• Burden of surgical disease: strategies to manage an existing public health emergency.

      McQueen, K A K; Parmar, P; Kene, M; Broaddus, S; Casey, K; Chu, K; Hyder, J A; Mihailovic, A; Semer, N; Sullivan, S R; et al. (2009-07)
      The World Health Organization estimates that the burden of surgical disease due to war, self-inflicted injuries, and road traffic incidents will rise dramatically by 2020. During the 2009 Harvard Humanitarian Initiative's Humanitarian Action Summit (HHI/HAS),members of the Burden of Surgical Disease Working Group met to review the state of surgical epidemiology, the unmet global surgical need, and the role international organizations play in filling the surgical gap during humanitarian crises, conflict, and war. An outline of the group's findings and recommendations is provided.
    • Cesarean Section Surgical Site Infections in Sub-Saharan Africa: A Multi-Country Study from Medecins Sans Frontieres

      Chu, K; Maine, R; Trelles, M (SpringerLink, 2014-10-31)
      Surgical site infections (SSI) are a significant cause of post-surgical morbidity and mortality and can be an indicator of surgical quality. The objectives of this study were to measure post-operative SSI after cesarean section (CS) at four sites in three sub-Saharan African countries and to describe the associated risk factors in order to improved quality of care in low and middle income surgical programs.
    • General surgeons: a dying breed?

      Chu, K; South African Medical Unit, Médecins Sans Frontières, 49 Jorissen St, Braamfontein 2017, Johannesburg, South Africa. kathryn.chu@joburg.msf.org (American Medical Association, 2009-06)
    • Improving Effective Surgical Delivery in Humanitarian Disasters: Lessons from Haiti

      Chu, K; Stokes, C; Trelles, M; Ford, N; Médecins sans Frontières, Cape Town, South Africa; Medecins sans Frontieres, Brussels, Belgium; Medecins sans Frontieres, Geneva, Switzerland (2011-04-26)
      Kathryn Chu and colleagues describe the experiences of Médecins sans Frontières after the 2010 Haiti earthquake, and discuss how to improve delivery of surgery in humanitarian disasters.
    • Open letter to young surgeons interested in humanitarian surgery

      Chu, K; South African Medical Unit, Médecins Sans Frontières, South Africa (2010-02-01)
    • Rethinking surgical care in conflict.

      Chu, K; Trelles, M; Ford, N; Médecins Sans Frontières, Braamfontein 2017, Johannesburg, Gauteng, South Africa. (2010-01-23)
    • Surgeons Without Borders: A Brief History of Surgery at Médecins Sans Frontières.

      Chu, K; Rosseel, P; Trelles, M; Gielis, P; Médecins Sans Frontières, 49 Jorrisen St., Braamfontein 2017, Johannesburg, South Africa, kathryn.chu@joburg.msf.org. (2009-08-12)
      Médecins Sans Frontières (MSF) is a humanitarian organization that performs emergency and elective surgical services in both conflict and non-conflict settings in over 70 countries. In 2006 MSF surgeons departed on approximately 125 missions, and over 64,000 surgical interventions were carried out in some 20 countries worldwide. Historically, the majority of MSF surgical projects began in response to conflicts or natural disasters. During an emergency response, MSF has resources to set up major operating facilities within 48 h in remote areas. One of MSF strengths is its supply chain. Large pre-packaged surgical kits, veritable "operating theatres to go," can be readied in enormous crates and quickly loaded onto planes. In more stable contexts, MSF has also strengthened the delivery of surgical services within a country's public health system. The MSF surgeon is the generalist in the broadest sense and performs vascular, obstetrical, orthopaedic, and other specialized surgical procedures. The organization aims to provide surgical services only temporarily. When there is a decrease in acute needs a program will be closed, or more importantly, turned over to the Ministry of Health or another non-governmental organization. The long-term solution to alleviating the global burden of surgical disease lies in building up a domestic surgical workforce capable of responding to the major causes of surgery-related morbidity and mortality. However, given that even countries with the resources of the United States suffer from an insufficiency of surgeons, the need for international emergency organizations to provide surgical assistance during acute emergencies will remain for the foreseeable future.
    • Surgical care for the direct and indirect victims of violence in the eastern Democratic Republic of Congo.

      Chu, K; Havet, P; Ford, N; Trelles, M (2010-04-14)
      ABSTRACT: BACKGROUND: The provision of surgical assistance in conflict is often associated with care for victims of violence. However, there is an increasing appreciation that surgical care is needed for non-traumatic morbidities. In this paper we report on surgical interventions carried out by Medecins sans Frontieres in Masisi, North Kivu, Democratic Republic of Congo to contribute to the scarce evidence base on surgical needs in conflict. METHODS: We analysed data on all surgical interventions done at Masisi district hospital between September 2007 to December 2009. Types of interventions are described, and logistic regression used to model associations with violence-related injury. RESULTS: 2869 operations were performed on 2441 patients. Obstetric emergencies accounted for over half (675, 57%) of all surgical pathology and infections for another quarter (160, 14%). Trauma-related injuries accounted for only one quarter (681, 24%) of all interventions; among these, 363 (13%) were violence-related. Male gender (adjusted odds ratio (AOR)=20.0, p<0.001), military status (AOR=4.1, p<0.001), and age less than 20 years (AOR=2.1, p<0.001) were associated with violence-related injury. Immediate peri-operative mortality was 0.2%. CONCLUSIONS: In this study, most surgical interventions were unrelated to violent trauma and rather reflected the general surgical needs of a low-income tropical country. Programs in conflict zones in low-income countries need to be prepared to treat both the war-wounded and non-trauma related life-threatening surgical needs of the general population. Given the limited surgical workforce in these areas, training of local staff and task shifting is recommended to support broad availability of essential surgical care. Further studies into the surgical needs of the population are warranted, including population-based surveys to improve program planning and resource allocation and the effectiveness of the humanitarian response.
    • Surgical task shifting in Sub-Saharan Africa.

      Chu, K; Rosseel, P; Gielis, P; Ford, N; Médecins Sans Frontières, Johannesburg, Gauteng, South Africa. kathryn.chu@joburg.msf.org (PLoS, 2009-05-19)
    • Ten Years of Experience Training Non-Physician Anesthesia Providers in Haiti.

      Rosseel, P; Trelles, M; Guilavogui, S; Ford, N; Chu, K; Médecins Sans Frontières, rue Dupré 94, 1090, Brussels, Belgium. (2009-08-06)
      Surgery is increasingly recognized as an effective means of treating a proportion of the global burden of disease, especially in resource-limited countries. Often non-physicians, such as nurses, provide the majority of anesthesia; however, their training and formal supervision is often of low priority or even non-existent. To increase the number of safe anesthesia providers in Haiti, Médecins Sans Frontières has trained nurse anesthetists (NAs) for over 10 years. This article describes the challenges, outcomes, and future directions of this training program. From 1998 to 2008, 24 students graduated. Nineteen (79%) continue to work as NAs in Haiti and 5 (21%) have emigrated. In 2008, NAs were critical in providing anesthesia during a post-hurricane emergency where they performed 330 procedures. Mortality was 0.3% and not associated with lack of anesthesiologist supervision. The completion rate of this training program was high and the majority of graduates continue to work as nurse anesthetists in Haiti. Successful training requires a setting with a sufficient volume and diversity of operations, appropriate anesthesia equipment, a structured and comprehensive training program, and recognition of the training program by the national ministry of health and relevant professional bodies. Preliminary outcomes support findings elsewhere that NAs can be a safe and effective alternative where anesthesiologists are scarce. Training non-physician anesthetists is a feasible and important way to scale up surgical services resource limited settings.