Surgery for children in low-income countries affected by humanitarian emergencies from 2008 to 2014: The Médecins Sans Frontières Operations Centre Brussels experience

Abstract

Purpose Pediatric surgical care is deficient in developing countries disrupted by crisis. We aimed to describe pediatric surgical care at Médecins Sans Frontières-Brussels (MSF-OCB) projects to inform resource allocation and define the pediatric-specific skillset necessary for humanitarian surgical teams. Methods Procedures performed by MSF-OCB from July 2008 to December 2014 were reviewed. Project characteristics, patient demographics and clinical data were described. Multivariable logistic regression was performed to determine predictors of perioperative death. Results Of 109,828 procedures, 26,284 were performed for 24,576 children (22% of all procedures). The most common pediatric operative indication was trauma (13,984; 57%). Nine percent of all surgical indications were due to violence (e.g., land mines, firearms, gender-based violence, etc.). The majority of procedures (19,582; 75%) were general surgical, followed by orthopedic (4350; 17%), and obstetric/gynecologic/urologic (2135; 8%). Perioperative death was low (42; 0.17%); independent predictors of death included age <1 year, use of general anesthesia with a definitive airway, and operation during conflict. Conclusion Surgical care for children comprised nearly a quarter of all procedures performed by MSF-OCB between 2008 and 2014. Attention to trauma surgery and infant perioperative care is particularly needed. These findings are important when resourcing projects and training surgical staff for humanitarian missions.

An in-country humanitarian neurosurgical services as model for low-and-middle-income countries: The case of Cote d’ Ivoire

“…These teams may be affiliated with international organizations such as the International Committee of the Red Cross (ICRC), Médecins Sans Frontières (MSF), or local healthcare providers. Humanitarian surgery plays a critical role in saving lives and restoring health to vulnerable individuals such as women and children ( Flynn-O’Brien et al., 2016 ).…”

Characterization of Humanitarian Trauma Care by US Military Facilities During Combat Operations in Afghanistan and Iraq

“…Their data shows a wide range of nontrauma pathologies (eg, obstetrical and gynecologic, tropical and infectious diseases, vascular, benign and malignant tumors, obstructions, congenital disorders, and nontraumatic bleeding). [21][22][23][24] MSF data also likely underestimates the total needs of the population due to the absence of prehospital care or emergency transportation such that patients suffering severe trauma or critical illness may not survive long enough to reach care. The observed similarities in this report for injury location, severity, mechanism, and non-OR and OR procedures between the civilian and NNCP cohorts are pronounced.…”

“…Médecins Sans Frontières (MSF), an independent humanitarian actor, has previously characterized the surgical needs of civilian populations in conflict zones. Their data shows a wide range of nontrauma pathologies (eg, obstetrical and gynecologic, tropical and infectious diseases, vascular, benign and malignant tumors, obstructions, congenital disorders, and nontraumatic bleeding) 21–24. MSF data also likely underestimates the total needs of the population due to the absence of prehospital care or emergency transportation such that patients suffering severe trauma or critical illness may not survive long enough to reach care.…”

Improving standard of pediatric surgical care in a low resource setting: the key role of academic partnership

“…There is a lively debate about the impact of these initiatives on immediate local health needs and the related investments in terms of capacity building of local providers. Disaster and crisis relief programs focus on the temporary deployment of highly equipped teams, but education is not within their scope [25]. Short term, selfcontained, missions from qualified international groups and associations often focus on selected pathologies (eye, cleft lip, congenital heart diseases).…”