Now showing items 1-20 of 51

    • "Reality rarely looks like the guidelines": a qualitative study of the challenges hospital-based physicians encounter in war wound management

      Älgå, A; Karlow Herzog, K; Alrawashdeh, M; Wong, S; Khankeh, H; Stålsby Lundborg, C (BioMed Central, 2018-06-27)
      Globally, armed conflict is a major contributor to mortality and morbidity. The treatment of war-associated injuries is largely experience-based. Evidence is weak due to difficulty in conducting medical research in war settings. A qualitative method could provide insight into the specific challenges associated with providing health care to injured civilians. The aim of this study was to explore the challenges hospital-based physicians encounter in war wound management, focusing on surgical intervention and antibiotic use.
    • 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.
    • [Orthopedic Surgery with Limited Resources After Mass Disasters and During Armed Conflicts : First International Guidelines for the Management of Limb Injuries and the Experience of Doctors Without Borders]

      Osmers, I (SpringerLink, 2017-08-29)
      Disasters and armed conflicts are often the unfortunate basis for aid projects run by Doctors Without Borders/Médecins Sans Frontières (MSF). The nature of war and disasters means that surgery is an integral part of this medical emergency aid. In these situations, resources are usually limited. As a result, surgical work in these contexts differs significantly from the daily routine of a surgeon working in a highly resourced hospital. The principles of surgery do not change but surgeons must adapt their tactical approach to the changed context otherwise there is a high risk of failing to improve the health of patients and potentially jeopardizing their prospects for recovery. Every experienced war surgeon has learned new skills the hard way. The Field Guide to Manage Limb Injury in Disaster and Conflict has been written to help new surgeons who may face the challenges of disaster and war surgery and to avoid unnecessary suffering for patients ( https://icrc.aoeducation.org ). Under the guidance of the International Committee of the Red Cross (ICRC), with participation of the World Health Organization (WHO), financed by the AO Foundation, and featuring the experiences of experts from different organizations (amongst them MSF), the book details techniques and guidelines for surgery in low resource settings. The following article provides a short summary of some of the surgical challenges when working with limited resources and reflects on a few specific recommendations for so-called war surgery.
    • 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.
    • 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.
    • 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; Dominguez, L (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.
    • 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; Duchenne, B; Ndelema, B; Etienne, W; Alders, P; Veerman, R; Van den Bergh, R (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.
    • 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.
    • Regional Anesthesia for Painful Injuries after Disasters (RAPID): Study Protocol For A Randomized Controlled Trial

      Levine, AC; Teicher, C; Aluisio, AR; Wiskel, T; Valles, P; Trelles, M; Glavis-Bloom, J; Grais, RF (BioMed Central, 2016-11-14)
      Lower extremity trauma during earthquakes accounts for the largest burden of disaster-related injuries. Insufficient pain management is common in resource-limited disaster settings, and regional anesthesia (RA) may reduce pain in injured patients beyond current standards of care. To date, no controlled trials have been conducted to evaluate the use of RA for pain management in a disaster setting.
    • Multidrug-Resistant Surgical Site Infections in a Humanitarian Surgery Project

      Murphy, RA; Okoli, O; Essien, I; Teicher, C; Elder, G; Pena, J; Ronat, JB; Bernabé, KJ (Cambridge University Press, 2016-08-11)
      The epidemiology of surgical site infections (SSIs) in surgical programmes in sub-Saharan Africa is inadequately described. We reviewed deep and organ-space SSIs occurring within a trauma project that had a high-quality microbiology partnership and active follow-up. Included patients underwent orthopaedic surgery in Teme Hospital (Port Harcourt, Nigeria) for trauma and subsequently developed a SSI requiring debridement and microbiological sampling. Data were collected from structured chart reviews and programmatic databases for 103 patients with suspected SSI [79% male, median age 30 years, interquartile range (IQR) 24-37]. SSIs were commonly detected post-discharge with 58% presenting >28 days after surgery. The most common pathogens were: Staphylococcus aureus (34%), Pseudomonas aeruginosa (16%) and Enterobacter cloacae (11%). Thirty-three (32%) of infections were caused by a multidrug-resistant (MDR) pathogen, including 15 patients with methicillin-resistant S. aureus. Antibiotics were initiated empirically for 43% of patients and after culture and sensitivity report in 32%. The median number of additional surgeries performed in patients with SSI was 5 (IQR 2-6), one patient died (1%), and amputation was performed or recommended in three patients. Our findings suggest the need for active long-term monitoring of SSIs, particularly those associated with MDR organisms, resulting in increased costs for readmission surgery and treatment with late-generation antibiotics.
    • 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)
    • Providing Anesthesia Care in Resource-limited Settings: A 6-year Analysis of Anesthesia Services Provided at Médecins Sans Frontières Facilities

      Ariyo, P; Trelles, M; Helmand, R; Amir, Y; Hassani, G H; Mftavyanka, J; Nzeyimana, Z; Akemani, C; Ntawukiruwabo, I B; Charles, A; Yana, Y; Moussa, K; Kamal, M; Suma, M L; Ahmed, M; Abdullahi, M; Wong, E G; Kushner, A; Latif, A (Lippincott Williams & Wilkins, 2016-03-01)
      Anesthesia is integral to improving surgical care in low-resource settings. Anesthesia providers who work in these areas should be familiar with the particularities associated with providing care in these settings, including the types and outcomes of commonly performed anesthetic procedures.
    • 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.
    • 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 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.
    • 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; Wong, Evan; Kushner, Adam L (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.
    • Operative trauma in low-resource settings: The experience of Médecins Sans Frontières in environments of conflict, postconflict, and disaster

      Wong, Evan G; Dominguez, Lynette; Trelles, Miguel; Ayobi, Samir; Hazraty, Khalil Rahman; Kasonga, Cheride; Basimuoneye, Jean-Paul; Santiague, Lunick; Kamal, Mustafa; Rahmoun, Alaa; Kushner, Adam L (Elsevier - We regret that this article is behind a paywall., 2015-05)
      Conflicts and disasters remain prevalent in low- and middle-income countries, and injury remains a leading cause of death worldwide. The objective of this study was to describe the operative procedures performed for injury-related pathologies at facilities supported by Médecins Sans Frontières (MSF) to guide the planning of future responses.
    • Operative Procedures in the Elderly in Low-Resource Settings: A Review of Médecins Sans Frontières Facilities: Reply

      Wong, E G; Trelles, M; Dominguez, L; Mupenda Mwania, J; Kasonga Tshibangu, C; Saqeb, S H; Hazrati, K U R; Gupta, S; Burnham, G; Kushner, A L (SpringerLink, 2015-04-22)