The provision of surgery within humanitarian crises is complex, requiring coordination and cooperation among all stakeholders. During the 2011 Humanitarian Action Summit best practice guidelines were proposed to provide greater accountability and standardization in surgical humanitarian relief efforts. Surgical humanitarian relief planning should occur early and include team selection and preparation, appropriate disaster-specific anticipatory planning, needs assessment, and an awareness of local resources and limitations of cross-cultural project management. Accurate medical record keeping and timely follow-up is important for a transient surgical population. Integration with local health systems is essential and will help facilitate longer term surgical health system strengthening. BackgroundThe international humanitarian community often relies on best practice guidelines to ensure appropriate patient care in the field where circumstances are less than ideal. These guidelines inform and orient organizations and individuals who are providing care following major disasters, conflict and other humanitarian emergencies. The purpose of developing guidelines in this context is to encourage accountability and quality in the humanitarian response across the many levels of humanitarian agencies involved in relief efforts. Such guidelines help prepare responders in these settings as the challenges and dilemmas are often quite different than those encountered at home. The overarching goal is to effectively serve the population at risk while respecting their fundamental right to life with dignity. This goal reflects the philosophy underlying the Sphere Project's Humanitarian Charter, which acts as a general statement of principles that should govern all aspects of humanitarian activities. 1 Professionalism has been evolving in the humanitarian community for more than a decade. Recent publications support not only humanitarian professionalism, but also a role for formal preparation and education through the establishment of core competencies. 2,3 The 2010 Haitian earthquake uncovered deficiencies in and recommendations for best practices, standards, accountability and accreditation that must be addressed in a timely and accurate manner. [4][5][6] The surgical community seeks to support and conform to those
Limb amputations are frequently performed as a result of trauma inflicted during conflict or disasters. As demonstrated during the 2010 earthquake in Haiti, coordinating care of these patients in austere settings is complex. During the 2011 Humanitarian Action Summit, consensus statements were developed for international organizations providing care to limb amputation patients during disasters or humanitarian emergencies. Expanded planning is needed for a multidisciplinary surgical care team, inclusive of surgeons, anesthesiologists, rehabilitation specialists and mental health professionals. Surgical providers should approach amputation using an operative technique that optimizes limb length and prosthetic fitting. Appropriate anesthesia care involves both peri-operative and long-term pain control. Rehabilitation specialists must be involved early in treatment, ideally before amputation, and should educate the surgical team in prosthetic considerations. Mental health specialists must be included to help the patient with community reintegration. A key step in developing local health systems the establishment of surgical outcomes monitoring. Such monitoring can optimizepatient follow-up and foster professional accountability for the treatment of amputation patients in disaster settings and humanitarian emergencies.
Technological or manmade Complex b Sudden-onset Tropical storm/tornado Earthquake/Tsunami Landslide Volcano Industrial accident Road/Air-traffic accident Terrorist attack Conflict Epidemics Slow-onset Drought Famine Air and water pollution Political or refugee unrest Conflict Poverty a The World Risk Index rates countries according to the impact risk from an extreme natural phenomena (slow or fast onset). The index is based on each country's vulnerability, exposure, coping and adapting capacities (Institute for Environment and Human Securiy 2014). Other indication risk, specific of geophysical hazards are the delineations of disaster-prone areas, such as the Ring of Fire and the Alpide belt. This index emphasizes the "unnatural" social, economic and political causes behind the denominated "natural disasters" above the extreme natural phenomena. b The term "complex emergencies" is usually classified under Technological/man-made. It was purposely separated here to highlight that complex emergencies are caused by interrelated natural and technological/man-made emergencies. Potential role of design When applied to healthcare, effective design thinking can deliver products, services, processes and environments that are intuitive, simple to understand, simple to use, convenient, comfortable and consequently less likely to lead to accidental misuse, error and accidents (Clarkson et al., 2003, p. 9).
There is a clear increase in the frequency, complexity and length of humanitarian crises. This trend has driven the attention of donor governments to the private sector in search of more cost effective solutions for the provision of aid. While the challenges that emerge when humanitarian values meet business interests in the humanitarian market have been explored, little is known about the perspective of enterprises from the private sector and how they approach the humanitarian aid context.This study aimed at exploring how characteristics, specific to humanitarian aid affect product development activities. In fact, mismatches between business and humanitarian systems go beyond the creation of logistical systems and extend to product development activities and adjacent servicing. We consider the findings a contribution to the definition of priorities for the future collaborative development of products and services by private sector and humanitarian aid stakeholders.
BackgroundThe lack of adequate information about fever in low-resource settings, its unreliable self-assessment, and poor diagnostic practices may result in delayed care and under-or-overdiagnosis of diseases such as malaria. The mismatches of existing fever thermometers in the context of use imply that the diagnostic tools and connected services need to be studied further to address the challenges of fever-related illnesses and their diagnostics.ObjectiveThis study aims to inform a product-service system approach to design a reliable and accessible fever thermometer and connected services, as well as contribute to the identification of innovative opportunities to improve health care in low-resource settings.MethodsTo determine what factors impede febrile people seeking health care to access adequate fever diagnostics, a literature search was conducted in Google Scholar and PubMed with relevant keywords. Next, these factors were combined with a patient journey model to design a new product-service system for fever diagnostics in low-resource settings.ResultsIn total, 37 articles were reviewed. The five As framework was used to categorize the identified barriers. The results indicate that there is a poor distribution of reliable fever diagnostic practices among remote communities. This paper speaks to the global public health and design communities. Three complementary considerations are discussed that support the idea of a more holistic approach to the design of fever diagnostics: (1) understanding of the fever diagnostics patient journey, (2) identifying user groups of the thermometers in a specific health care system, and (3) assessing different needs and interests of the different users.ConclusionsAccess to basic, primary health care may be enhanced with better information and technology design made through the involvement of system users.
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