GHF2010 – PS18 – Emergency and Essential Surgery: Where Do We Stand?

Session Outline

Parallel session PS18, Tuesday, April 20 2010, 11:00-12:30, Room 2
Chair(s): Pierre Hoffmeyer, Head, Department of Surgery, Geneva University Hospitals, Switzerland
Charles Mock
, Medical Officer, Department of Violence and Injury Prevention and Disability, World Health Organization, Switzerland
A Surgeon's Experience in Haiti
Mathieu Assal, Associate Professor, Division of Orthopaedic Surgery, Geneva University Hospitals, Switzerland
The Challenge of Developing Surgical Care in Africa
Vincent Djientcheu, Professor, Department of Neurosurgery, Central Hospital Yaoundé, Cameroon
The Global Initiative for Emergency and Essential Surgical Care
Meena Nathan Cherian, Emergency and Essential Surgical Care, Clinical Procedures Unit, Department of Essential Health Technologies, Health Systems and Services, World Health Organization, Switzerland
WHO Trauma Care Checklist
Angela Lashoher, Patient Safety Programme, Information, Evidence and Research Cluster, World Health Organization, Switzerland

Session Documents

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Session Report

Submitted by: Erica Chan Wong (ICVolunteers); Contributors: Matthew O'Brien (ICVolunteers)

Dominican Red Cross volunteer in Cite Soleil, Port-au-Prince, attending 10-year old girl, Photo: American Red Cross/Talia Frenkel

In exciting presentations from Haiti, Cameroon and the World Health Organization, the speakers highlighted the challenges of providing surgical care in low-resource settings as well as the measures currently underway to improve surgical access and outcomes worldwide.

Dr. Mathieu Assal, of the Geneva University Hospitals, began the session with an account of his experience working with the Swiss Humanitarian Unit in Haïti soon after the 12 January earthquake. One component of his presentation was a video showing a typical day in the medical tents where his team worked.  His video successfully captured the emotion and atmosphere at the clinic located near the site of the original Hôpital Universitare de Haïti. The surgical teams from Switzerland provided much of the equipment and worked with local hospital staff utilising surgical techniques that were adapted to the local protocols and resources.  In doing so, they ensured that the hospital care was sustained following their departure. In addition, Dr. Assal discussed the common types of injuries suffered by quake victims and the effective techniques used to treat them.  Specifically, he highlighted crush injuries, skull fractures, de-gloving, compartmental injuries and fractures. Most interestingly, he found that amputations were in fact very rare despite what was portrayed by the media. During the period in question, Dr. Assal noted that the patient load was not overwhelming, but that the complications caused by delayed treatment were a challenge.

Dr. Vincent Djientcheu, from the Department of Neurosurgery in the Central Hospital Yaoundé (Cameroon), presented an optimistic view of the barriers to surgical care in low-resource settings as well as possible solutions to overcome them.  Diversity of culture and traditional concepts of disease found in Africa, as well as limited funding, were cited as barriers. As a result, there is lack of training and compensation for health care professionals, delay in technology transfer and poorly organised health care systems. Even so, Dr. Djientcheu noted that there is much potential for change in Africa. The financial and emotional support of family and friends, increased enthusiasm of health care workers and local production of generic drugs all point to a positive future for surgical care in Africa. Similarly to Dr. Assal, Dr. Djientcheu highlighted the importance of bilateral collaboration with local staff to promote sustainable initiatives and local ownership. In a personal interview following the session, Dr. Djientcheu expressed the need for outside support in Africa, and emphasised international collaboration as necessary for Africa’s survival. He also described an effective programme as one that addresses local needs and maintains strong communication with local contacts. Ultimately, Dr. Djentcheu encourages outside support and bilateral cooperation as a means to improve access to surgical care in Africa.

Dr. Meena Nathan Cherian, of the Emergency and Essential Surgical Care, Clinical Procedures Unit at the WHO, expressed a need to prioritise surgical care as an integral part of public health. She set out the recently developed WHO approach to surgical care, including a global forum of biennial meetings since 2005, to address the barriers to accessing emergency and basic lifesaving care through discussions of progress and future goals. As part of this initiative, the WHO standards entitled “Surgical Care at the District Hospital” as well as the “Integrated Management for Emergency and Essential Surgical Care” have been published to provide basic guidelines and education materials toward developing surgical systems. An exciting change took place in 2008 when surgery was included in the World Health Report as an integral part of the continuum of care between primary care and the district level. Finally, Dr. Cherian described advocacy, research and support of centres of excellence as key ways in which individuals can contribute to this WHO initiative.

Last but not least, Dr. Angela Lashoher, of the Patient Safety Programme at the WHO, gave a presentation about the development and use of checklists to improve the safety and outcomes of surgery.  She described successful use of checklists and mentioned that two checklists, the WHO Trauma Care Checklist and the WHO Safe Childbirth Checklist, are currently being evaluated and show promise for the improvement of outcomes. To conclude her brief presentation, Dr. Lashoher emphasised that checklists do not solve all problems but are able to help hospitals consistently deliver quality care to all patients.

All presenters highlighted the need for improved access and standards for surgical care as an essential component of public health. While recognising the need for continued effort toward this goal, the presenters showed confidence in the potential for further progress.

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