• Amputation in emergency situations: indications, techniques and Médecins Sans Frontières France's experience in Haiti

      Herard, Patrick; Boillot, François; MSF, Paris, France. patrick.herard@paris.msf.org (2012-05-15)
      PURPOSE: The decision to amputate is always difficult but becomes even harder in emergency situations, which usually present extra complicating factors. MSF EXPERIENCE: These include human factors (related to both the surgeon and the patient); poor or nonexistent medical facilities, especially in war conditions or resource-poor countries; and cultural and religious considerations. Médecins Sans Frontières (MSF) has developed a quick medical and logistical response that relies on surgical protocols adapted to emergency situations, together with complete "kits" of medical equipment, supplies and inflatable facilities. CONCLUSION: Our response to Haiti's 2010 earthquake relied on these tools but also highlighted the need to develop more detailed protocols that will help our teams on the ground.
    • Anesthesia Provision in Disasters and Armed Conflicts

      Trelles Centurion, M; Van Den Bergh, R; Gray, H (Springer, 2017)
      Disasters and armed conflicts are characterized by high numbers of trauma cases, and occur mainly in developing countries where the healthcare response is already impaired, resulting in an inadequate response. Aside of the trauma cases, other surgical health conditions are also still present and require urgent care. Surgical care needs are different from context to context and depend on local means and capabilities.
    • Are American Surgical Residents Prepared for Humanitarian Deployment?: A Comparative Analysis of Resident and Humanitarian Case Logs

      Lin, Y; Dahm, J; Kushner, A; Lawrence, J; Trelles, M; Dominguez, L; Kuwayama, D (Springer International Publishing, 2017-08-04)
      Effective humanitarian surgeons require skills in general surgery, OB/GYN, orthopedics, and urology. With increasing specialization, it is unclear whether US general surgery residents are receiving exposure to these disparate fields. We sought to assess the preparedness of graduating American surgical residents for humanitarian deployment.
    • Association Between Gender, Surgery and Mortality for Patients Treated at Médecins Sans Frontières Trauma Centre in Kunduz, Afghanistan.

      Tounsi, LL; Daebes, HL; Warnberg, MG; Jaweed, M; Mamozai, BA; Nasim, M; Drevin, G; Trelles, M; von Schreeb, J (Springer, 2019-05-07)
      INTRODUCTION: There is paucity of literature describing type of injury and care for females in conflicts. This study aimed to describe the injury pattern and outcome in terms of surgery and mortality for female patients presenting to Médecins Sans Frontières Trauma Centre in Kunduz, Afghanistan, and compare them with males. MATERIALS AND METHODS: This study retrospectively analysed patient data from 17,916 patients treated at the emergency department in Kunduz between January and September 2015, before its destruction by aerial bombing in October the same year. Routinely collected data on patient characteristics, injury patterns, triage category, time to arrival and outcome were retrieved and analysed. Comparative analyses were conducted using logistic regression. RESULTS: Females constituted 23.6% of patients. Burns and back injuries were more common among females (1.4% and 3.3%) than among males (0.6% and 2.0%). In contrast, open wounds and thoracic injuries were more common among males (10.1% and 0.6%) than among females (5.2% and 0.2%). Females were less likely to undergo surgery (OR 0.60, CI 0.528-0.688), and this remained significant after adjustment for age, nature of injury, triage category, multiple injuries and delay to arrival (OR 0.80, CI 0.690-0.926). Females also had lower unadjusted odds of mortality (OR 0.49, CI 0.277-0.874), but this was not significant in the adjusted analysis (OR 0.81, CI 0.446-1.453). CONCLUSION: Our main findings suggest that females seeking care at Kunduz Trauma Centre arrived later, had different injury patterns and were less likely to undergo surgery as compared to males.
    • Averted Health Burden Over 4 Years at Médecins Sans Frontières (MSF) Trauma Centre in Kunduz, Afghanistan, Prior to its Closure in 2015

      Trelles, M; Stewart, B T; Hemat, H; Naseem, M; Zaheer, S; Zakir, M; Adel, E; Van Overloop, C; Kushner, A L (Elsevier, 2016-07)
    • Before the Bombing: High Burden of Traumatic Injuries in Kunduz Trauma Center, Kunduz, Afghanistan

      Hemat, H; Shah, S; Isaakidis, P; Das, M; Kyaw, NTT; Zaheer, S; Qasemy, AQ; Zakir, M; Mahama, G; Van Overloop, C; et al. (Public Library of Science, 2017-03-10)
      Médecins Sans Frontières (MSF) has been providing healthcare in Afghanistan since 1981 including specialized health services for trauma patients in Kunduz Trauma Center (KTC) from 2011. On October 3rd, 2015, a US airstrike hit the KTC, killing 42 people including 14 MSF staff. This study aims to demonstrate the impact on healthcare provision, after hospital destruction, by assessing the extent of care provided for trauma and injuries by the MSF KTC and to report on treatment outcomes from January 2014 to June 2015, three months prior to the bombing.
    • The blast wounded of Raqqa, Syria: observational results from an MSF-supported district hospital.

      OKeeffe, J; Vernier, L; Cramond, V; Majeed, S; Carrion Martin, AI; Hoetjes, M; Amirtharajah, M (BioMed Central, 2019-06-20)
      BACKGROUND: In June 2017, the U.S.-backed Syrian Democratic Forces (SDF) launched a military operation to retake the city of Raqqa, Syria, from the so-called Islamic State. The city population incurred mass numbers of wounded. In the post-offensive period, the population returned to a city (Raqqa) contaminated with improvised explosive devices (IEDs) and explosive remnants of war (ERWs), resulting in a second wave of wounded patients. Médecins Sans Frontières (MSF) supported a hospital in Tal-Abyad (north of Raqqa) and scaled up operations in response to this crisis. We describe the cohort of blast-wounded cases admitted to this hospital in order help prepare future humanitarian responses. METHODS: We retrospectively extracted data from clinical charts in the MSF-supported hospital. We included all new admissions for blast-wounded patients with key data elements documented. We performed comparative analyses from the offensive period (June 6, 2017 to October 17, 2017) and the post-offensive period (October 18, 2017 to March 17, 2018). RESULTS: We included 322 blast related injuries. There were more than twice the number of cases with blast injuries in the post-offensive period as the offensive period (225 vs. 97, p = <.001). The offensive period saw a significantly higher proportion of female patients (32.0%, n = 31 vs. 11.1%, n = 25, p < 0.001) and paediatric patients (42.3%, n = 41 vs 24.9%, n = 56, p = 0.002). Blast-injured patients in the post-offensive period included more cases with multiple traumatic injuries (65.8%, n = 148 vs. 39.2%, n = 38, p < 0.001). The treatment of the blast-injured cases in the post-offensive period was more labor intensive with those patients having a higher median number of interventions (2 vs 1, p = <0.001) and higher median number of days in hospital (7 vs 4, p = < 0.001). CONCLUSIONS: In the wake of the Raqqa offensive, the MSF-supported district hospital received an unpredicted second, larger and more complex wave of blast-wounded cases as the population returned to a city strewn with IEDs and ERWs. These findings indicate the high risk of traumatic injury to the population even after warring factions have vacated conflict zones. Medical humanitarian actors should be prepared for a continued and scaled up response in areas known to be highly contaminated with explosive ordnance.
    • 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.
    • Comparative cost-effectiveness analysis of two MSF surgical trauma centers

      Gosselin, R A; Maldonado, A; Elder, G; School of Public Health, University of California Berkeley, Berkeley, CA, USA; Medecins Sans Frontieres, Paris, France (2010-09-22)
      INTRODUCTION: There is a dearth of data on cost-effectiveness of surgical care in resource-poor countries. Doctors Without Borders (Médecins Sans Frontières; MSF) is a nongovernmental organization (NGO) involved in the many facets of health care for underserved populations, including surgical care. METHODS: A cost-effectiveness analysis (CEA) was attempted at two of their surgical trauma hospitals: Teme Hospital in Nigeria and La Trinité Hospital in Haiti. CONCLUSION: At $172 and $223 per Disability-Adjusted Life-Year (DALY) averted, respectively, they are in line with other reported CEAs for surgical and nonsurgical activities in similar contexts.
    • Design and Implementation of a Training Programme for General Practitioners in Emergency Surgery and Obstetrics in Precarious Situations in Ethiopia.

      Sohier, N; Fréjacques, L; Gagnayre, R; Training Department, Médecins Sans Frontières, Paris, France. office@paris.msf.org (Published by Royal College of Surgeons of England, 1999-11)
      Médecins Sans Frontières (MSF) has been implementing medical assistance programs in Ethiopia since 1994, including the rehabilitation of health structures and the supply of drugs and medical equipment. In 1995, the serious shortage of surgeons in Ethiopia prompted MSF to add a programme to train general practitioners to perform surgery in the Woldya region. The results of the relevant feasibility study were encouraging. The programme's design is based on recent educational data and MSF's experience with introducing transcultural training in countries where unstable conditions prevail. The training programme is currently being studied by the Ethiopian Health Ministry for use as a model for training general practitioners in surgery throughout the country.
    • Emergency Obstetric Care in a Rural District of Burundi: What Are the Surgical Needs?

      De Plecker, E; Zachariah, R; Kumar, A M V; Trelles, M; Caluwaerts, S; van den Boogaard, W; Manirampa, J; Tayler-Smith, K; Manzi, M; Nanan-N'zeth, K; et al. (Public Library of Science, 2017-02-07)
      In a rural district hospital in Burundi offering Emergency Obstetric care-(EmOC), we assessed the a) characteristics of women at risk of, or with an obstetric complication and their types b) the number and type of obstetric surgical procedures and anaesthesia performed c) human resource cadres who performed surgery and anaesthesia and d) hospital exit outcomes.
    • Fistulojejunostomy for Refractory Post-Traumatic Biliary Fistula in an Austere Environment: An Unusual, Time-Honored Procedure

      Kada, Fathalla; Abyad, Muhammad; Contini, Sandro; De Paoli, Laura; Mancini, Luisa (Elsevier - We regret that this article is behind a paywall., 2015-02-04)
    • Forensic Investigation Into a Death: Post-Traumatic Amnesia in a Worker with a Work-Related Head Injury Sustained in a Coal-Fired Thermal Power Plant in India

      Muralidhar, V (BMJ Publishing Group, 2017-03-15)
      This is the first reported case of a work-related head injury in a coal-fired thermal power plant in India. This case highlights the trend of not reporting work injuries due to fears of reprisal from the management team that may include the termination of employment. Post-traumatic amnesia in a worker presenting with head trauma must be recognised by coworkers, so the cause of injury can be elicited early and the victim gets timely medical help. There are few published studies on work-related traumatic brain injury, and they provide no information on either anatomical localisation or signs and symptoms. It is imperative that this under-researched area is studied, so detailed epidemiology and accurate national and global statistics are made available to address this dangerous yet preventable condition.
    • 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)
    • Humanitarian Surgery: A Call to Action for Anesthesiologists

      Marchbein, D (Lippincott Williams & Wilkins, 2013-11)
    • 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.
    • Invasive Infection and Outcomes in a Humanitarian Surgical Burn Program in Haiti

      Murphy, RA; Nisenbaum, L; Labar, AS; Sheridan, RL; Ronat, JB; Dilworth, K; Pena, J; Kilborn, E; Teicher, C (SpringerLink - We regret that this article is behind a paywall., 2016-02-25)
      Compare to high-income settings, survival in burn units in low-income settings is lower with invasive infections one leading cause of death. Médecins Sans Frontières is involved in the treatment of large burns in adults and children in Haiti.