Medical Humanitarian Assistance Research Articles

Experiences of Deployed Physicians in Support of Operation Allies Refuge/Operation Allies Welcome: Lessons to Inform Improvements in Training.

Stability operations, including humanitarian assistance and disaster relief missions, are key functions of U.S. Military medicine and the Military Medical Humanitarian Assistance Course (MMHAC) is a 2-day course widely used to prepare military medical personnel for such missions. It focuses on caring for those most vulnerable in the wake of disasters, particularly children. The large-scale humanitarian deployment of military medical providers in support of Operation Allies Welcome/Operation Allies Refuge (OAW/OAR) presents an opportunity to evaluate the preparedness of these providers to care for the needs of the Afghan travelers, so we explored the experiences of military medical providers deployed in support of OAW/OAR to inform improvements in the MMHAC. We conducted a qualitative study of military medical providers who were deployed in support of OAW/OAR using a series of three virtual focus groups. Focus group questions were structured around the main topics covered in the MMHAC (patient care, ethical considerations, logistical concerns, and preventive and public health) and explicitly asked about adaptive leadership challenges faced and strategies used to overcome them. We analyzed transcripts using inductive thematic analysis within a constructivist paradigm, with adaptive leadership as a sensitizing concept. The study was approved by the Institutional Review Board of Uniformed Services University. We constructed 4 themes from participant responses, each addressing challenges that medical providers faced during their mission: (1) Medical providers navigated tension between medical and public health priorities and military mission priorities; (2) Chronic and complex care needs posed unique challenges for medical personnel; (3) Challenges in patient care were compounded by logistical and system-based barriers; and (4) Cultural barriers led to ethical dilemmas that physicians felt inadequately prepared to handle, most notably with respect to gender-related concerns. Within each theme, participants described which aspects of MMHAC training were most helpful and which areas were inadequate. Physicians found the OAR/OAW mission meaningful but also identified challenges related to medical care provision, public health, logistics, and ethical dilemmas that hindered their ability to carry out their medical mission. Lessons learned from OAW/OAR highlight several areas in which the MMHAC training could be augmented and improved to further mitigate these challenges.

Portable Ultrasonography Onboard Deployment in the PLA(N) Peace Ark Hospital Ship in Mission Harmony 2018.

From June 28 to November 22, 2018, the Chinese People's Liberation Army Navy - PLA(N) - Peace Ark hospital ship had conducted Mission Harmony 2018, providing humanitarian medical assistance and carrying out international cooperation, in 4 Pacific island countries and 6 Central and South American countries. Compared with its application only in onshore outreach medical teams in the previous Mission Harmony, portable ultrasonography was used both onboard and onshore in Mission Harmony 2018. The purpose of this study was to assess the performance of onboard portable ultrasonography in PLA(N) Peace Ark hospital ship during Mission Harmony-2018, share our onboard working experience, and provide a reference for humanitarian assistance missions in the future. A retrospective review was performed on a cohort of patients checked by onboard portable ultrasonography. Patients' gender, age, the distribution of examined organs, and multiple applications of the portable ultrasonography were analyzed. Some limitations of portable ultrasonography on the mission and possible improvements in the future were also discussed. A total of 5277 cases (mean age: 43.74 years; range: 2 months-105 years) of ultrasound examinations were performed during the mission; among them, 3126 (59.2%) cases were performed by portable ultrasonography, including 3024 onboard cases and 102 onshore cases. The portable ultrasonography had been applied in many scenarios, for example, onboard emergency triage process, onboard bedside medical support, and onshore outreach medical service, which had become one of the indispensable auxiliary examination methods for its compatibility, portability, and flexibility. The onboard deployment of portable ultrasonography played a versatile and irreplaceable role in the humanitarian medical assistance and medical cooperation carried out by the PLA(N) Peace Ark hospital ship, and will contribute to such kind of missions in the future.

Utility of Point of Care Ultrasound in Humanitarian Assistance Missions.

Point of care ultrasound (POCUS) is increasingly used in primary care in the USA and has been shown to provide significant benefit to care in deployed military settings and during disaster relief efforts. It is less studied as a tool during humanitarian assistance missions. We sought to determine the utility of POCUS in a humanitarian assistance setting during the February 2019 joint U.S.-Brazilian hospital assistance mission aboard the Hospitalar Assistance Ship Carlos Chagas along the Madeira River in the Brazilian Amazon. Point of care ultrasound was offered as a diagnostic modality to primary care physicians during the course of a month-long mission. A handheld IVIZ ultrasound machine was loaned for use during this mission by Sonosite. A P21v phased array (5-1 MHz) or an L38v linear (10-5 MHz) transducer was used for scanning. Requests for POCUS examinations, their findings, and changes in patient management were recorded. Point of care ultrasound examinations were requested and performed in 24 of 814 (3%) outpatient primary care visits. Ten of these studies (42% of POCUS examinations, 1.2% of all patient visits) directed patient management decisions, in each case preventing unnecessary referral. In this austere setting, POCUS proved to be an inexpensive, effective tool at preventing unnecessary referrals. Future medical humanitarian assistance missions may likewise find POCUS to be a primary care force-multiplier.

The Ultimate Objective

In this interview with editors Tanja R. Müller and Gemma Sou, Tony Redmond reflects on his long career as a professor and practitioner of international emergency medicine and founder of UK-Med, an NGO that provides international emergency humanitarian medical assistance and which hosts the UK International Emergency Trauma Register (UKIETR) and UK International Emergency Medical Register (UKIEMR). He questions the usefulness of prioritising innovation in medical humanitarianism and advocates aiming for the same duty of care that one would offer in one’s everyday practice at home. In this, Tony is also critical of the term ‘humanitarian space’, as it by definition proclaims an imagined geographical entity where normal rules should not apply.

Cooperative System between NGOs and the Private Sector for Disaster Relief in Japan

Introduction:Disasters disturb the balance of medical supply and demand. Because normal supply chains break down in the wake of disasters, it is difficult to deliver daily necessities to affected areas. In addition, without a reliable supply of medical equipment and medicines, the number of sick and injured patients increases.Aim:We propose that emergency medical teams should bring medical equipment and daily necessities when responding to disasters.Methods:The Social Emergency Management Alliance (SEMA) was established in 2017. SEMA is a cooperative system between NGOs and the private sector for disaster relief in Japan. Humanitarian Medical Assistance (HuMA) utilized this system to provide emergency medical assistance during the Western Japan Floods in 2018.Results:After the flooding, increased amounts of dust caused many cases of conjunctivitis. There were also numerous cases of heat stroke and dehydration, especially in the elderly. We requested SEMA to bring eye drops to wash out dust and isotonic drinks to prevent dehydration and heat stroke to Mabi Town, Okayama. SEMA coordinated with the private sector to provide eye drops and isotonic drinks via a forwarding agent, and we were able to distribute them to affected people and prevent worsening disease.Discussion:NGOs working within affected areas can assess the exact needs of affected people in order to avoid waste. Such collaboration through SEMA will allow for more effective disaster relief in the future. It is our hope that more private companies join SEMA to reduce the suffering of disaster victims.

STI for SDGs: Perspectives from Medical Humanitarian Assistance

STI for SDGs: Perspectives from Medical Humanitarian Assistance

Medical resource preparation and allocation for humanitarian assistance based on module organization

This research aims to associate the allocation of medical resources with the function of the modular organization and the possible needs for humanitarian assistance missions. The overseas humanitarian medical assistance mission, which was sent after a disaster on the hospital ship Peace Ark, part of China's People's Liberation Army (PLA) Navy, was considered as study model. The cases used for clustering and matching sample formation were randomly selected from the existing information related to Peace Ark's mission. Categories of the reusable resources clustered by this research met the requirement of the actual consumption almost completely (more than 95%) and the categories of non-reusable resources met the requirement by more than 80%. In the mission's original resource preparing plan, more than 30% of the non-reusable resource categories remained unused during the mission. In the original resource preparing plan, some key non-reusable resources inventories were completely exhausted at the end of the mission, while 5% to 30% of non-reusable resources remained in the resource allocation plan generated by this research at the end of the mission. The medical resource allocation plan generated here can enhance the supporting level for the humanitarian assistance mission. This research could lay the foundation for an assistant decision-making system for humanitarian assistance mission.

Investing in Knowledge for Those Most in Need

Background: Worldwide, increasing numbers of violence and trauma victims are to perceive. Humanitarian surgery is treating an essential part of the global burden of disease. As an international humanitarian aid organization, we are aiming to save life, reduce suffering, and support social reintegration of our patients. Humanitarian surgery is a fundamental pillar of our humanitarian medical assistance. Acute or chronic sequelae of hand trauma are very frequent in this field, affecting the victim’s social and/or economic life substantially negative in a long term. In the absence of highly specialized surgeons, support is predominately provided by general and visceral surgeons. Due to the specification of surgeons within their qualification trajectory, many surgeons are lacking specific knowledge in orthopedic and hand surgery, which is urgently requested in the day-to-day business in humanitarian aid. Objective: How do surgeons, working in the humanitarian aid, benefit from a context-tailored training activity? Method: Conduction of a 4-day “International Surgical Workshop,” held in the anatomy lab of a German University Hospital, open for surgeons working in the humanitarian field. The training activity consists of 9 different modules. Participants receive 16 hours’ lecturing and 16 hours’ practical teaching on corpses. The course is evaluated 2 times: (1) overall evaluation (e.g. set up, timing, content), conducted in the end of the course, using focus group discussions and formulized questionnaires and (2) evaluation regarding its sustainability, conducted 6 month back after training, with the support of a formalized online questionnaire (return rate 69% in 2014). Results: Since 2009, 181 surgeons, from 41 nationalities participated in the training. The training’s content, timing, and format met highly the requirements of the target group. The overall evaluation was 3.6 points out of 4. Among other modules (e.g. craniotomy, gynecology, vascular, external fixation, reconstructive surgery), participants were qualified on most common hand-surgical traumata seen in the field of humanitarian crisis (e.g. machete and explosive/gunshot lesions, burn, contractures) by experienced hand surgeons. The practical focus was hereby on tendon repair, tendon transposition, nerve repair, contracture release, local flaps for soft tissue repair, infection, and bone trauma management. The theoretical and practical knowledge gained in hand and reconstructive surgery and external fixation had the highest practical relevance and usefulness for humanitarian work (4.7-5.1 out of 6) in the evaluation 6 months after training. As all surgeons went back to the field after training, this activity has a high degree of sustainability. Conclusion: Hand surgery is an essential part of humanitarian surgery. A context-tailored training activity, incorporating theoretical and hands-on training in hand surgery for humanitarian surgeons is fundamental. The training activity has a great benefit for the humanitarian surgeons and the victims in humanitarian crisis with a high degree of sustainability. However, the conduction of the activity remains as a high challenge for humanitarian aid organizations.

Ethics of emergent information and communication technology applications in humanitarian medical assistance.

New applications of information and communication technology (ICT) are shaping the way we understand and provide humanitarian medical assistance in situations of disaster, disease outbreak or conflict. Each new crisis appears to be accompanied by advancements in humanitarian technology, leading to significant improvements in the humanitarian aid sector. However, ICTs raise ethical questions that warrant attention. Focusing on the context of humanitarian medical assistance, we review key domains of ICT innovation. We then discuss ethical challenges and uncertainties associated with the development and application of new ICTs in humanitarian medical assistance, including avoiding harm, ensuring privacy and security, responding to inequalities, demonstrating respect, protecting relationships, and addressing expectations. In doing so, we emphasize the centrality of ethics in humanitarian ICT design, application and evaluation.

Factors affecting mortality of pediatric trauma patients encountered in Kandahar, Afghanistan.

The North Atlantic Treaty Organization (NATO) Role 3 Multinational Medical Unit (R3-MMU) is a tertiary care trauma facility that receives casualties, both coalition and civilian, and provides humanitarian medical assistance when able to the Kandahar province in southern Afghanistan. We examined the cohort of pediatric patients evaluated at the facility during a 16-month period to determine the characteristics and care requirements of this unique patient population. A database of Afghan patients younger than 18 years of age admitted to the NATO R3-MMU between January 2010 and April 2011 was developed from the Joint Theatre Trauma Registry. This patient cohort was analyzed to determine demographics, injury mechanism, injury severity, resource utilization and factors associated with mortality. A total of 263 children were admitted to the NATO R3-MMU during the study period, representing 12% of all trauma admissions during this time period. The median age was 9 years (range 3 mo-17 yr) with a predominance of male patients (82%). Battle-related trauma was responsible for 62% of admissions, with explosive blast injury constituting the predominant mechanism (42%). The average injury severity score was 12.3 ± 9.3. Overall mortality was 8%. Factors associated with increased risk of death included admission acidosis, coagulopathy, hypothermia and female sex. Children represent a significant proportion of traumatic injuries encountered in a modern war zone; many of them are critically injured. Organizations that provide health care in such environments should be prepared to care for this patient population where their mandates and facilities allow for it.

Needs, acceptability, and value of humanitarian medical assistance in remote Peruvian Amazon riverine communities.

Much debate exists regarding the need, acceptability, and value of humanitarian medical assistance. We conducted a cross-sectional study on 457 children under 5 years from four remote riverine communities in the Peruvian Amazon and collected anthropometric measures, blood samples (1-4 years), and stool samples. Focus groups and key informant interviews assessed perspectives regarding medical aid delivered by foreigners. The prevalence of stunting, anemia, and intestinal parasites was 20%, 37%, and 62%, respectively. Infection with multiple parasites, usually geohelminths, was detected in 41% of children. The prevalence of intestinal parasites both individual and polyparasitism increased with age. Participants from smaller communities less exposed to foreigners expressed lack of trust and fear of them. However, participants from all communities were positive about foreigners visiting to provide health support. Prevalent health needs such as parasitic infections and anemia may be addressed by short-term medical interventions. There is a perceived openness to and acceptability of medical assistance delivered by foreign personnel.

Medical relief for the 2011 Japan earthquake: A nursing account

In 2011 the east coast of Japan experienced a massive earthquake which triggered a devastating tsunami destroying many towns and killing over 15 000 people. The work presented in this paper is a personal account that outlines the relief efforts of the Humanitarian Medical Assistance team and describes the efforts to provide medical assistance to evacuees. The towns most affected had a large proportion of older people who were more likely to have chronic conditions and required medication to sustain their health. Since personal property was destroyed in the tsunami many older people were left without medication and also did not remember which type of medication they were taking. Some evacuees had brought a list of their medication with them, this assisted relief teams in obtaining the required medication for these people. The more successful evacuation centers had small numbers of evacuees who were given tasks to administer the center that kept them occupied and active.

Tropical Medicine Training in the Department of Defense

OVERVIEW With increased emphasis by the Department of Defense (DoD) on stabilization of the peace, including medical stability operations, deployment to tropical environments will not decrease in the foreseeable future. Although every medical provider should have some training in the recognition of tropical diseases, a growing need exists for providers with advanced training in the diagnosis, treatment, and prevention of these illnesses. Too often, all providers are incorrectly assumed to possess detailed knowledge about these conditions rarely seen in the continental United States. Tropical medicine practitioners must be knowledgeable in relevant aspects of infectious diseases, preventive medicine, parasitology, and entomology. They must be competent in the diagnosis of tropical diseases, including the application of laboratory and radiologic techniques in austere settings. Critically, they must understand the impact of tropical diseases on deployed military personnel and endemic communities alike. The DoD offers several courses in tropical medicine that vary in length, scope, detail, and target audience. Here we seek to increase awareness of the availability and scope of these courses. This list is not exhaustive and excludes locally produced courses and courses that focus on a single area of tropical medicine. The courses described herein include the Masters of Tropical Medicine and Hygiene (MTM&H) at the Uniformed Services University of the Health Sciences (USU), the Masters of Public Health (MPH) with a concentration in Tropical Public Health (TPH) at USU, the Training in Tropical Medicine and Travelers’ Health Course at USU, courses within the U.S. Military Tropical Medicine (MTM) program, the Global Medicine Course, the Walter Reed Army Institute of Research (WRAIR) Tropical Medicine Course, the Military Medical Humanitarian Assistance Course (MMHAC), and the training program offered by the Armed Forces Health Surveillance Center (AFHSC) and USU.

Experience of Médecins Sans Frontières in laboratory medicine in resource-limited settings

In medical humanitarian assistance, the diagnosis of diseases plays a crucial role. Laboratory investigations are one of the main diagnostic tools utilized in Médecins Sans Frontières' (MSF) programs. Currently MSF supports and/or operates more than 130 laboratories in approximately 45 countries. The variety of analysis offered depends largely on the context of the program and the availability of context adapted tools and ranges from sophisticated laboratories specializing in tuberculosis culture to small laboratories within a primary health care program or operating as mobile clinics. The largest laboratories in MSF are found in programs with the main objective to diagnose, treat and monitor patients with tuberculosis and/or human immunodeficiency virus. Other MSF programs are either disease-specific (e.g., malaria, Chagas, kala azar or visceral leishmaniasis, sleeping sickness, malnutrition, sexually transmitted infections) or are integrated in primary or secondary health care structures.

(A266) Huma Disaster Relief Medical Mission for Flood-Affected Victims in the Islamic Republic of Pakistan

A Flood disaster struck the Islamic Republic of Pakistan in July 2010. It affected 3 million people and caused 1,400 deaths. Humanitarian Medical Assistance (HuMA) is a non-profit organization in Japan. The organization dispatched three personnel to Islamabad on 20 August in order to conduct an initial needs assessment. They discovered that medical assistance and supplies could not reach all of the victims, especially in the North. Their visits to the surrounding regions highlighted the Nowshera district of KPK province, which had not received enough assistance from the government or aid organizations despite the fact that there were thousands of Internally Displaced Persons (IDPs) with health issues such as diarrhea, eye and skin disease, and upper respiratory tract infection (URTI). On 03 September, the HuMA Disaster Relief Mission began with the purpose of providing medical treatment and promoting public health for the flood victims in the Nowshera District. Eleven medical providers and coordinators from HuMA operated field mobile clinics in the district in collaboration with a local counterpart non-governmental organization, Nippa Welfare Association (NWA). This project was supported financially by the grant funding from Japan Platform. Humanitarian Medical Assistance served seven sites in Nowshera Districts as mobile field clinics, and consulted 2,216 patients. Total distribution of disease was: (1) URTI = 18.1%; (2) skin disease = 17.9%; (3) musculoskeletal = 15.2%; and (4) others = 19.7%. The team considered continuous medical consultation in the Nowshera District after 2010. The HuMa medical activities ended at the end of September, and the organization donated multi-vitamin tablets, syrups, FE tablets, and anti-biotic cream in order to assist NWA's continuing assistance for the affected communities. The medical providers also left lists of medicines for local doctors and medical staff. Humanitarian Medical Assistance also provided basic supplies needed to prevent victims from experiencing further sanitation problems.

(P1-109) Humanism in Disaster Medicine

The main trends in the development of the ideology of humanism in disaster medicine can be formulated in the following theses: 1. Responsibility of governmental bodies for providing medical safety of a human being in emergencies; 2. Responsibility of public health in the society; 3. Main tasks in nuclear threats connected as applied to disaster medicine are the responsibility of United Nations; 4. History of humanitarian medicine and the development of the World Health Organization's activities in providing medical humanitarian assistance; 5. Ethics of modern physical investigations in the light of development of nuclear and thermonuclear hazards; 6. Roles and trends of humanitarian medicine in modern society; 7. Philosophical and humanitarian approaches and ethics in the modern scientific investigations in the whole; 8. Ethics in modern medicine, biology, and disaster medicine; 9. Rights of victims to receive humanitarian medical assistance in local military conflicts; and 10. Threat of acts of terrorism with the use of chemical, biological, radiological, or nuclear agents and technologies; The paradox of the modern age is that the “principal basis and aim of disaster medicine are humanitarian by their primordial nature”, but the reduction of common human values can lead to a global disaster. On the other hand, emergencies should lead mankind to unity, to the deep understanding of biosocial aspects of survival when the best qualities of human nature are revealed. International disaster medicine problems should be considered as tools for providing an optimal basis for the development of human relations. The development of humanitarian and disaster medicine should be realized with consideration of deep-laid moral positions, on the basis of ethic principles and high moral values, among which, the primordial values are individual existence of everybody and survival of mankind as a species.

Towards a Better Approach to Medical Humanitarian Assistance in Iraq and Future Counterinsurgency Operations

Towards a Better Approach to Medical Humanitarian Assistance in Iraq and Future Counterinsurgency Operations

Strategy at the Crossroads: Medical Humanitarian Assistance Missions for Navy Hospital Ships

Strategy at the Crossroads: Medical Humanitarian Assistance Missions for Navy Hospital Ships

Humanitarian Assistance Medicine: Perceptions of Preparedness: A Survey-Based Needs Assessment of Recent U.S. Army Internal Medicine Residency Graduates

The U.S. military provides humanitarian assistance in many areas around the globe. With recent changes in the force structure of the U.S. Army, internal medicine physicians are now at the forefront of providing this care, but the extent of their involvement is not known. This study measured the frequency with which recently trained Army internists provided humanitarian assistance, and it assessed their perceived preparedness for such missions. All graduates from Army internal medicine programs for 4 consecutive years were invited by e-mail to participate in an Internet-based survey. Eighty-nine personnel (49% of those contacted) completed the survey. Of those in a deployable position for >6 months, 72% provided medical humanitarian assistance. Most thought that additional training was needed, especially in tropical disease management, sanitation, and the practices of civilian humanitarian workers. This study demonstrates that military-trained internists are frequently involved in humanitarian assistance medicine, and it suggests that they might benefit from additional training.

Overview of Overseas Humanitarian, Disaster, and Civic Aid Programs

The U.S. Department of Defense (DoD) conducts humanitarian assistance missions under the Overseas Humanitarian Disaster and Civic Aid program for the statutory purposes of training military personnel, serving the political interests of the host nation and United States, and providing humanitarian relief to foreign civilians. These purposes are undertaken via the humanitarian assistance (HA), humanitarian and civic assistance, and excess property donation programs. DoD conducts over 200 such projects annually at a direct cost of approximately 27 million dollars in fiscal year 2001. Although varying by year and command, as many as one-half of these projects involve aspects of health care. These range from short-term patient care to donation of medical supplies and equipment excess to the needs of the DoD. Despite the considerable resources invested and importance of international actions, there is presently no formal evaluation system for these HA projects. Current administrative staffing of these programs by military personnel is often by individuals with many other duties and responsibilities. As a result, humanitarian projects are often inadequately coordinated with nongovernmental organizations, private volunteer organizations, or host-nation officials. Nonmedical military personnel sometimes plan health-related projects with little or no coordination with medical experts, military or civilian. After action reports (AARs) on these humanitarian projects are often subjective, lack quantitative details, and are devoid of measures of effectiveness. AARs are sometimes inconsistently completed, and there is no central repository of information for analysis of lessons learned. (The approximate 100 AARs used in the conduct of these studies are available for official use in the Learning Resources Center, Uniformed Services University of Health Sciences.) Feedback from past humanitarian projects is rare and with few exceptions; DoD-centric projects of a similar design are often repeated. Critical reviews to determine whether other kinds of projects might be more effective are rarely conducted. Recommendations for improving the effectiveness of DoD HA under Overseas Humanitarian Disaster and Civic Aid programs include: ensuring adequate staffing to meet the complex, dynamic nature of humanitarian missions and measuring the effectiveness of each project in mandatory, standardized AARs. For medical HA projects, application of public health strategies would compliment the patient care approach of the majority of medical projects to date. This offers possibilities for enhancing host nation infrastructure, allowing improvements beyond the short period of most military humanitarian projects.