Surgical skills needed for humanitarian missions in resource-limited settings

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Surgical skills needed for humanitarian missions
in resource-limited settings
A four year audit of MSF data from 21 countries

• Evan G. Wong, Miguel Trelles, Lynette Dominguez,
  Shailvi Gupta, Gilbert Burnham, Adam L.Kushner

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Background

• Surgeons from high-income countries are
  interested in global surgery and humanitarian
  missions.

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Background

• Knowledge of the surgical skills needed to
  respond to humanitarian missions is essential to
• Guide recruitment.
• Build capacity of surgeons.
• Plan for interventions.

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MSF and surgery

• MSF is providing surgical care for more than 40
  years and between 2008 and 2013, 46 projects in
  23 countries performed surgical activities.
• A global analysis of the kind of needed surgery
  was not performed before with data available in
  MSF.

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In Sierra Leone, 25 of households reported a
surgical condition needing attention, and 25
deaths of the households member in the previous
year might have been averted by timely surgical
care.
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Objectives

• To review the surgical procedures at MSF-OCB
  facilities between 2008 and 2012 in order to
  ascertain
• the commonly performed operations.
• the necessary surgical skills.

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Methods

• Study design retrospective analysis of
  standardized surgical databases.
• Study sites OCB health facilities in 21
  countries.
• Study period June 2008 December 2012.
• Study population all patients who underwent
  surgery.

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Indications for surgery

• Trauma
• Violence
• Accident
• Obstetrical
• Foetal-Maternal
• Post partum complications

• Non-trauma
• Infection
• Ischemia
• Tumor
• Haemorrhage
• Other

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Types of surgical procedures

• Minor
• Wound surgery
• Visceral
• Orthopaedics
• Gynaecology, obstetrics urology
• Specialized surgery

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Patient characteristics
n ()
Total no of patients 83,911
Average age (years) 28
Children lt 1 year 1 5 years 845 (1) 4,098 (5)
Females 48,575 (58)
Total surgical procedures 93,385
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Indications for surgery (n83,911)
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Types of surgical procedures (n93,385)
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Commonly performed obstetric, gynaecologic, and
urologic procedures
Procedure n ()
Caesarean section 24,182 (65)
Instrumental delivery, episiotomy or perineal laceration 3,002 (9)
Curettage 2,462 (7)
Hysterectomy, oophorectomy, pelvic tumorectomy 2,228 (6)
Obstetrical fistula 1,585 (5)
Urological procedures 1,354 (4)
Ectopic pregnancy 663 (2)
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Commonly performed visceral surgical procedures
Procedure n ()
Hernia, other anogenital 9,873 (47)
Bowel resection 4,949 (23)
Minor tumour resection 3,316 (16)
Exploratory laparotomy 2,498 (12)
Repair or resection of spleen, liver, kidney 570 (3)
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Commonly performed orthopaedic procedures
Procedure n ()
Fracture reduction 2, 945 (42)
External fixation 974 (14)
Limb amputation 841 (12)
Internal fixation 803 (12)
Other (corrective procedure) 624 (9)
Internal fixation removal 464 (7)
Others 281 (4)
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Conclusions

• Over four years and in 21 countries
• MSF-OCB performed about 100,000 surgical
  procedures of wide diversity.
• The most common surgical procedures included
  Caesarean sections, hernia, bowel resection, and
  fracture reduction.
• One in fifteen patients who underwent surgery
  were under 5 years.

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Conclusions

• All surgeons interested in humanitarian missions
  must have the surgical skills to manage the most
  common surgical procedures but major human
  resource gaps !
• Specific anaesthesia and surgical skills are
  needed to cater to paediatric needs remains
  unaddressed !
• MSF should advocate and directly invest in
  specific training programmes and capacity
  building to meet our humanitarian surgical needs.

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Many thanks
To the surgical teams on the ground, the Medical
Department, LUXOR and the patients and
beneficiaries of MSF