Surgical skills needed for humanitarian missions in resource-limited settings

Evan G. Wong, Miguel Trelles, Lynette Dominguez, Shailvi Gupta, Gilbert Burnham, Adam L.Kushner

A four year audit of MSF data from 21 countries

Background

Surgeons from high-income countries are interested in global surgery and humanitarian missions.

Background

Knowledge of the surgical skills needed to respond to humanitarian missions is essential to:

Guide recruitment.Build capacity of surgeons. Plan for interventions.

MSF and surgery MSF is providing surgical care for more than 40

years; and between 2008 and 2013, 46 projects in 23 countries performed surgical activities.

A global analysis of the kind of needed surgery was not performed before with data available in MSF.

In Sierra Leone, 25% of households

reported a surgical condition needing

attention, and 25% deaths of the

households member in the previous year

might have been averted by timely

surgical care.

ObjectivesTo review the surgical procedures at MSF-OCB facilities between 2008 and 2012 in order to ascertain: the commonly performed operations.the necessary surgical skills.

Methods

Study design: retrospective analysis of standardized surgical databases.

Study sites: OCB health facilities in 21 countries.

Study period: June 2008 – December 2012.

Study population: all patients who underwent surgery.

Indications for surgery

Trauma Violence Accident

Obstetrical Foetal-Maternal Post partum

complications

Non-trauma Infection Ischemia Tumor Haemorrhage Other

Types of surgical procedures

Minor Wound surgery Visceral Orthopaedics Gynaecology, obstetrics & urology Specialized surgery

Patient characteristics

n (%)

Total no of patients 83,911

Average age (years) 28

Children •< 1 year•1 – 5 years

845 (1)4,098 (5)

Females 48,575 (58)Total surgical procedures 93,385

Indications for surgery (n=83,911)

Types of surgical procedures (n=93,385)

Commonly performed obstetric, gynaecologic, and urologic procedures

Procedure n (%)Caesarean section 24,182 (65)

Instrumental delivery, episiotomy or perineal laceration 3,002 (9)

Curettage 2,462 (7)

Hysterectomy, oophorectomy, pelvic tumorectomy 2,228 (6)

Obstetrical fistula 1,585 (5)

Urological procedures 1,354 (4)

Ectopic pregnancy 663 (2)

Commonly performed visceral surgical procedures

Procedure n (%)

Hernia, other anogenital 9,873 (47)

Bowel resection 4,949 (23)

Minor tumour resection 3,316 (16)

Exploratory laparotomy 2,498 (12)

Repair or resection of spleen, liver, kidney 570 (3)

Commonly performed orthopaedic procedures

Procedure n (%)Fracture reduction 2, 945 (42)

External fixation 974 (14)

Limb amputation 841 (12)

Internal fixation 803 (12)

Other (corrective procedure) 624 (9)

Internal fixation removal 464 (7)

Others 281 (4)

ConclusionsOver four years and in 21 countries:

MSF-OCB performed about 100,000 surgical procedures of wide diversity.

The most common surgical procedures included: Caesarean sections, hernia, bowel resection, and fracture reduction.

One in fifteen patients who underwent surgery were under 5 years.

Conclusions

All surgeons interested in humanitarian missions must have the surgical skills to manage the most common surgical procedures – but major human resource gaps !

Specific anaesthesia and surgical skills are needed to cater to paediatric needs – remains unaddressed !

MSF should advocate and directly invest in specific training programmes and capacity building to meet our humanitarian surgical needs.

Many thanks

To the surgical teams on the ground, the Medical Department, LUXOR and the patients and beneficiaries of

MSF