The 7th French Airborne Forward Surgical Team experience of surgical support to the population of a low-income country: a prospective study on 341 patients with short-term follow-up

2018 ◽  
Vol 164 (6) ◽  
pp. 423-427 ◽  
Author(s):  
Yvain Goudard ◽  
C Butin ◽  
C Carfantan ◽  
G Pauleau ◽  
E Soucanye de Landevoisin ◽  
...  
Keyword(s):  
Low Income ◽  
Elective Surgery ◽  
Surgical Care ◽  
Host Population ◽  
Surgical Team ◽  
Low Income Country ◽  
Operative Outcomes ◽  
Surgical Teams ◽  
A Prospective Study

BackgroundThe 7th Airborne Forward Surgical Team (FST) has deployed to Chad in 2015 and 2016, in support of French military forces. Humanitarian surgical care is known to represent a significant part of the surgical activity in such missions, but to date limited data have been published on the subject.MethodsAll surgical patients from a civilian host population treated by the FST during these missions have been prospectively included. Indications, operative outcomes and postoperative outcomes were evaluated.ResultsDuring this period, the FST operated on 358 patients. Humanitarian surgical care represented 95% of the activity. Most patients (92.7%) were operated for elective surgery. Emergencies and infectious diseases represented, respectively, 7.3% and 9.1% of cases. The mean length of stay (LOS) was three days (2–4), and the median follow-up was 30 days (22–34). Mortality rate was 0.6% and morbidity was 5.6%. Parietal surgery had no significant complication and had shorter LOS (p<0.001). Emergent surgeries were more complicated (p<0.01) and required more reoperations (p<0.05). Surgical infectious cases had longer LOS (p<0.01).ConclusionsHumanitarian surgical care can be provided without compromising the primary mission of the medical forces. Close surveillance and follow-up allowed favourable outcomes with low morbidity and mortality rates. Humanitarian care is responsible for a considerable portion of the workload in such deployed surgical teams. Accounting for humanitarian care is essential in the planning and training for such future medical operations.

A model for neurosurgical humanitarian aid based on 12 years of medical trips to South and Central America

2009 ◽  
Vol 4 (1) ◽  
pp. 4-9 ◽  
Author(s):  
Rajshri Mainthia ◽  
Gary W. Tye ◽  
Jay Shapiro ◽  
Egon M. R. Doppenberg ◽  
John D. Ward
Keyword(s):  
Surgical Care ◽  
Tethered Cord ◽  
Public Health Research ◽  
Surgical Team ◽  
Host Countries ◽  
Healthcare Needs ◽  
Virginia Commonwealth University ◽  
Surgical Teams

The pediatric neurosurgical mission trips led by physicians at Virginia Commonwealth University (VCU) Health Systems began in 1996 with the formation of Medical Outreach to Children, founded by 1 of the authors (J.D.W.) after a visit to Guatemala. Since then, 19 surgical trips to 4 different countries in Central and South America have been coordinated from 1996 to 2008. This humanitarian work serves a number of purposes. First and foremost, it provides children with access to surgical care that they would otherwise not receive, thereby significantly improving their quality of life. Second, the visiting surgical team participates in the education of local physicians, parents, and caregivers to help improve the healthcare provided to the children. Last, the team works to promote sustainable global health solutions in the countries it travels to by generating a forum for clinical and public health research discourse. Thus far, a total of 414 children have undergone 463 operations, including 154 initial shunt surgeries, 110 myelomeningocele repairs, 39 lipoma resections, 33 tethered cord releases, 18 shunt revisions, 16 encephalocele repairs, 9 lipomyelomeningocele repairs, and 7 diastematomyelia repairs. The complication rate has been 5–8%, and the team has obtained reliable follow-up in ~ 77% of patients. A correlation was found between an increase in the number of trained neurosurgeons in the host countries and a decrease in the average age of patients treated by the visiting surgical team over time. It is also hypothesized that a decrease in the percentage of myelomeningocele repairs performed by the surgical team (as a fraction of total cases between 1996 and 2006) correlates to an increase in the number of local neurosurgeons able to treat common neural tube defects in patients of younger ages. Such analysis can be used by visiting surgical teams to assess the changing healthcare needs in a particular host country.

scholarly journals Presentation, surgery and 1-year outcomes of childhood cataract surgery in Tanzania

2020 ◽  
pp. bjophthalmol-2020-316042
Author(s):  
Furahini Godfrey Mndeme ◽  
Blandina Theophyl Mmbaga ◽  
Mchikirwa Msina ◽  
Judith Mwende ◽  
Sonia J Vaitha ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Low Income ◽  
Visual Outcome ◽  
Low Income Countries ◽  
Similar Proportion ◽  
Poor Visual Outcome ◽  
A Prospective Study ◽  
Good Vision ◽  
Childhood Cataract

BackgroundRecent reports have suggested a significant change in the causes of blindness in children in low-income countries cataract becoming the leading cause. We aimed to investigate the presentations and surgical outcomes in children with cataract operated at different ages in Tanzania.MethodsWe conducted a prospective study of 228 children aged ≤192 months at three tertiary centres, 177 with bilateral cataracts and prospectively followed them for 1-year postsurgery. We collected demographic, surgical, preoperative and postoperative clinical characteristics using the standard childhood cataract surgical assessment questionnaire. Families were encouraged to return for follow-up by phone with travel reimbursement where necessary.ResultsPreoperatively, 76% bilateral children were blind in the better eye. 86% of children were followed up at 1 year and 54% bilateral children achieved visual acuity of 0.48 logMAR or better in the better eye and 5% were blind. 33% of unilateral children achieved visual acuity of 0.48 logMAR or better and 17% were blind. Preoperative blindness (adjusted OR (AOR) 14.65; 95% CI 2.21 to 97.20), preoperative nystagmus/strabismus (AOR 9.22; 95% CI 2.66 to 31.97) and aphakia (AOR, 5.32; 95% CI 1.05 to 26.97) predicted poor visual outcome in bilateral cases. 9% of 342 refracted eyes had initial postoperative cylinder of 1.5 D or more, as did a similar proportion (11%) of 315 eyes refracted 1 year after surgery. Acute fibrinous uveitis occurred in 41 (12%) eyes.ConclusionThree-quarters of children were blind preoperatively whereas over half had good vision 1-year postoperatively. Preoperative blindness, nystagmus/strabismus and aphakia predicted poor visual outcome, suggesting that cataract density determines density of amblyopia.

scholarly journals Lasting impact: a qualitative study of perspectives on surgery by adult recipients of free mission-based surgical care in Benin

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e028235
Author(s):  
Kristin L Close ◽  
Floor T.E. Christie-de Jong
Keyword(s):  
Elective Surgery ◽  
Surgical Care ◽  
Interview Data ◽  
Quality Initiatives ◽  
Semistructured Interviews ◽  
Patient Database ◽  
Positive Experiences ◽  
Surgical Teams ◽  
Age Range ◽  
Surgical System

ObjectivesThis study aimed to explore how adult patients who received free mission-based elective surgery experienced surgery and its outcomes, in order to provide recommendations for improved service delivery, measurement of impact and future quality initiatives for the humanitarian organisation Mercy Ships and other mission-based surgical platforms.SettingData were collected in June 2017 in Cotonou, Benin, where the participants had previously received free mission-based elective surgery aboard the Africa Mercy, a non-governmental hospital ship.ParticipantsSixteen patients (seven male, nine female, age range 22–71, mean age 43.25) who had previously received surgical care aboard the Africa Mercy hospital ship between September 2016 and May 2017 participated in the study.MethodsUsing a qualitative design, 16 individual semistructured interviews were conducted with the assistance of two interpreters. Participants were recruited using purposive sampling from the Mercy Ships patient database. Interview data were coded and organised into themes and subthemes using thematic content analysis in an interpretivist approach.FindingsAnalysis of interview data revealed three main themes: barriers to surgery, experiences with Mercy Ships and changes in perspectives of surgery after their experiences. Key findings included barriers to local surgical provision such as cost, a noteworthy amount of fear and distrust of local surgical teams, exceptional positive experiences with the care at Mercy Ships, and impactful surgery, resulting in high levels of trust in foreign surgical teams.ConclusionsWhile foreign surgical teams are meeting an immediate need for surgical care, the potential enduring legacy is one of trusting only foreigners for surgery. Patients are a critical component to a well-functioning surgical system, and mission-based surgical providers must formulate strategies to mitigate this legacy while strengthening the local surgical system.

Assessment of Physical Growth and Motor Development of Preterm Babies Based on Developmental Assessment Scale For Indian Infants (DASII)

2020 ◽  
Vol 34 (1-2) ◽  
pp. 11-14
Author(s):  
E. S. Akshara ◽  
Poorva Gohiya ◽  
Jyotsna Shrivastav
Keyword(s):  
Low Income ◽  
Motor Development ◽  
Head Circumference ◽  
Preterm Births ◽  
Physical Growth ◽  
Low Income Countries ◽  
Developmental Assessment ◽  
Preterm Babies ◽  
A Prospective Study

Background: The rate of preterm births ranges from 5% to 18% across 184 countries. Almost 12% births are preterm in low-income countries compared with 9% in high-income countries. Almost 1 million children die each year due to complications of preterm birth. Of those who survive, suffer from face developmental disabilities and undernourishment. Aims and Objectives: To assess the physical growth and its relation with the development of babies taken into study. Materials and Methods: A prospective study was conducted on 159 preterm babies of gestational age 32 to 36 weeks. All the treatments given during hospitalization, course of stay, and special procedures done were recorded. Baby’s weight, length, and head circumference were again noted at the time of discharge. Anthropometric measurements were done at every follow-up visit. Neurodevelopmental screening was performed at each follow-up. At the end of 12 months the risk factors contributing to the delayed development were analyzed. Results: 95.5% infants born as preterm had a length of more than 58 cm (– 3SD) and weight 5.6 kg at 1 year and 50% infants had a head circumference of more than 39 cm (– 3SD). Conclusion: Preterm babies when followed-up for 1 year of age did attain appropriate weight and length of their corrected age. Microcephaly was observed in 30% of babies at 1 year of age, of which 15.7% were found with developmental delay.

scholarly journals Adding the Capacity for an Intensive Care Unit Dedicated to COVID 19, Preserving the Operational Capability of a French Golden Hour Offset Surgical Team in Sahel

2020 ◽  
Author(s):  
Henri de Lesquen ◽  
Marie Bergez ◽  
Antoine Vuong ◽  
Alexandre Boufime-Jonqheere ◽  
Nicolas de l’Escalopier
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Large Scale ◽  
Damage Control ◽  
Surgical Care ◽  
Damage Control Surgery ◽  
Surgical Team ◽  
Golden Hour ◽  
Surgical Teams

Abstract Introduction In April 2020, the military medical planning needs to be recalibrated to support the COVID-19 crisis during a large-scale combat operation carried out by the French army in Sahel. Material and Methods Since 2019, proper positioning of Forward Surgical Teams (FSTs) has been imperative in peer-to-near-peer conflict and led to the development of a far-forward surgical asset: The Golden Hour Offset Surgical Team (GHOST). Dedicated to damage control surgery close to combat, GHOST made the FST aero-mobile again, with a light logistical footprint and a fast setting. On 19 and 25 March 2020, Niger and Mali confirmed their first COVID-19 cases, respectively. The pandemic was ongoing in Sahel, where 5,100 French soldiers were deployed in the Barkhane Operation. Results For the first time, the FST had to provide, continuously, both COVID critical care and surgical support to the ongoing operation in Liptako. Its deployment on a Main Operating Base had to be rethought on Niamey, to face the COVID crisis and support ongoing operations. This far-forward surgical asset, embedded with a doctrinal Role-1, sat up a 4-bed COVID intensive care unit while maintaining a casualty surgical care capacity. A COVID training package has been developed to prepare the FST for this innovative employment. This far-forward surgical asset was designed to support a COVID-19 intensive care unit before evacuation, preserving forward surgical capability for battalion combat teams. Conclusion Far-forward surgical assets like GHOST have demonstrated their mobility and effectiveness in a casualty care system and could be adapted as critical care facilities to respond to the COVID crisis in wartime.

scholarly journals Effective treatment of perinatal depression for women in debt and lacking financial empowerment in a low-income country

2012 ◽  
Vol 201 (6) ◽  
pp. 451-457 ◽  
Author(s):  
Atif Rahman ◽  
Siham Sikander ◽  
Abid Malik ◽  
Ikhlaque Ahmed ◽  
Barbara Tomenson ◽  
...  
Keyword(s):  
Low Income ◽  
Perinatal Depression ◽  
Controlled Trial ◽  
Secondary Analysis ◽  
Behavioural Therapy ◽  
Low Income Countries ◽  
Household Debt ◽  
Low Income Country ◽  
Interaction Terms

BackgroundPoverty may moderate the effect of treatment of depression in low-income countries.AimsTo assess poverty and lack of empowerment as moderators of a cognitive-behavioural therapy (CBT)-based intervention for perinatal depression in rural Pakistan.MethodUsing secondary analysis of data from a randomised controlled trial (trial registration: ISRCTN65316374) we identified predictors of depression at 1-year follow-up and moderators of the intervention (n=791).ResultsPredictors of follow-up depression included household debt, the participant not being empowered to manage household finance and the interaction terms for these variables with the trial arm. Effect sizes for women with and without household debt were 0.80 and 0.55 respectively. The effect size for women in debt and not empowered financially was 0.94 compared with 0.50 for women with neither of these factors.ConclusionsOur findings demonstrate the importance of household debt and lack of financial empowerment of women as important maintaining factors of depression in low-income countries and our locally developed intervention tackled these problems successfully.

scholarly journals Medical outcome and post-natal growth approach of premature infant in ambulatory follow-up in N’Djamena (Chad)

2021 ◽  
Vol 9 (1) ◽  
pp. 256-261
Author(s):  
Kanezouné Gongnet ◽  
Silé Souam Nguelé ◽  
Hikdjolbo Gonzabo
Keyword(s):  
Preterm Infants ◽  
Low Income ◽  
Respiratory Infections ◽  
Morbidity Rate ◽  
Average Weight ◽  
Average Height ◽  
Low Income Country ◽  
Mother And Child ◽  
Growth Approach

The survival of preterm infants depends on the health development level of each country and those who survive need a closer follow-up after the discharge. The objective of this study was to evaluate morbidity, mortality and post-natal growth of preterm infants in the first six-month of life in a low income country. This was a longitudinal study from May 2015 to June 2016 in the pediatrics department of the Mother and Child Teaching Hospital of N’Djamena. It involved all preterm infants hospitalized during six months of inclusion period and followed in this structure. The morbidity rate was 26.9% in the first month of follow-up. The more frequent pathologies were acute respiratory infections (37%), functional digestive troubles (33%) followed by anemia and malaria (15%). Eight infants (11.9%) had been hospitalized again with 3 deaths recorded (4.5%). The growth was regular but the measures were mostly less than -2 Z score. Average weight was 6165.6 g at 6 months; average height: 60.72 cm and average head circumference: 41.62 cm. Adjustment of cranial circumference was earliest with 53 and 87% of normal value at 3 and 6 months respectively. The improvement of care of preterm infants would need the development of perinatalogy and follow-up network.

Follow-Up Care for Pediatric Hearing Aid Users at an Audiology Clinic in Malawi

2020 ◽  
Vol 5 (6) ◽  
pp. 1809-1812
Author(s):  
Helen Brough ◽  
Tiwaope Kachaje
Keyword(s):  
Hearing Loss ◽  
Hearing Aids ◽  
Low Income ◽  
Negative Impact ◽  
Hearing Aid ◽  
Face To Face ◽  
Low Income Country ◽  
Follow Up Care ◽  
Children With Hearing Loss

Purpose Hearing loss can have a negative impact on a child's development. Hearing aids, if fitted appropriately, maintained well, and used regularly, can offer benefit to children with hearing loss. Regular reviews of hearing aid users can help to monitor a child's progress and provide timely intervention when problems arise or needs change. This study investigates the follow-up care received by children fitted with hearing aids at a clinic in Malawi. Method A clinical audit was done of the frequency of face-to-face follow-up appointments, following which all pediatric hearing aid users who had not recently received follow-up care were called to invite them for a review, and then a re-audit was conducted. Results Of the 47 children in the audit, 46 had not had a recent face-to-face follow-up appointment. Strenuous efforts were made to call those 46 children to the clinic for review: 20 caregivers agreed to bring their child for review, 10 of whom attended. It was not possible to contact 24 caregivers. Conclusions Reasons for low attendance for review at this service are not known, but may be related to the financial circumstances of the patients' families as well as difficulty in maintaining contact with families. It has not yet been possible to establish a system for routine follow-up care for pediatric hearing aid users at this well-established clinic in a low-income country.

scholarly journals Probable Exit Strategy Against COVID-19 of Low Resource Country like Nepal: Open Floor Discussion

2020 ◽  
Vol 58 (224) ◽  
Author(s):  
Bibek Rajbhandari ◽  
Minani Gurung ◽  
Lisasha Poudel ◽  
Archana Shrestha ◽  
Biraj Man Karmacharya
Keyword(s):  
Low Income ◽  
Social Life ◽  
Contact Tracing ◽  
Infected Person ◽  
Trial And Error ◽  
Exit Strategy ◽  
Low Income Country ◽  
Open Floor ◽  
Low Resource Country

Lockdown is essential for containing the spread of SARS-CoV-2. It is the best measure to maintainextreme social distancing which has been effective in controlling the infection and saving lives.But they are causing huge loss economically, disrupting social life and causing distress around theworld. Reopening too quickly or too boldly without a goal-oriented strategy could mean a secondwave of infection as fierce or even worse as the first. The fundamentals of the virus remain the same –one infected person will, without a lockdown pass it onto three others on average. The consequencesof lifting the lockdown are unforeseeable and the stakes are high. Due to the different spectrumof severity with same strain of virus and uncertainty of post lockdown era, lifting the lockdownwill be a trial and error approach. Nevertheless, at some point the lockdown has to be lifted. Thestrategic approach would be innumerable testing, investigations, strong contact tracing, isolationand follow-up. In a low-income country like Nepal, this will mean negotiating a tricky balancebetween terminating the spread of SARS-CoV-2, and allowing people to recover their livelihoodsbefore they slip into extreme poverty and anguish.

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