 23 countries performed surgical activities. • A global analysis of the kind of needed surgery was not performed before with data available in MSF.

  5. In Sierra Leone, 25% of households reported a surgical condition needing attention, and 25% deaths of the households member in the previous year might have been averted by timely surgical care.

  6. Objectives To review the surgical procedures at MSF-OCB facilities between 2008 and 2012 in order to ascertain: • the commonly performed operations. • the necessary surgical skills.

  7. Methods • Study design: retrospective analysis of standardized surgical databases. • Study sites: OCB health facilities in 21 countries. • Study period: June 2008 – December 2012. • Study population: all patients who underwent surgery.

  8. Indications for surgery • Trauma • Violence • Accident • Obstetrical • Foetal-Maternal • Post partum complications • Non-trauma • Infection • Ischemia • Tumor • Haemorrhage • Other

  9. Types of surgical procedures • Minor • Wound surgery • Visceral • Orthopaedics • Gynaecology, obstetrics & urology • Specialized surgery

  10. Patient characteristics

  11. Indications for surgery (n=83,911)

  12. Types of surgical procedures (n=93,385)

  13. Commonly performed obstetric, gynaecologic, and urologic procedures

  14. Commonly performed visceral surgical procedures

  15. Commonly performed orthopaedic procedures

  16. Conclusions Over four years and in 21 countries: • MSF-OCB performed about 100,000 surgical procedures of wide diversity. • The most common surgical procedures included: Caesarean sections, hernia, bowel resection, and fracture reduction. • One in fifteen patients who underwent surgery were under 5 years.

  17. Conclusions • All surgeons interested in humanitarian missions must have the surgical skills to manage the most common surgical procedures – but major human resource gaps ! • Specific anaesthesia and surgical skills are needed to cater to paediatric needs – remains unaddressed ! • MSF should advocate and directly invest in specific training programmes and capacity building to meet our humanitarian surgical needs.

  18. Many thanks To the surgical teams on the ground, the Medical Department, LUXOR and the patients and beneficiaries of MSF

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