Quality of Care in Humanitarian Surgery

Abstract

The numbers of disasters caused by natural events have increased significantly over the past two decades. This has seen the need for the corresponding disaster-related medical and surgical assistance to increase proportionally. The increase in the number of natural disasters is dominated by hydrometeorological events, such as flooding and strong winds, although geophysical disasters such as landslides and earthquakes appear to have a more destructive impact on both people and property [1]. Earthquakes killed, on average, 50,184 people per year during the period 2000–2008 and caused severe injuries to a significant number people who, as a result, required some type of surgical care/attention [2, 3]. This medical/surgical care has all too often taken place in challenging conditions, as Chu et al. describe accurately in their introduction [4], probably referring to the devastating earthquake in Port-au Prince, Haiti last year. It is positive news that there has been a concomitant increase in the number of international humanitarian agencies of various kinds that are able to mobilize on such occasions. However, it also creates both logistical and medical/surgical problems. In Haiti, the number of agencies involved in the humanitarian operation has been estimated to many hundred [5]. These agencies ranged from groups of doctors arriving without any equipment, to small clinics with special surgical/orthopedic equipment, to large nongovernmental organizations with well equipped multidisciplinary field hospitals, to the large U.S. hospital ship. Whether surgical procedures were performed under acceptable conditions is unclear in many cases. Were the surgeons prepared for the surgical challenges they were to face? How many operations did they expect to perform? Two amputations? A cesarean section? Has the need for these interventions remained unchanged despite the disaster? What kind of limb-saving intervention is realistic, or what amputation technique should be adopted in that context? Most importantly, who was accountable for what treatments/procedures were offered, and who took responsibility for the continuation of those treatments once the mission was completed? Chu et al. stressed the importance of ensuring the quality of the surgical procedures conducted in the humanitarian setting by applying structural, process, and outcome measures. Their suggestions of applying minimum standards for safe surgery, treatment protocols, and standardized data collection as well as better training for surgeons and anesthesiologists should be achievable today. This should be endorsed by the dominant nongovernmental organizations in this field, such as the Medecins Sans Frontieres and the Red Cross, as well as the International Society of Surgery. In the future, further improvement of the quality of care in the field of humanitarian surgery should be possible to achieve by some kind of registration and accreditation of the various actors. In addition, less competition, better coordination, and cooperation among the agencies is necessary. It is easy to agree with Chu et al. when they say, ‘‘the surgical humanitarian community should pull together before the next disaster strikes.’’ L. Riddez (&) Section of Emergency and Trauma Surgery, Gastro Center Surgery, Karolinska University Hospital, Stockholm, Sweden e-mail: louis.riddez@karolinska.se