Global surgery in a postconflict setting - 5-year results of implementation in the Russian North Caucasus

Abstract

BackgroundCollaborations for global surgery face many challenges to achieve fair and safe patient care and to build sustainable capacity. The 2004 terrorist attack on a school in Beslan in North Ossetia in the Russian North Caucasus left many victims with complex otologic barotrauma. In response, we implemented a global surgery partnership between the Vladikavkaz Children's Hospital, international surgical teams, the North Ossetian Health Ministry, and civil society organizations. This study's aim was to describe the implementation and 5-year results of capacity building for complex surgery in a postconflict, mid-income setting.DesignWe conducted an observational study at the Children's Hospital in Vladikavkaz in the autonomous Republic of North Ossetia-Alania, part of the Russian Federation. We assessed the outcomes of 15 initial patients who received otologic surgeries for complex barotrauma resulting from the Beslan terrorism attack and for other indications, and report the incidence of intra- and postoperative complications.ResultsPatients were treated for trauma related to terrorism (53%) and for indications not related to violence (47%). None of the patients developed peri- or postoperative complications. Three patients (two victims of terrorism) who underwent repair of tympanic perforations presented with re-perforations. Four junior and senior surgeons were trained on-site and in Germany to perform and teach similar procedures autonomously.ConclusionsIn mid-income, postconflict settings, complex surgery can be safely implemented and achieve patient outcomes comparable to global standards. Capacity building can build on existing resources, such as operation room management, nursing, and anesthesia services. In postconflict environments, substantial surgical burden is not directly attributable to conflict-related injury and disease, but to health systems weakened by conflicts. Extending training and safe surgical care to include specialized interventions such as microsurgery are integral components to strengthen local capacity and ownership. Our experience identified strategies for fair patient selection and might provide a model for potentially sustainable surgical system building in postconflict environments.

Outcomes of Short‐Term Surgical Trips in Otolaryngology—Head and Neck Surgery: A Scoping Review

“…The publications covered STSTs from 1989 to 2021, with one study from the 1980s, 18 five from the 1990s, 19–23 15 from the 2000s, 24,25,34–38,26–33 and 26 from 2010 to 2021 39,40,49–58,41,59–61,42–48 . The average study period was 4.14 years with a range of one week to 25 years.…”

“…Thirteen of our 47 articles mentioned education as the primary aim of the study, with two (10.6%) focusing solely on education 13,28,36,40,51–53,57,59,61 . Although many STSTs likely included HIC resident learners, nine (19%) mentioned resident involvement in LMIC work.…”

“…The publications covered STSTs from 1989 to 2021, with one study from the 1980s, 18 five from the 1990s, [19][20][21][22][23] 15 from the 2000s, 24,25,[34][35][36][37][38][26][27][28][29][30][31][32][33] and 26 from 2010 to 2021. 39,40,[49][50][51][52][53][54][55][56][57][58]41,[59][60][61][42][43][44][45][46][47][48] The average study period was 4.14 years with a range of one week to 25 years.…”

“…Thirteen of our 47 articles mentioned education as the primary aim of the study, with two (10.6%) focusing solely on education. 13,28,36,40,[51][52][53]57,59,61 Although many STSTs likely included HIC resident learners, nine (19%) mentioned resident involvement in LMIC work. None of the studies mentioned predetermined roles or responsibilities for their residents nor tracked their educational/surgical outcomes.…”