Humanitarian Surgical Missions Research Articles

Three-stage correction of severe idiopathic scoliosis with limited skeletal traction during a humanitarian surgical mission: illustrative case.

Underprivileged and underserved patients from developing countries often present late with advanced, untreated spinal deformities. We report a three-stage all-posterior approach using limited skeletal traction with Gardner-Wells tongs (GWTs) for the management of severe idiopathic scoliosis during a humanitarian surgical mission trip. A 17-year-old high-school female was previously diagnosed with juvenile idiopathic scoliosis (diagnosed at age 8) and progressed to a severe 135° kyphoscoliosis. Procedural stage 1 involved spinal instrumentation and posterior releases via posterior column osteotomies from T3 to L4. She then underwent 7 days of skeletal traction with GWTs in the intensive care unit as stage 2. In stage 3, rod engagement, posterior spinal fusion, and partial T10 vertebral column resection were performed. There were no changes in intraoperative neuromonitoring during either surgery and she woke up neurologically intact after both stages of the surgical procedure. Skeletal traction with GWTs is a viable alternative to traditional halo-gravity traction in settings with limited resources. Three-stage spinal deformity correction using limited skeletal traction is a feasible and effective approach for managing severe scoliosis during humanitarian surgical mission trips.

Pediatric Otolaryngology Short-Term Mission Outcomes at a Surgical Mission Hospital in Guatemala.

The frequency of humanitarian surgical mission trips has grown over recent decades. Unfortunately, research on patient outcomes from these trips has not increased proportionately. We aim to analyze the safety and efficacy of surgeries in a low- and middle-income country missions-based surgery center in Guatemala City, Guatemala,and identify factors that influence surgical outcomes. Retrospective cohort study. Guatemalan surgery center is called the Moore Center. Pediatric patients underwent otolaryngology surgery between 2017 and 2019. All patients required follow up. We analyzed the effect of patient, surgical, and geographic factors on follow up and complications with univariate and multivariate analyses. A total of 1094 otolaryngologic surgeries were performed between 2017 to 2019, which comprised 37.4% adenotonsillectomies, 26.8% cleft lip (CL)/cleft palate (CP) repairs, 13.6% otologic, and 20% "other" surgeries. Patients traveled on average 88 km to the center (±164 km). Eighty-nine percent attended their first follow up and 55% attended their second. The 11% who missed their first follow up lived farther from the center (p < .001) and had a higher ASA classification (p < .001) than the 89% who did attend. Sixty-nine (6.3%) patients had 1 or more complications. CL/CP surgery was associated with more complications than other procedures (p < .001). Of 416 tonsillectomies, 4 patients (1%) had a bleeding episode with 2 requiring reoperation. This surgical center models effective surgical care in low-resource areas. Complications and follow-up length vary by diagnosis. Areas to improve include retaining complex patients for follow up and reducing complications for CL/CP repair.

Perspectives on competencies for care in austere settings

Austerity in surgical care may manifest by limited equipment/supplies, deficient infrastructure (power, water), rationing/triage requirements, or the unavailability of specialty surgical or medical expertise. Some settings in which surgeons may experience austerity include the following: military deployed operations (domestic and foreign), humanitarian surgical missions, care in rural or remote settings, mass-casualty events, natural disasters, and/or care in low- and some middle-income countries. Expanded competencies beyond those required in routine surgical practice can optimize the quality of surgical care in such settings. The purpose of this expert panel review is to introduce those competencies.

Addressing Surgical Care Disparities: Residents' Involvement in Global Mission Trips.

Humanitarian mission trips have been organized by several residency programs and organizations to cater to surgical care in underdeveloped countries. While there is cross-talk on the existence of such opportunities, there is a paucity of guidance to residents on participation in such trips, their benefits, and the myriad of intangibles to consider while planning to pursue such opportunities. Through this article, the authors highlight the background and utility of humanitarian surgical missions and summarize the clinical and surgical experiences that these trips offer for residents choosing to embark on these altruistic journeys.

Understanding the motivation of nurses volunteering for non-disaster humanitarian service

BackgroundNurses who volunteer in a nondisaster humanitarian surgical mission receive little attention in the research literature. PurposeThe purpose of this study was to explore how nurses involved in short-term nondisaster humanitarian care perceived and managed their experiences of working in a volunteer nursing capacity in a low- to middle-income country. MethodAn immersive ethnographic method was used. Participants comprised 150 international registered nurses from 12 countries. Data collection incorporated 49 semistructured interviews and reflections on 1,500 hours of participant observation. Data were analysed using a thematic, inductive approach, following the consolidated criteria for reporting qualitative research guidelines. ResultsThe results of this qualitative enquiry revealed essential aspects of the nursing culture within a specific humanitarian nursing context—that is, promoting social justice and addressing health disparity through the delivery of compassionate surgical care. This paper presents data describing nurses’ motivations for participating as volunteers in humanitarian work. DiscussionNurses are more likely to offer increased effort and enthusiasm when there is congruency between their beliefs, their professional identity, and their ability to enact on these. Understanding humanitarian nurses’ motivations gives guidance to leaders involved in managing, attracting, and retaining suitable nursing staff and orienting, debriefing, and supporting re-entry after withdrawing from short-term medical assignments that share a common imperative to care for the underserved.

Humanitarian Surgical Missions in Times of COVID-19: Recommendations to Safely Return to a Sub-Saharan Africa Low-Resource Setting.

BackgroundSince the declaration of the pandemic, humanitarian medicine has been discontinued. Until now, there have been no general recommendations on how humanitarian surgical missions should be organized.MethodsBased on our experience in the field of humanitarian surgical missions to Sub-Saharan Africa, a panel of recommendations in times of COVID-19 was developed. The fields under study were as follows: (1) Planning of a multidisciplinary project; (2) Organization of the infrastructure; (3) Screening, management and treatment of SARS-COV-2; (4) Diagnostic tests for SARS-COV-2; (5) Surgical priorization and (6) Context of patients during health-care assistance. We applied a risk bias measurement to obtain a consensus among humanitarian health-care providers with experience in this field.ResultsA total of 94.36% of agreement were reached for the approval of the recommendations. Emergency surgery must be a priority, and elective surgery adapted. For emergency surgery, we established a priority level 1a (< 24 h) and 1b (< 72 h). For an elective procedure, according our American College of Surgeon adaptation score, process with more than 60 points should be reconsidered. Due to the low life expectancy in many African countries, we consider 45–50 years as age of risk. In case of SARS-COV-2 active infection or high clinical suspicion, the screening, management and treatment should be following the international guidelines adapted to duration of the stay, available infrastructure, size of the cooperation team and medical resources.ConclusionsHumanitarian surgical mission in times of COVID-19 is a challenge that must extrapolate the established recommendations to the local cooperation environment.Supplementary InformationThe online version contains supplementary material available at (10.1007/s00268-021-06001-x).

Point-of-care resuscitation research: From extreme to mainstream: Trauma Association of Canada Fraser Gurd Lecture 2019.

The Gurd Family surgical legacy was deeply intertwined with National service in both World Wars. My own personal research mission has attempted to emulate such service, by enhancing the tools and techniques available to facilitate point-of-care diagnosis and resuscitation in extreme and adverse environments. Our efforts involving point-of-care diagnosis/resuscitation and the telementored guidance of those remotely responding to catastrophic injury have included collaborations with National Aeronautics and Space Administration (NASA) the Canadian Space Agency, the Canadian Forces, its democratic allies, and non-governmental surgical organizations. Research has been conducted in resuscitative suites and operating theaters, research laboratories, parabolic flight aircraft, on humanitarian surgical missions, and from ski-hills and firehalls. The initial phases of these efforts involved inaugural studies in resuscitative sonography including defining the Extended Focused Assessment with Sonography for Trauma (EFAST) examination. Although the original work was commissioned for Space Medicine, generalization to mainstream practice further justifies space medicine research. Iterative steps in advancing telementored resuscitation have subsequently involved the maturation of space-mandated telementored ultrasound support (TMUS), exploration of TMUS in terrestrial clinical practice, and the creation of increasingly mobile (hand-held) TMUS solutions. Subsequently it was recognized that teleultrasound is simply one informatic dimension of remote telemedicine, and current efforts are focused in a Program known as TeleMentored Ultrasound Supported Medical Interactions (TMUSMI) of remote responders required to intervene with catastrophic trauma. While this research program has yielded many techniques and findings that have benefited mainstream terrestrial practice, these investigations are currently ongoing, and we hope to demonstrate that TMUSMI may benefit all Canadians especially those in remote areas, as well as potentially every global inhabitant without immediate access to care. Further, we propose that to fully utilize these techniques, a new specialty, that of the remote medical mentor will be required, a new specialty that will require the creation and scientific validation of its principles and techniques.

Seroprevalence of HIV, Hepatitis B and C Viruses Infections among Candidates for Cataract Surgery

Introduction: The safety issue of mass surgeries in areas of higher endemicity for HIV, HBV and HCV is raised. Objective: The objective was to determine the frequency of HIV, HBV and HCV among people undergoing a cataract surgery during humanitarian surgical mission. Patients and Method: This prospective study was conducted at CHU Owendo from April to September 2018. Cataract-operated patients were the targeted population. Rapid screening tests were used for diagnosis. Parameters such as age, sex, frequency of HIV, HBV, HCV, and co-infections were analyzed. Sero-positivity was correlated with age and sex. A total of 1403 patients were included. Statistical analysis was performed with EPI Info 7.2 (Chi2 uncorrected, Mann-Whitnney and Wilcoxon, p < 0.05). Results: Patients mean age was 66.3 ± 11.6 years; 42.1% of them were male. With 18.0% of the study population, HIV-positive people had mean age of 78.4 ± 9.3 years, compared to 61.2 ± 10.1 years for sero-negative (p < 0.001). HIV prevalence was 4.6% (95% CI = [3.7 - 5.9]), HBV was 2.9% (95% CI = [2.1 - 3.9]), and HCV was 11.8% (95% CI = [10.2 - 13.6]). Co-infections occurred in 1.2% (95% CI = [0.8 - 1.9]) of patients undergoing surgery. Conclusion: This study showed high prevalence of HIV, HBV and HCV among patients undergoing cataract surgery with predominance for HCV. Viral co-infections prevalence was also significant.

Cost-Effectiveness Analysis of Mesh Repair for Inguinal Hernia During a Humanitarian Surgical Mission in Rural Nigeria

Background: Humanitarian short-term surgery missions remain under debate, even though the proportion of the burden of surgical diseases around the world that could be treated based on surgery is constantly rising. The primary objective of this study was to prove the cost-effectiveness (CE) of a hernia repair–teaching mission in the rural setting of Nigeria. Methods: We present a CE analysis (CEA) of a 2-week surgery mission performing inguinal hernias with mesh repair according to the Lichtenstein maneuver. All data were collected prospectively. The contribution to the local health system was measured based on the disability-adjusted life years (DALYs). Further on, the CEA was analyzed and separated for surgeons from Nigeria and Europe, respectively. Results: During this mission a total of 107 patients with 123 hernias were treated. An average of 6,61 DALYs per patient were averted. The total costs for the mission team amounted to $8485.26, with a total of $19,210.73 from a societal perspective. Single-procedure costs amounted to $198.87 per patient, with $39.35 per procedure from a patient perspective. The CEA showed $31.04/DALY averted from a societal perspective, $13.71/DALY averted from a provider perspective, and $6.81/DALY averted from a patient perspective. This was well below the threshold of $2790 (gross domestic product per capita). Sensitivity analysis showed robust results. Conclusion: With these results we proved CE and remained about 90 times below the threshold of the gross domestic product per capita.

First Do No Harm: Predicting Surgical Morbidity During Humanitarian Medical Missions.

Despite good intentions, humanitarian surgical missions are unavoidably linked to some degree of complication. We hypothesized that the American College of Surgeons Surgical Risk Calculator (ACS-SRC) could estimate the risk of complications of procedures performed during the US Navy's Pacific Partnership 2015 (PP15) mission. Patient information and surgical details recorded during PP15 were entered into the ACS-SRC. Risks of complications for each procedure were calculated. Receiver operating characteristics and Brier scores were calculated to compare the predicted outcomes to the observed complications. Of the 174 unique procedures performed during PP15 (representing 465 patients), 99 were found in the ACS-SRC (representing 256 patients). Risk calculations for PP15 were: 1.5% risk (IQR 0.9, 2.4) of "serious" complications and 2.0% risk (IQR 1.3, 2.8) of "any" complication. ACS-SRC specific risks were calculated as follows: pneumonia 0.1%, cardiac 0.0%, surgical site infection (SSI) 0.6%, urinary tract infection 0.2%, venous thromboembolism 0.1%, renal failure 0.0%, OR return 0.9%, and death 0.0%. The only specific ACS-SRC complication observed was "OR return" (0.35%) and SSI (0.35%). The observed PP15 rates for "serious" or "any" complications (ACS-SRC definition) were 0.70% (2/285) each. Receiver operating characteristics for ACS-SRC for predicting "serious" or "any" complication were 0.743 (p = 0.118) and 0.654 (p = 0.227), respectively. Although the ACS-SRC over-predicted risk compared to observed outcomes, it may offer a good starting point for humanitarian surgery risk calculation. Observed outcomes may be limited by loss-to-follow-up bias. Emphasis should be placed on establishing patient follow-up as part of humanitarian surgical mission planning and execution.

Long-Term Outcomes after Humanitarian Surgical Missions: Are Patients Still Satisfied?

Johnston, Peter MD; Patel, Hamil; Gyakobo, Mawuli K. MB ChB, PhD, FWACP; Sifri, Ziad C. MD, FACS Author Information

Safe and sustainable: the extracranial approach toward frontoethmoidal meningoencephalocele repair.

OBJECTIVE Although rare, frontoethmoidal meningoencephaloceles continue to pose a challenge to neurosurgeons and plastic reconstructive surgeons. Especially when faced with limited infrastructure and resources, establishing reliable and safe surgical techniques is of paramount importance. The authors present a case series in order to evaluate a previously proposed concise approach for meningoencephalocele repair, with a focus on sustainability of internationally driven surgical efforts. METHODS Between 2001 and 2016, a total of 246 patients with frontoethmoidal meningoencephaloceles were treated using a 1-stage extracranial approach by a single surgeon in the Department of Neurosurgery of the Yangon General Hospital in Yangon, Myanmar, initially assisted by European surgeons. Outcomes and complications were evaluated. RESULTS A total of 246 patients (138 male and 108 female) were treated. Their ages ranged from 75 days to 32 years (median 8 years). The duration of follow-up ranged between 4 weeks and 16 years (median 4 months). Eighteen patients (7.3%) showed signs of increased intracranial pressure postoperatively, and early CSF rhinorrhea was observed in 27 patients (11%), with 5 (2%) of them requiring operative dural repair. In 8 patients, a decompressive lumbar puncture was performed. There were 8 postoperative deaths (3.3%) due to meningitis. In 15 patients (6.1%), recurrent herniation of brain tissue was observed; this herniation led to blindness in 1 case. The remaining patients all showed good to very good aesthetic and functional results. CONCLUSIONS A minimally invasive, purely extracranial approach to frontoethmoidal meningoencephalocele repair may serve well, especially in middle- and low-income countries. This case series points out how the frequently critiqued lack of sustainability in the field of humanitarian surgical missions, as well as the often-cited missing aftercare and dependence on foreign supporters, can be circumvented by meticulous training of local surgeons.

Introduction of the American Academy of Facial Plastic and Reconstructive Surgery FACE TO FACE Database.

The American Academy of Facial Plastic and Reconstructive Surgery FACE TO FACE database was created to gather and organize patient data primarily from international humanitarian surgical mission trips, as well as local humanitarian initiatives. Similar to cloud-based Electronic Medical Records, this web-based user-generated database allows for more accurate tracking of provider and patient information and outcomes, regardless of site, and is useful when coordinating follow-up care for patients. The database is particularly useful on international mission trips as there are often different surgeons who may provide care to patients on subsequent missions, and patients who may visit more than 1 mission site. Ultimately, by pooling data across multiples sites and over time, the database has the potential to be a useful resource for population-based studies and outcome data analysis. The objective of this paper is to delineate the process involved in creating the AAFPRS FACE TO FACE database, to assess its functional utility, to draw comparisons to electronic medical records systems that are now widely implemented, and to explain the specific benefits and disadvantages of the use of the database as it was implemented on recent international surgical mission trips.

Humanitarian Surgical Missions: Guidelines for Successful Anesthesia Support.

Many anesthesiologists and CRNAs are provided little training in preparing for a humanitarian surgical mission. Furthermore, there is very little published literature that outlines how to plan and prepare for anesthesia support of a humanitarian surgical mission. This article attempts to serve as an in-depth planning guide for anesthesia support of humanitarian surgical missions. Recommendations are provided on planning requirements that most anesthesiologists and CRNAs do not have to consider on routinely, such as key questions to be answered before agreeing to support a mission, ordering and shipping supplies and medications, travel and lodging arrangements, and coordinating translators in a host nation. Detailed considerations are included for all the phases of mission planning: advanced, mission-specific, final, mission-execution, and postmission follow-up planning, as well as a timeline in which to complete each phase. With the proper planning and execution, the anesthetic support of humanitarian surgical missions is a very manageable task that can result in an extremely satisfying sense of accomplishment and a rewarding experience. The authors suggest this article should be used as a reference document by any anesthesia professional tasked with planning and supporting a humanitarian surgical mission.

Humanitarian Activities of Interplast Turkiye: 6 Years of Experience in Uzbekistan for Surgical Treatment of Cleft Patients and Related Secondary Deformities.

Cleft lip and palate (CL/P) is one of the leading congenital deformities among the world. Children born with CL/P experience problems with feeding, speech, hearing, and dentition. In developed countries, CL/P patients are receiving optimal health care involving multidisciplinary team approach and staged surgical operations, whereas in developing countries, there is severe shortage of both medical and financial sources. To overcome these limitations, humanitarian surgical missions are essential. The aim of this article is to share our experience of humanitarian surgical mission in Uzbekistan consisting of 6 consecutive visits between 2009 and 2014. The series of these humanitarian activities consisting of 6 consecutive visits was organized by the cooperation of Interplast Turkiye and governmental Turkish Coordination and Cooperation Agency. After initial evaluation, triage at the initial setting and prompt anesthesia evaluation among many more of them, 529 patients mostly with cleft, craniofacial, or congenital deformities were operated. The success of this type of mission is not solely based on the expertise of the team members, but also meticulous planning, patient selection, good coordination with the local colleagues and communication. At this point, caregivers attending from a culturally close and similar language-spoken countries will certainly have more advantages in achieving a mission. Volunteer surgical missions for congenital deformities can be an important relief for this burden in developing countries. Nevertheless, training the native surgeons and supporting the plastic surgery foundations in these countries are as important as providing the necessary health care by such humanitarian missions.

Simultaneous total upper and lower lip reconstruction during a humanitarian surgical mission to Africa

Simultaneous total upper and lower lip reconstruction during a humanitarian surgical mission to Africa

Syrian war shrapnel injury: cubital nerve defect grafting during humanitarian surgical mission. Clinical case presentation

Background and aim of this clinical case presentation is to reveal the importance of early nerve injury diagnosis and surgical treatment in war wounded patients. Methods. The author treated patients in Amman Charity Hospital were among different plastic surgery cases where limb nerve injuries with nerve grafting indication. The presented case was treated with autologus sural nerve graft. Results were evaluated at 3 months after the surgery and revealed detectable nerve conductibility at the Electromiography test. In conclusion, in cases with delayed nerve repair surgical treatment in war wounded patients, the vascularised nerve graft can be a better solution for nerve defect surgical treatment.

Http://www.omicsgroup.org/journals/can-skintoskin-holding-in-the-nicu-support-lactation-2167-1168-1000360.php?aid=78129

Objective: Humanitarian medical and/or surgical missions have become common over the past 50 years. Little is known, however, about the quality of these missions, especially when a patient becomes unstable and requires resuscitation. We would like to present the “mock code” Operation Smile uses to ensure the best quality of care should a medical or surgical emergency arise during a mission. Operation Smile, a worldwide children’s medical charity, provides surgery for children with correctable facial deformities in 51 countries. The mock code was initially implemented as an educational tool to enhance skills and team dynamics. It has become a useful practice for preparing a team of medical professionals to respond to an unexpected medical or surgical emergency. A mock code is performed at each mission prior to the start of the surgical week. The mission team consists of 35-60 members, including medical professionals from many different countries and diverse backgrounds. Team members have varying levels of expertise, and thus a mock code is vital to give good resuscitative care. The volume of cases, the variety of professional backgrounds, the unfamiliar equipment and protocols, the language and cultural barriers, and the fact that these individuals have not previously worked together makes it essential to develop an emergency-preparedness plan. Emergencies involving pediatric patients generate a great deal of anxiety for the child, for the parents, and for the medical and nursing staff involved. Running an emergency code is always a challenge, especially when the patient is a child. Conclusion: The use of this tool allows us to build a special alliance between medical and nursing staff prior to an emergency. The mock code empowers nurses and doctors to feel more prepared to respond to pediatric emergencies and improve the quality of resuscitative care, should the need arise.

Humanitarian Surgical Missions: Planning for Success.

Humanitarian surgical missions can provide much needed care for those who are otherwise unable to receive such care because of limited local health care resources and cost. These missions also offer excellent training opportunities and can be life-changing experiences for those who participate in them. A successful humanitarian surgical mission requires careful planning and coordination and can be challenging for those tasked with the responsibilities to organize and lead these missions. This article addresses many of the issues and challenges encountered when planning and leading humanitarian surgical missions and offers a template to be used by those who take on these challenges.

Doing more with less: performance improvement in humanitarian endocrine surgery.

Appreciating the luxury of our modern operating rooms and arsenal of surgical instruments never seemed easier than when forced to operate in a very low-resource setting. As we have both experienced during short-term humanitarian surgical mission trips to Africa, performing specialized endocrine surgical procedures in resource-limited settings can make technically difficult cases seem all the more challenging. The article by O Donohoe et al. highlights a collection of key points regarding endocrine surgery in Sub-Saharan Africa [1]. First and foremost, continued development of the surgical workforce in Sub-Saharan Africa is of paramount importance. Local surgeons are often required to perform procedures that are frequently funneled to fellowshiptrained subspecialists in developed countries. Mission surgical specialists can provide invaluable onsite, personalized, one-on-one committed teaching and consultation to these surgeons. The experienced, sage surgeon comfortable with complex endocrine procedures is poised to do this and could increase the chances of excellent outcomes—a necessity with limited care [2]. Improved training of local non-specialist African surgeons is undoubtedly one of the most effective methods to establish sustainability and reliable endocrine surgical care in areas such as these. For decades, humanitarian surgical efforts have often focused on short-term surgical excursions, where teams of specialists and equipment fly in, operate around the clock, and fly out like a whirlwind. While compassion and care was clearly extended to the local patient population during the short visit, minimal emphasis was placed on long-term results and little or no patient follow-up occurred. Today, increasing emphasis is placed on patient outcomes, and humanitarian surgery is no different. Papers from McClenaghan and colleagues and Grimes et al., strongly support tracking outcomes and improving patient follow-up for surgical interventions in low-resource settings [3, 4]. Finally, tracking outcomes in a prospective manner for thyroid resections performed in resource-poor settings allows surgeons to better delineate local guidelines and standards of care as well as identifying specific areas for performance and quality improvement. In short, ‘‘A prospective analysis of thyroidectomy outcomes in a resource-limited setting’’ serves as an important example of the beginnings of quality and outcomes research in areas of the world crippled by endemic disease with significant disparities in available surgical care. This paper can easily serve as an inspiration and valuable reference for endocrine surgeons interested in effective and sustainable humanitarian surgical efforts.