Evaluation of a surgical service in the chronic phase of a refugee camp: an example from the Thai-Myanmar border

Abstract

BackgroundPublished literature on surgical care in refugees tends to focus on the acute (‘emergent’) phase of crisis situations. Here we posit that there is a substantial burden of non-acute morbidity amenable to surgical intervention among refugees in the ‘chronic’ phase of crisis situations. We describe surgery for non-acute conditions undertaken at Mae La Refugee Camp, Thailand over a two year period.MethodsSurgery was performed by a general surgeon in a dedicated room of Mae La Refugee Camp over May 2005 to April 2007 with minimal instruments and staff. We obtained the equivalent costs for these procedures if they were done at the local Thai District General Hospital. We also acquired the list (and costs) of acute surgical referrals to the District General Hospital over September 2006 to December 2007.Results855 operations were performed on 847 patients in Mae La Refugee Camp (60.1% sterilizations, 13.3% ‘general surgery’, 5.6% ‘gynaecological surgery’, 17.4% ‘mass excisions’, 3.5% ‘other’). These procedures were worth 2,207,500 THB (75,683.33 USD) at costs quoted by the District General Hospital. Total cost encountered for these operations (including staff costs, consumables, anaesthesia and capital costs such as construction) equaled 1,280,000 THB (42,666 USD). Pertaining to acute surgical referrals to District General hospital: we estimate that 356,411.96 THB (11,880.40 USD) worth of operations over 14 months were potentially preventable if these cases had been operated at an earlier, non-acute state in Mae La Refugee Camp.ConclusionsA considerable burden of non-acute surgical morbidity exists in ‘chronic’ refugee situations. An in-house general surgical service is found to be cost-effective in relieving some of this burden and should be considered by policy makers as a viable intervention.

Empirical lessons regarding contraception in a protracted refugee setting: A descriptive study from Maela camp on the Thai-Myanmar border 1996 – 2015

“…The stark increase in the uptake of female sterilization beginning in 2005 ( Fig 3 ) coincides with employment of a surgeon by SMRU (2005–2007) who could provide tubal ligation immediately post-partum. Uptake was high because the doctor lived in the camp full time and could fluently speak the local camp languages (both S’gaw Karen and Burmese) allowing adequate explanation and strong doctor-patient relationships [ 39 ]. Local misconceptions and fears surrounding operations could be addressed directly rather than through an interpreter [ 40 ].…”

“…For example, low literacy amongst the female population [ 46 ] required resources to be channeled toward training staff who speak local languages (S’gaw Karen, Pwo Karen and Burmese) in order to provide verbal or pictorial information and counseling to women. Qualified personnel (such as the previously mentioned surgeon) that could provide permanent contraception in a socio-culturally appropriate manner also required funds [ 39 ]. Free provision of contraceptives in the refugee camp probably contributed positively to uptake but data on the impact of patient donations was poor.…”

Family planning knowledge, attitudes and practices in refugee and migrant pregnant and post-partum women on the Thailand-Myanmar border – a mixed methods study

“…There is a paucity of information on the use of long-acting reversible contraceptives (LARC) in the Thailand-Myanmar border area despite the protracted nature of the camps, but a 2013 study involving in-depth interviews of 31 intrauterine-device (IUD) users, 21 of whom were from MLA Refugee camp, portrayed positive experiences [ 11 ]. An older report from 2005–07 evaluating surgical services (2005–07) in the same camp confirmed 477 sterilizations were provided for women with a median age of 33 years and a median parity of 5 which at the time was indicative of a significant unmet need for the procedure [ 12 ]. Current data on migrants from the area are not collated into any single data collection point with a range of community based organizations and non-government organizations providing services.…”

Conflict and Health: seven years of advancing science in humanitarian crises

“…Some of the rare reports on substance abuse including tobacco and alcohol among conflict-affected populations in Kenya, Liberia, Northern Uganda, Iran, Pakistan, and Thailand are found in the journal [ 55 - 58 ]. Similarly, four observational studies of surgery and occupational health following trauma have set the stage for further investigation of these important topics [ 21 , 59 - 61 ].…”