Rural Camps Research Articles

Cost‐Effective Surgery for Cleft Lip and Palate in the Developing World: To the Editor

In their article in World Journal of Surgery, Magee and co-workers have done a commendable job of quantifying the burden of cleft lip and palate (CL/P) in developing countries, using the disability adjusted life years (DALY) framework [1]. The defined economic gain will help in the campaign for a CL/P-free world. In the same issue, Corlew advocates an economic CL/P model for effective health policy [2]. As surgeons from the developing world and facilitators of many such operative camps, we would like to contribute a few additions toward this goal. The authors state that the CL/P missions were a mix of international and local resources, with a huge variation in operating costs. The cost per DALY averted ranged from US$278 to US$1,827. Although it is not explicitly stated, that team transportation costs exceeded the charges for cargo and supplies suggests that the Chinandega, Nicaraugua, mission could be an international mission. Perhaps this is the most important conclusion of the article: that local/hybrid missions are more cost effective than international missions. The ability of Operation Smile to build local capacity is a worthy model for achieving a long-term and sustainable model for achieving a CL/P-free world. In the article by Magee and co-workers, for 8 missions, cost calculations were based on primary CL/P cases, which were only 56.11% (303/540) of the total cases. The remainder include a wide spectrum of procedures, from rhinoplasty to skin tag excision, and their inclusion would markedly affect the CL/P cost calculation. We also observed inconsistencies in the tables. In describing the Chinandega mission [1], Table 2 shows the number of cases of CL \5 years to be greater (26) than the total number of cases in Table 3 (23). For the Ho Chi Minh City and Chinandega missions [1], respectively, Table 3 shows the total number of CL/P cases to be 60 and 44, whereas Table 5 indicates totals of 62 and 46. Second, we must report as hosts that Operation Smile practices are ‘‘in accordance with the global standard of care’’. But, in camps of certain organizations, there is inconsistency in the levels of surgical skill and competence represented, and this has resulted in camps being discontinued midway through a mission. It is assumed that visiting surgeons are trained in international surgery and that it is appropriate that they be allowed to operate without regional licensing or recertification. We are also concerned about the lack of follow-up and management of complications, as well as the need for reoperation, long-term speech therapy, and orthodontics, all of which become the responsibility of the host organization. Although ‘‘lack of adequate local facilities’’ is a common refrain among visiting medical personnel, the costs to local hospitals of aftercare have not been added into the DALY calculation. Third, in a typical Indian metropolitan tertiary hospital an average of 47 CL/P patients per year would undergo operation. At such a center, the total cost to the patient, including travel and local stay, is approximately Rs. 12,000 (US$261), and at a rural camp with local resources the cost to the patient is approximately Rs. 6,000 (US$130.50) [Rs. 46 = US$1]. Finally, although studies [1, 3] claim that a substantial surgical burden of CL/P has been addressed by international missions, we must emphasize that there are not enough data regarding CL/P prevalence in the developing P. Thakkar (&) N. Roy Department of Surgery, Bhabha Atomic Research Centre Hospital, Anushaktinagar, Chembur, Mumbai 400094, India e-mail: purvithakkar@gmail.com

Less Air Pollution Leads to Rapid Reduction of Airway Inflammation and Improved Airway Function in Asthmatic Children

Renzetti G, Silvestre G, D'Amario C, et al. Pediatrics. 2009;123(3):1051–1058 PURPOSE OF THE STUDY. To investigate whether relocating children with asthma from an environment of high pollution to one of low pollution has an effect on short-term airway inflammation. STUDY POPULATION. This was a case study of 37 children, ≥7 years of age, with untreated, mild, persistent asthma who were recruited from an urban asthma clinic in Italy and followed at a rural school camp for 1 week. The children came from homes that had implemented dust mite precautions, and they stayed in a …

Hair and scalp mycobiota in school children in Nablus area.

Hair and scalp mycobiota of 1389 clinically normal children aged 6-12 years attending 12 schools in the Nablus District, Palestinian Authority, was assessed on three occasions over 8-month period (October 1998-May 1999) using the hair brush technique. One hundred and one fungal species belonging to 33 genera were recovered: 6 dermatophytes, 16 dermatophyte-like keratinophilic fungi, and 79 other keratinophilic fungal species. Species varied considerably in their frequency of occurrence and abundance based on their relative importance values (RIVs). The most frequent and abundant species were: Cladosporium cladosporioides, Cl. herbarum, Penicillium chrysogenum and Aspergillus flavus, Microsporum canis, Aphanoascus fulvescence and Chrysosporum sulfureum were the most frequent and abundant species of all dermatophytes and dermatophyte-like keratinophilic fungi recovered. The most frequent and abundant dermatophytes in different communities were M. canis in rural (RIV 0.87) and urban children (0.45), and Trichophyton violaceum (1.41) in refugee camp children. Chrysosporium species were the most frequent and abundant dermatophyte-like keratinophilic fungus in children from all localities followed by Aphanoascus fulvescence. Comparable results on the frequency and abundance of human hair and scalp mycobiota component fungi were obtained based on age group and sex of children. Higher number of species was recovered in spring months (73 species) than in autumn (57) and winter (44) months. Similar occurrence pattern was also noted for dermatophyte-like keratinophilic species and dermatophytes. Higher percentages of children with moderate (11-50) and heavy (< or = 50) spore loads (7.54 and 0.73, respectively) were found in urban school children community than in rural and refugee camp school children (4.7 and 0.1, respectively). Also significantly higher light (1-10) spore load percentages were found in rural (63.67) and refugee camp (62.9) than in urban children (52.6). Of all localities, school children with light spore load comprised the highest percentage of the children examined (37.4), followed by moderate (6.13), and heavy (0.41) spore load categories. However, children with undetected spore load comprised 36.05% of all children. Spore load distribution did not show clear seasonal variations in the study period. Higher percentages of moderate and heavy spore loads were found in male children (8.72 and 0.69, respectively) than in female children (3.4 and 0.1, respectively). However, higher percentages of undetected (38.3) or light spore loads (58.4) were found in females than in males (34.04 and 56.53, respectively).

Escherichia coli O157:H7 Outbreak at a Summer Camp—Virginia, 1994

On August 8, 1994, the Virginia Department of Health was notified that several campers and counselors at a summer camp had developed bloody diarrhea. The outbreak began during the July 17-30 session at a rural camp where activities included frequent overnight trips at which meals were cooked over a campfire. This report summarizes the findings from the investigation, which confirmed E. coli O157:H7 as the causative agent.(ABSTRACT TRUNCATED AT 250 WORDS)

Xerophthalmia clinics in rural eye camps

Even though the primary prevention of many eye diseases can be effectively incorporated into the existing pattern of rural eye camps, efforts in this direction are restrained and insubstantial. We describe our technique and experience in the prevention of xerophthalmia by organising a distinct entity called a xerophthalmia clinic in our eye camps. The clinic consists of an Ophthalmologist or an Ophthalmic assistant who will exclusively examine children who come to the eye camp. This is perhaps, the first report on rural xerophthalmia clinics, in ophthalmic literature. Over a seven year period from 1984 to 1990 we have conducted 71 xerophthalmia clinics amongst the ninty eye camps organised. A total of 11,370 children were examined in the xerophthalmia clinic out of which 18.9% were afflicted with the disease. Therapeutic doses of Vitamin A were administered on the spot to the afflicted and prophylactic doses were administered to the rest. Intensive health education efforts are made through clinics to effectuate change in dietry habits towards consumption of locally grown DGLV (Dark Green Leafy Vegetables) like Anthenum, chenopodium and Amaranthus. A bipronged offensive consisting of mega-dosing and health education is, for the present and the foreseeable future, the best strategy to combat xerophthalmia in this desert region. A year by year breakdown of prevalence rates in the present study shows that in years of severe drought the prevalence of xerophthalmia increases three fold over the non-drought or mild drought years, thereby demonstrating that drought is a substantial risk factor in developing countries leading to vitamin A deficiency and xerophthalmia.

Gender, Urban–Rural–Camp, and Regional Differences Among Self-Esteem Scores of Palestinian Children

(1992). Gender, Urban–Rural–Camp, and Regional Differences Among Self-Esteem Scores of Palestinian Children. The Journal of Psychology: Vol. 126, No. 2, pp. 207-209.

Laparoscopic Sterilisation in Camps in Rural India

Since 1973 laparoscopic sterilization under local anesthesia has been available as a day case procedure at preplanned camps to rural women in India. This study attempted to evaluate the safety and feasibility of this approach through analysis of the records of the 9066 women who were sterilized at camps between January 1 1973 and June 30 1983. During this period the mean age of sterilization acceptors gradually decreased from 33.4 years to 27.4 years and mean parity dropped from 4.4 to 3.2. 93.2% of cases involved interval sterilization. There has been a trend away from tubal diathermy and toward greater use of rings and clips. The time from injection of the local anesthetic to completion of surgeryu averaged 14 minutes. No deaths or injuries to a major vessel occurred in this series. Surgical difficulties were encountered in 7.9% of subjects and laparotomy was required in .5%. The overall complication rate was 5.3% which is comparable to that observed in other series and commendable considering the rather inadequate camp facilities. Perforation of the uterus was the most frequent complication (1.2%). There were 5 pregnancies in this series all occurring within 1 yearof the procedure. The Falope ring had been used in 4 of these cases. No ectopic pregnancy was reported. The failure rate in this series was .60/100 woman-years. It is concluded laparoscopic sterilization in rural camps has been an acceptable and useful contribution to fertility control in the developing world. The authors consider this approach to be cheaper and more effective than reversible methods.

A general assessment of the environmental impact of refugees in Somalia with attention to the refugee agricultural programme

This paper attempts to examine the broad features of Somalia's harsh physical environment into which several hundreds of thousands of refugees, with mainly a nomadic or semi-nomadic life style and culture, dramatically descended six years ago. The thirty-six rural camps in which at least half of them live are described as is the refugee agricultural programme which is training several thousand families so that they may be "self-supporting." The four regions where the camps are located are each briefly summarized in terms of their soils, their climates, their natural vegetation, and the type of agriculture which the refugee farmers practice. A more detailed analysis is then given on the following critical environmental concerns: Vegetation and erosion on refugee farms, the growing problem of refugee livestock, the destruction of trees, and irrigation practices and salinity on refugee farms. The paper concludes with an argument to preserve Somalia's environment from careless and destructive exploitation, which is leading towards desertification, and calls for an in-depth study of the situation.

Imported filariasis in Pakistan

Night blood surveys for filariasis were carried out in two camps of repatriates from Bangladesh. The sample consisted of 1,101 Biharis above one year of age of whom 9·0% were found infected with Wuchereria bancrofti. The infection rate was significantly higher in males (10·2%) than in females (6·7%). Of the three mosquito species ( Anopheles stephensi, Culex pipiens fatigans and C. tritaeniorhynchus) collected in and around the camps, 4·1 and 2·5% of C. p. fatigans were found positive for W. bancrofti from the urban and rural camps, respectively. Infective stage larvae were found in the head, thorax and abdomen of C. p. fatigans in the months of May, June and July, suggesting that transmission could have been occurring in May, the hottest and driest month of the year.

Contaminated roof-collected rainwater as a possible cause of an outbreak of salmonellosis.

Roof-collected rainwater is a common water source in subtropical regions and has not been associated with human illness. In Trinidad, the West Indies, a church group, attending a rural camp, developed gastrointestinal illness, caused by Salmonella arechevalata. This rare serotype was isolated from stool specimens of campers, foods eaten at the camp, and a water tap, which was supplied by a storage tank of roof-collected rainwater. The surface of the roof, used as water catchment, was covered with bird faeces. It is postulated that rainwater, falling on the roof, washed off animal excrement which contained S. arechevalata and led to the outbreak of salmonellosis through camper ingestion of contaminated food and water.

Problems in the rehabilitation of the physically disabled in rural areas of India/1

Some 550 disabled patients were examined by a rehabilitation team by organizing a rural camp at Meerut. This rehabilitation team consisted of orthopaedic surgeons, doctors, a prosthetist, an orthotist, a medical social worker and other skilled workers. Out of the 550 disabled patients, 271 were amputees, and 184 cases had poliomyelitis. Males predominated by 4:1. Disability was most common up to the age of 30 years. Of the 271 amputees, 146 were of upper limb while 125 were of lower limb. Only 86 lower limb amputees were suitable for fitting a prosthesis, while 39 others needed surgery of physiotherapy. Only 87 of the 184 polio cases were found suitable for appliances, the remainder needing surgery or physiotherapy. Ways of reducing the numbers of disabled were examined and improved rehabilitation procedures suggested.

Feeling the Pinch: Kenya, Al-Shabaab, and East Africa’s Refugee Crisis

Kenya currently hosts over four hundred thousand refugees.In the last two decades it has turned towards a policy of containment in an attempt to confine refugees to its two rural camps, Kakuma and Dadaab. Kenya’s tolerance forthe ongoing refugee problem which peaked in the 1990s due to major conflicts in the region is waning and concurrently issues of national security are growing. The Somali armed faction, Al-Shabaab, has been reportedly infiltrating Kenya’s Somali refugee community. Recently, there have been reports that the government of Kenya has been covertly recruiting Somali refugees to return to Somalia to fight against Al-Shabaab. The use of refugees by Kenya to counter the threat of Al-Shabaab demonstrates a new perception of outside threats and suggests that Kenya is now willing to sacrifice ideals of humanitarianism to secure its border with Somalia. The border remains officially closed but thousands of refugees fleeing the violence in Somalia continue to pour into Kenya.&#x0D; To understand why Kenya is taking such a hardened stance towards refugee populations, it is important to comprehend Kenya’s strategic importance in East Africa.Secondly, in the complex relationship between internal factors and international pressures, one can discern the friction between adhering to the human rights of refugees whilst remaining a global player in the war on terror. A comparison of Kenya’s past treatment of refugees to its present position suggests that the nation’s most significant priority is national security, and not remaining a haven for humanitarianism.

THE IMMUNITY OF CITY-BRED RECRUITS

The existence of large bodies of men mobilized in various army camps where they were subject to systematized medical supervision during the past two years has furnished unique opportunities for gathering statistics on an unprecedented scale with respect to the incidence of certain forms of disease. Frequent medical inspection of thousands of men is an uncommon experience, at least on the scale which the preparation for war made possible in the United States. The conclusions afforded by the wealth of data obtainable from such sources are likely to be far more tenable than those drawn from comparatively few cases, however carefully they may be studied. According to figures recently compiled by Love and Davenport¹in the Section of Medical Records of the Medical Department of the U. S. Army, it appears that the prevailingly rural camps had at least 25 per cent. more cases of influenza, 10 per cent.