Journal Article > ReviewAbstract
Surgery. 2015 May 1; Volume 157 (Issue 5); DOI:10.1016/j.surg.2014.12.021
Wong EG, Dominguez LB, Trelles M, Ayobi S, Hazraty K, et al.
Surgery. 2015 May 1; Volume 157 (Issue 5); DOI:10.1016/j.surg.2014.12.021
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.
Journal Article > ReviewAbstract
Lancet. 2015 April 27; Volume 385; DOI:10.1016/S0140-6736(15)60826-1
Sharma DB, Hayman K, Stewart BT, Dominguez LB, Trelles M, et al.
Lancet. 2015 April 27; Volume 385; DOI:10.1016/S0140-6736(15)60826-1
Conference Material > Poster
Gohy B, Brodin N, Musambi M, Mafuko JM, Ndiramiye E, et al.
MSF Scientific Days International 2021: Research. 2021 May 18
Journal Article > ResearchFull Text
Int Health. 2016 November 3; Volume 8 (Issue 6); 390-397.; DOI:10.1093/inthealth/ihw035
Valles P, Van den Bergh R, van den Boogaard W, Tayler-Smith K, Gayraud O, et al.
Int Health. 2016 November 3; Volume 8 (Issue 6); 390-397.; DOI:10.1093/inthealth/ihw035
BACKGROUND
Trauma is a leading cause of death and represents a major problem in developing countries where access to good quality emergency care is limited. Médecins Sans Frontières delivered a standard package of care in two trauma emergency departments (EDs) in different violence settings: Kunduz, Afghanistan, and Tabarre, Haiti. This study aims to assess whether this standard package resulted in similar performance in these very different contexts.
METHODS
A cross-sectional study using routine programme data, comparing patient characteristics and outcomes in two EDs over the course of 2014.
RESULTS
31 158 patients presented to the EDs: 22 076 in Kunduz and 9082 in Tabarre. Patient characteristics, such as delay in presentation (29.6% over 24 h in Kunduz, compared to 8.4% in Tabarre), triage score, and morbidity pattern differed significantly between settings. Nevertheless, both EDs showed an excellent performance, demonstrating low proportions of mortality (0.1% for both settings) and left without being seen (1.3% for both settings), and acceptable triage performance. Physicians' maximum working capacity was exceeded in both centres, and mainly during rush hours.
CONCLUSIONS
This study supports for the first time the plausibility of using the same ED package in different settings. Mapping of patient attendance is essential for planning of human resources needs.
Trauma is a leading cause of death and represents a major problem in developing countries where access to good quality emergency care is limited. Médecins Sans Frontières delivered a standard package of care in two trauma emergency departments (EDs) in different violence settings: Kunduz, Afghanistan, and Tabarre, Haiti. This study aims to assess whether this standard package resulted in similar performance in these very different contexts.
METHODS
A cross-sectional study using routine programme data, comparing patient characteristics and outcomes in two EDs over the course of 2014.
RESULTS
31 158 patients presented to the EDs: 22 076 in Kunduz and 9082 in Tabarre. Patient characteristics, such as delay in presentation (29.6% over 24 h in Kunduz, compared to 8.4% in Tabarre), triage score, and morbidity pattern differed significantly between settings. Nevertheless, both EDs showed an excellent performance, demonstrating low proportions of mortality (0.1% for both settings) and left without being seen (1.3% for both settings), and acceptable triage performance. Physicians' maximum working capacity was exceeded in both centres, and mainly during rush hours.
CONCLUSIONS
This study supports for the first time the plausibility of using the same ED package in different settings. Mapping of patient attendance is essential for planning of human resources needs.
Journal Article > Short ReportFull Text
Colomb. J. Anesthesiol. 2015 December 23; Volume 44 (Issue 1); 13-16.
Izquierdo G, Trelles M, Khan N
Colomb. J. Anesthesiol. 2015 December 23; Volume 44 (Issue 1); 13-16.
INTRODUCTION
Helmand province, whose capital is Lashkar-Gah, is one of the most volatile provinces affected by the conflict in Afghanistan. Doctors without Borders began to work in Boost Hospital in 2009.
METHOD
Retrospective review of surgical procedures at the Doctors without Borders Operational Center in Brussels, February 11, 2010 to September 30, 2012.
RESULTS
5719 surgeries were performed on 4334 patients. 47% were emergency interventions and 75% were first interventions. 39.7% (n = 1721) of patients were female. In the Gyneco-obstetric (G) area, the average age was 31.3 years. 848 Cesarean operations (76%) were performed and 95% of these were urgent. Of these patients (n = 598) 64% were at ASA II. Spinal anesthesia (SA) was administered in 44.4% (n = 415) of patients, followed by general anesthesia without intubation (GA-) in 39.3% (n = 367). In 16% (n = 151), general anesthesia was administered with endotracheal intubation (GA+). Transoperatory mortality was 0.8% (n=7).
CONCLUSIONS
The Boost Hospital offers a surgical service of relevance in the south of Afghanistan. This hospital is supported by Doctors without Borders (MSF) and has helped to reduce the maternal mortality in that region through the provision of quality care in obstetric emergencies. By applying health standards, and medical teams and material, MSF has helped the Afghan population, particularly gestating mothers, to improve its health while achieving a transoperatory mortality in Cesareans of <1%.
Helmand province, whose capital is Lashkar-Gah, is one of the most volatile provinces affected by the conflict in Afghanistan. Doctors without Borders began to work in Boost Hospital in 2009.
METHOD
Retrospective review of surgical procedures at the Doctors without Borders Operational Center in Brussels, February 11, 2010 to September 30, 2012.
RESULTS
5719 surgeries were performed on 4334 patients. 47% were emergency interventions and 75% were first interventions. 39.7% (n = 1721) of patients were female. In the Gyneco-obstetric (G) area, the average age was 31.3 years. 848 Cesarean operations (76%) were performed and 95% of these were urgent. Of these patients (n = 598) 64% were at ASA II. Spinal anesthesia (SA) was administered in 44.4% (n = 415) of patients, followed by general anesthesia without intubation (GA-) in 39.3% (n = 367). In 16% (n = 151), general anesthesia was administered with endotracheal intubation (GA+). Transoperatory mortality was 0.8% (n=7).
CONCLUSIONS
The Boost Hospital offers a surgical service of relevance in the south of Afghanistan. This hospital is supported by Doctors without Borders (MSF) and has helped to reduce the maternal mortality in that region through the provision of quality care in obstetric emergencies. By applying health standards, and medical teams and material, MSF has helped the Afghan population, particularly gestating mothers, to improve its health while achieving a transoperatory mortality in Cesareans of <1%.
Journal Article > ResearchFull Text
Public Health Action. 2016 September 21; Volume 6 (Issue 3); 193-198.; DOI:10.5588/pha.16.0043
Shirodkar S, Anande L, Dalal A, Desai C, Correa G, et al.
Public Health Action. 2016 September 21; Volume 6 (Issue 3); 193-198.; DOI:10.5588/pha.16.0043
SETTING
While surgery for pulmonary tuberculosis (PTB) is considered an important adjunct for specific cases, including drug-resistant tuberculosis, operational evidence on its feasibility and effectiveness is limited.
OBJECTIVE
To describe surgical outcomes and programmatic challenges of providing surgery for PTB in Mumbai, India.
DESIGN
A descriptive study of routinely collected data of surgical interventions for PTB from 2010 to 2014 in two Mumbai hospitals, one public, one private.
RESULTS
Of 85 patients, 5 (6%) died and 17 (20%) had complications, with wound infection being the most frequent. Repeat operation was required in 12 (14%) patients. Most procedures were performed on an emergency basis, and eligibility was established late in the course of treatment. Median time from admission to surgery was 51 days. Drug susceptibility test (DST) patterns and final treatment outcomes were not systematically collected.
CONCLUSION
In a high-burden setting such as Mumbai, important data on surgery for PTB were surprisingly limited in both the private and public sectors. Eligibility for surgery was established late, culture and DST were not systematically offered, the interval between admission and surgery was long and TB outcomes were not known. Systematic data collection would allow for proper evaluation of surgery as adjunctive therapy for all forms of TB under programmatic conditions.
While surgery for pulmonary tuberculosis (PTB) is considered an important adjunct for specific cases, including drug-resistant tuberculosis, operational evidence on its feasibility and effectiveness is limited.
OBJECTIVE
To describe surgical outcomes and programmatic challenges of providing surgery for PTB in Mumbai, India.
DESIGN
A descriptive study of routinely collected data of surgical interventions for PTB from 2010 to 2014 in two Mumbai hospitals, one public, one private.
RESULTS
Of 85 patients, 5 (6%) died and 17 (20%) had complications, with wound infection being the most frequent. Repeat operation was required in 12 (14%) patients. Most procedures were performed on an emergency basis, and eligibility was established late in the course of treatment. Median time from admission to surgery was 51 days. Drug susceptibility test (DST) patterns and final treatment outcomes were not systematically collected.
CONCLUSION
In a high-burden setting such as Mumbai, important data on surgery for PTB were surprisingly limited in both the private and public sectors. Eligibility for surgery was established late, culture and DST were not systematically offered, the interval between admission and surgery was long and TB outcomes were not known. Systematic data collection would allow for proper evaluation of surgery as adjunctive therapy for all forms of TB under programmatic conditions.
Journal Article > ResearchAbstract Only
Prehosp Disaster Med. 2014 January 15; Volume 29 (Issue 1); 21-26.; DOI:10.1017/S1049023X13009278
Teicher CL, Alberti KP, Porten K, Elder G, Baron E, et al.
Prehosp Disaster Med. 2014 January 15; Volume 29 (Issue 1); 21-26.; DOI:10.1017/S1049023X13009278
INTRODUCTION
During January 2010, a 7.0 magnitude earthquake struck Haiti, resulting in death and destruction for hundreds of thousands of people. This study describes the types of orthopedic procedures performed, the options for patient follow-up, and limitations in obtaining outcomes data in an emergency setting.
PROBLEM
There is not a large body of data that describes larger orthopedic cohorts, especially those focusing on internal fixation surgeries in resource-poor settings in postdisaster regions. This article describes 248 injuries and over 300 procedures carried out in the Médecins Sans Frontières-Orthopedic Centre Paris orthopedic program.
METHODS
Surgeries described in this report were limited to orthopedic procedures carried out under general anesthesia for all surgical patients. Exclusion factors included simple fracture reduction, debridement, dressing changes, and removal of hardware. This data was collected using both prospective and retrospective methods; prospective inpatient data were collected using a data collection form designed promptly after the earthquake and retrospective data collection was performed in October 2010.
RESULTS
Of the 264 fractures, 204 were fractures of the major long bones (humerus, radius, femur, tibia). Of these 204 fractures of the major long bones, 34 (16.7%) were upper limb fractures and 170 (83.3%) were lower limb fractures. This cohort demonstrated a large number of open fractures of the lower limb and closed fractures of the upper limb. Fractures were treated according to their location and type. Of the 194 long bone fractures, the most common intervention was external fixation (36.5%) followed by traction (16.7%), nailing (15.1%), amputation (14.6%), and plating (9.9%).
CONCLUSION
The number of fractures described in this report represents one of the larger orthopedic cohorts of patients treated in a single center in the aftermath of the 2010 earthquake in Haiti. The emergent surgical care described was carried out in difficult conditions, both in the hospital and the greater community. While outcome and complication data were limited, the proportion of patients attending follow-up most likely exceeded expectations and may reflect the importance of the rehabilitation center. This data demonstrates the ability of surgical teams to perform highly-specialized surgeries in a disaster zone, and also reiterates the need for access to essential and emergency surgical programs, which are an essential part of public health in low- and medium-resource settings.
During January 2010, a 7.0 magnitude earthquake struck Haiti, resulting in death and destruction for hundreds of thousands of people. This study describes the types of orthopedic procedures performed, the options for patient follow-up, and limitations in obtaining outcomes data in an emergency setting.
PROBLEM
There is not a large body of data that describes larger orthopedic cohorts, especially those focusing on internal fixation surgeries in resource-poor settings in postdisaster regions. This article describes 248 injuries and over 300 procedures carried out in the Médecins Sans Frontières-Orthopedic Centre Paris orthopedic program.
METHODS
Surgeries described in this report were limited to orthopedic procedures carried out under general anesthesia for all surgical patients. Exclusion factors included simple fracture reduction, debridement, dressing changes, and removal of hardware. This data was collected using both prospective and retrospective methods; prospective inpatient data were collected using a data collection form designed promptly after the earthquake and retrospective data collection was performed in October 2010.
RESULTS
Of the 264 fractures, 204 were fractures of the major long bones (humerus, radius, femur, tibia). Of these 204 fractures of the major long bones, 34 (16.7%) were upper limb fractures and 170 (83.3%) were lower limb fractures. This cohort demonstrated a large number of open fractures of the lower limb and closed fractures of the upper limb. Fractures were treated according to their location and type. Of the 194 long bone fractures, the most common intervention was external fixation (36.5%) followed by traction (16.7%), nailing (15.1%), amputation (14.6%), and plating (9.9%).
CONCLUSION
The number of fractures described in this report represents one of the larger orthopedic cohorts of patients treated in a single center in the aftermath of the 2010 earthquake in Haiti. The emergent surgical care described was carried out in difficult conditions, both in the hospital and the greater community. While outcome and complication data were limited, the proportion of patients attending follow-up most likely exceeded expectations and may reflect the importance of the rehabilitation center. This data demonstrates the ability of surgical teams to perform highly-specialized surgeries in a disaster zone, and also reiterates the need for access to essential and emergency surgical programs, which are an essential part of public health in low- and medium-resource settings.
Journal Article > CommentaryAbstract Only
Role of Anesthesiology in Global Health. 2014 November 19; DOI:10.1007/978-3-319-09423-6_9
Trelles M, Kahn P, Cone J, Teicher CL
Role of Anesthesiology in Global Health. 2014 November 19; DOI:10.1007/978-3-319-09423-6_9
Médecins Sans Frontières/Doctors Without Borders (MSF) has been running surgical programs since the early 1980s. This chapter provides an overview of the anesthesia component of these programs and explores some lessons learned from the experience of one of MSF’s five Operations Centers—in this case, the Belgium-based unit (MSF-Belgium). During the period from 2010 until the end of 2013, these projects provided surgical care to more than 56,000 surgical patients in 23 countries and performed over 73,000 surgical procedures. This experience has shown that surgeons and anesthetists need to discard preconceived notions of an inevitable link between the technical complexity of surgical and anesthesia techniques and the ability to reduce morbidity and mortality. On the contrary, MSF has found that keeping our interventions simple, accessible and sustainable within a given context is often the most effective way to best serve the needs of the many.
Journal Article > Short ReportAbstract
J Am Coll Surg. 2015 February 4; Volume 220 (Issue 5); DOI:10.1016/j.jamcollsurg.2015.01.022
Kada F, Abyad M, Contini S, De Paoli L, Mancini L
J Am Coll Surg. 2015 February 4; Volume 220 (Issue 5); DOI:10.1016/j.jamcollsurg.2015.01.022
Journal Article > ResearchSubscription Only
World J Surg. 2021 February 9; Volume 45 (Issue 5); 1400-1408.; DOI:10.1007/s00268-021-05972-1
Rahman A, Chao TE, Trelles M, Dominguez LB, Mupenda J, et al.
World J Surg. 2021 February 9; Volume 45 (Issue 5); 1400-1408.; DOI:10.1007/s00268-021-05972-1
BACKGROUND
Médecins Sans Frontières (MSF) provides surgical care in fragile states, which are more vulnerable to conflict. The primary objective of this study was to compare the indications for operative intervention in surgical projects in fragile states during periods of active conflict (CON) and non-conflict (NON-CON). In addition, risk factors for non-obstetric and obstetric operative mortality were identified.
METHODS
This was a retrospective analysis of MSF surgical projects in fragile states January 1, 2008–December 31, 2017. Variables considered in the analysis include age, gender, American Society of Anesthesiology physical status, emergency status, re-intervention status, indication for surgical intervention, and conflict/non-conflict time period.
RESULTS
There were 30 surgical projects in 13 fragile states with 87,968 surgical interventions in 68,667 patients. Obstetric needs were the most common indication for surgical intervention (n = 28,060, 31.9%) but were more common during NON-CON (n = 23,142, 35.7%) compared to CON periods (n = 4,918, 21.2%, p < 0.001). Trauma was more common during CON (42.0%) compared to NON-CON (23.0%) periods (p < 0.001). Non-obstetric operative mortality was similar during CON (0.2%) compared to NON-CON (0.2%, p = 0.920), but obstetric operative mortality was higher (0.5%) during CON compared to NON-CON (0.2%, p < 0.001) periods. Risk factors for obstetric and non-obstetric mortality included age ≥ 30 years, ASA greater than 1, and emergency intervention.
CONCLUSIONS
Humanitarian surgeons working in fragile states should be prepared to treat a range of surgical needs including trauma and obstetrics during conflict and non-conflict periods. The mortality in obstetric patients was higher during conflict periods, and further research to understand ways to protect this vulnerable group is needed.
Médecins Sans Frontières (MSF) provides surgical care in fragile states, which are more vulnerable to conflict. The primary objective of this study was to compare the indications for operative intervention in surgical projects in fragile states during periods of active conflict (CON) and non-conflict (NON-CON). In addition, risk factors for non-obstetric and obstetric operative mortality were identified.
METHODS
This was a retrospective analysis of MSF surgical projects in fragile states January 1, 2008–December 31, 2017. Variables considered in the analysis include age, gender, American Society of Anesthesiology physical status, emergency status, re-intervention status, indication for surgical intervention, and conflict/non-conflict time period.
RESULTS
There were 30 surgical projects in 13 fragile states with 87,968 surgical interventions in 68,667 patients. Obstetric needs were the most common indication for surgical intervention (n = 28,060, 31.9%) but were more common during NON-CON (n = 23,142, 35.7%) compared to CON periods (n = 4,918, 21.2%, p < 0.001). Trauma was more common during CON (42.0%) compared to NON-CON (23.0%) periods (p < 0.001). Non-obstetric operative mortality was similar during CON (0.2%) compared to NON-CON (0.2%, p = 0.920), but obstetric operative mortality was higher (0.5%) during CON compared to NON-CON (0.2%, p < 0.001) periods. Risk factors for obstetric and non-obstetric mortality included age ≥ 30 years, ASA greater than 1, and emergency intervention.
CONCLUSIONS
Humanitarian surgeons working in fragile states should be prepared to treat a range of surgical needs including trauma and obstetrics during conflict and non-conflict periods. The mortality in obstetric patients was higher during conflict periods, and further research to understand ways to protect this vulnerable group is needed.