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

Publisher: Taylor & Francis Country of Publication: United States NLM ID: 101496665 Publication Model: eCollection Cited Medium: Internet ISSN: 1654-9880 (Electronic) Linking ISSN: 16549880 NLM ISO Abbreviation: Glob Health Action Subsets: MEDLINE

Publication: <2016- > : Philadelphia, PA : Taylor & Francis
Original Publication: Häggeby : Co-Action Publishing

International Cooperation*; Barotrauma/*surgery ; Capacity Building/*methods ; Ear, Middle/*surgery ; Program Development/*methods ; Surgical Procedures, Operative/*education; Adolescent ; Adult ; Barotrauma/complications ; Child ; Child, Preschool ; Ear, Middle/injuries ; Explosions ; Female ; Germany ; Global Health ; Health Services Accessibility ; Hospitals, Pediatric ; Humans ; Infant ; International Educational Exchange ; Male ; Russia

Background: Collaborations 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.
Design: We 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.
Results: Patients 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.
Conclusions: In 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.

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Keywords: capacity building; ear–nose–throat surgery; humanitarian surgery; mid-income countries; otologic surgery; otologic trauma; terrorism

Date Created: 20151027 Date Completed: 20160627 Latest Revision: 20181113

20250114

PMC4620685

10.3402/gha.v8.29227

26498745