• The short musculoskeletal functional assessment (SMFA) score amongst surgical patients with reconstructive lower limb injuries in war wounded civilians

      Teicher, C; Foote, N L; Al Ani, A M K; Alras, M S; Alqassab, S I; Baron, E; Ahmed, K; Herard, P; Fakhri, R M (Elsevier, 2014-10-24)
      The MSF programme in Jordan provides specialized reconstructive surgical care to war-wounded civilians in the region. The short musculoskeletal functional assessment score (SMFA) provides a method for quantitatively assessing functional status following orthopaedic trauma. In June 2010 the Amman team established SMFA as the standard for measuring patients' functional status. The objective of this retrospective study is to evaluate whether the SMFA scores can be useful for patients with chronic war injuries.
    • Sniper-induced sciatic nerve injury.

      Mathieu, L; Algassab, S; Fakhi, RM (BMJ Publishing Group, 2019-07-29)
    • South African General Surgeon Preparedness for Humanitarian Disasters

      Chu, KM; Karjiker, P; Naidu, P; Kruger, D; Taylor, A; Trelles, M; Dominguez, L; Rayne, S (Springer, 2018-12-06)
      Background Humanitarian medical organizations provide surgical care for a broad range of conditions including general surgical (GS), obstetric and gynecologic (OBGYN), orthopedic (ORTHO), and urologic (URO) conditions in unstable contexts. The most common humanitarian operation is cesarean section. The objective of this study was to identify the proportion of South African general surgeons who had operative experience and current competency in GS, OBGYN, ORTHO, and URO humanitarian operations in order to evaluate their potential for working in humanitarian disasters. Methods This was a cross-sectional online survey of South African general surgeons administered from November 2017–July 2018. Rotations in OBGYN, ORTHO, and URO were quantified. Experience and competency in eighteen humanitarian operations were queried. Results There were 154 SA general surgeon participants. Prior to starting general surgery (GS) residency, 129 (83%) had OBGYN, 125 (81%) ORTHO, and 84 (54%) URO experience. Experience and competency in humanitarian procedures by specialty included: 96% experience and 95% competency for GS, 71% experience and 51% com- petency for OBGYN, 77% experience and 66% competency for ORTHO, and 86% experience and 81% competency for URO. 82% reported training, and 51% competency in cesarean section. Conclusions SA general surgeons are potentially well suited for humanitarian surgery. This study has shown that most SA general surgeons received training in OBGYN, ORTHO, and URO prior to residency and many maintain competence in the corresponding humanitarian operations. Other low- to middle-income countries may also have broad-based surgery training, and the potential for their surgeons to offer humanitarian assistance should be further investigated.
    • 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.
    • Surgery for Conditions of Infectious Etiology in Resource-Limited Countries Affected by Crisis: The Médecins Sans Frontières Operations Centre Brussels Experience

      Sharma, Davina; Hayman, Kate; Stewart, Barclay T; Dominguez, Lynette; Trelles, Miguel; Saqeb, Sanaulhaq; Kasonga, Cheride; Hangi, Theophile Kubuya; Mupenda, Jerome; Naseer, Aamer; et al. (Mary Ann Liebert, Inc., 2015-07-31)
      Surgery for infection represents a substantial, although undefined, disease burden in low- and middle-income countries (LMICs). Médecins Sans Frontières-Operations Centre Brussels (MSF-OCB) provides surgical care in LMICs and collects data useful for describing operative epidemiology of surgical need otherwise unmet by national health services. This study aimed to describe the experience of MSF-OCB operations for infections in LMICs. By doing so, the results might aid effective resource allocation and preparation of future humanitarian staff.
    • Surgery in low-income countries during crisis: experience at Médecins Sans Frontières facilities in 20 countries between 2008 and 2014

      Trelles, M; Dominguez, L; Stewart, B (Wiley-Blackwell, 2015-04-16)
      The global burden of trauma and surgical conditions fall disproportionately on low- and middle-income countries (LMICs).(1, 2) Inopportunely, developing countries are least equipped to provide essential surgical care.(3) Consequently, LMICs have a significant burden of unmet surgical needs.(4) When these fragile health systems are disrupted by conflict, a natural disaster or an epidemic the volume and quality of surgical care decreases even further. This article is protected by copyright. All rights reserved.
    • Surgery with Limited Resources in Natural Disasters: What Is the Minimum Standard of Care?

      Trelles Centurion, M; Crestani, R; Dominguez, L; Caluwaerts, A; Benedetti, G (Springer International Publishing, 2018)
      In a challenging scenario, such as in the aftermath of a natural disaster, minimum standards of care must be in place from the moment surgical care activities are launched.
    • Surgical Burn Care by Médecins Sans Frontières-Operations Center Brussels: 2008 to 2014.

      Stewart, B; Trelles, M; Dominguez, L; Wong, E; Fiozounam, H T; Hassani, G H; Akemani, C; Naseer, A; Ntawukiruwabo, I B; Kushner, A (Wolters Kluwer, 2015-08-27)
      Humanitarian organizations care for burns during crisis and while supporting healthcare facilities in low-income and middle-income countries. This study aimed to define the epidemiology of burn-related procedures to aid humanitarian response. In addition, operational data collected from humanitarian organizations are useful for describing surgical need otherwise unmet by national health systems. Procedures performed in operating theatres run by Médecins Sans Frontières-Operations Centre Brussels (MSF-OCB) from July 2008 through June 2014 were reviewed. Surgical specialist missions were excluded. Burn procedures were quantified, related to demographics and reason for humanitarian response, and described. A total of 96,239 operations were performed at 27 MSF-OCB projects in 15 countries between 2008 and 2014. Of the 33,947 general surgical operations, 4,280 (11%) were for burns. This proportion steadily increased from 3% in 2008 to 24% in 2014. People receiving surgical care from conflict relief missions had nearly twice the odds of having a burn operation compared with people requiring surgery in communities affected by natural disaster (adjusted odds ratio, 1.94; 95% confidence interval, 1.46-2.58). Nearly 70% of burn procedures were planned serial visits to the theatre. A diverse skill set was required. Unmet humanitarian assistance needs increased US$400 million dollars in 2013 in the face of an increasing number of individuals affected by crisis and a growing surgical burden. Given the high volume of burn procedures performed at MSF-OCB projects and the resource intensive nature of burn management, requisite planning and reliable funding are necessary to ensure quality for burn care in humanitarian settings.
    • 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 Care of Pediatric Patients in the Humanitarian Setting: The Médecins Sans Frontières Experience, 2012-2013

      Trudeau, MO; Baron, E; Hérard, P; Labar, AS; Lassalle, X; Teicher, CL; Rothstein, DH (American Medical Association, 2015-11-01)
      Little is known about the scope of practice and outcomes in pediatric surgery performed by humanitarian organizations in resource-poor settings and conflict zones. This study provides the largest report to date detailing such data for a major nongovernmental organization providing humanitarian surgical relief support in these settings.
    • 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)
    • Teaching humanitarian surgery: Filling the gap between NGO needs and subspecialized surgery through a novel inter-university certificate

      Thoma, M; Dominguez, L; Ledecq, M; Goolaerts, JP; Moreels, R; Nyaruhirira, I; Brichant, JF; Roumeguere, T; Reding, R (Taylor & Francis, 2020-12-17)
      Background: Access to surgical care is a global health burden. A broad spectrum of surgical competences is required in the humanitarian context whereas current occidental surgical training is oriented towards subspecialties. We proposed to design a course addressing the specificities of surgery in the humanitarian setting and austere environment. Method: The novelty of the course lies in the implication of academic medical doctors alongside with surgeons working for humanitarian non-governmental organizations (NGO). The medical component of the National Defense participated regarding particular topics of war surgery. The course is aimed at trained surgeons and senior residents interested in participating to humanitarian missions. Results: The program includes theoretical teaching on surgical knowledge and skills applied to the austere context. The course also covers non-medical aspects of humanitarian action such as international humanitarian law, logistics, disaster management and psychological support. It comprises a large-scale mass casualty exercise and a practical skills lab on surgical techniques, ultrasonography and resuscitation. Attendance to the four teaching modules, ATLS certification and succeeding final examinations provide an interuniversity certificate. 30 participants originating from 11 different countries joined the course. Various surgical backgrounds, training levels as well as humanitarian experience were represented. Feedback from the participants was solicited after each teaching module and remarks were applied to the following session. Overall participant evaluations of the first course session are presented. Conclusion: Teaching humanitarian surgery joining academic and field actors seems to allow filling the gap between high-income country surgical practice and the needs of the humanitarian context.
    • 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.
    • Traumatic Aortic Transection.

      Anakwe, R E B; Department of Orthopaedic Surgery, Borders General Hospital, Melrose, Scotland, UK. raymundus@doctors.org.uk (2005-06)
      Traumatic aortic transection is an uncommon but often fatal injury. It is typically a high energy injury and may occur in the multiply injured patient. This injury is often missed. There is evidence that airbags and seat belts protect against these injuries. We present the case of a patient who survived.
    • Traumatic Injuries are the Main Indication for Limb Amputations During and After Humanitarian Crises

      Naidu, P; Dominguez, LB; Trelles, M; Chu, KM (Springer, 2021-01-15)
      Background Populations at risk during humanitarian crises can suffer traumatic injuries or have medical conditions that result in the need for limb amputation (LA). The objectives of this study were to describe the indications for and associations with LA during and after humanitarian crises in surgical projects supported by Médecins Sans Frontières (MSF). Methods MSF-Operational Center Brussels data from January 1, 2008, to December 31, 2017, were analyzed. Surgical projects were classified into (annual) periods of crises and post-crises. Indications were classified into trauma (intentional and unintentional) and non-trauma (medical). Associations with LA were also reported. Results MSF-OCB performed 936 amputations in 17 countries over the 10-year study period. 706 (75%) patients were male and the median age was 27 years (interquartile range 17–41 years). Six hundred and twenty-one (66%) LA were performed during crisis periods, 501 (53%) during conflict and 119 (13%) post-natural disaster. There were 316 (34%) LA in post-crisis periods. Overall, trauma was the predominant indication (n = 756, 81%) and accounted for significantly more LA (n = 577, 94%) in crisis compared to post-crisis periods (n = 179, 57%) (p < 0.001). Discussion Our study suggests that populations at risk for humanitarian crises are still vulnerable to traumatic LA. Appropriate operative and post-operative LA management in the humanitarian setting must be provided, including rehabilitation and options for prosthetic devices.
    • Working on the Congolese front line

      Breuillac, B; Médecins Sans Frontières, Paris, France (2009-01-14)