Providing surgical care in Somalia: A model of task shifting.
Providing surgical care in Somalia: A model of task shifting.
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DOI：
10.1186/1752-1505-5-12
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发表时间：
2011-07-15
影响因子：
3.6
通讯作者：
Trelles, Miguel
中科院分区：
文献类型：
--
作者：
Chu, Kathryn M;Ford, Nathan P;Trelles, Miguel
背景：索马里是世界上政治最不稳定的国家之一。持续的不安全迫使国际社会采取不一致的医疗对策，几乎没有收集数据。本文介绍了无国界医生组织在索马里古里埃尔的“远程”外科护理模式。提供必要的先决条件，安全手术的挑战进行了讨论，以及在这个资源有限的context.METHODS的成功和局限性的任务转移：在2006年1月，无国界医生组织开设了一个项目，位于古里埃尔之间的莫加迪舒和加尔卡约。其目标是减少因怀孕和分娩并发症以及暴力和非暴力创伤造成的死亡率。在该计划开始时，外籍外科医生和麻醉师建立了安全的手术实践和执行手术程序。2008年1月后，外籍人士被疏散，由于不安全和手术护理已提供由当地索马里医生和护士定期监督访问外籍staff.RESULTS：2006年10月至2009年12月，2086手术进行了1602例。大多数（1049，65%）为男性，中位年龄为22岁（四分位距，17-30岁）。1460例（70%）干预为紧急干预。创伤占所有外科病理的76%（1585）;枪伤占暴力伤害的89%（584）。手术死亡率（0.5%的所有手术干预）是不高时，索马里工作人员提供的护理相比，当外籍外科医生和麻醉师。结论：在任何冲突的情况下，手术护理的交付是困难的，但在国际支持是有限的情况下，挑战是更加极端的。在这种模式中，任务转移，或提供服务的培训较少的干部，被利用和围手术期死亡率仍然很低，证明安全的手术实践，可以完成，即使没有训练有素的外科医生和麻醉师的存在。如果索马里的安全状况有所改善，将重新建立由外籍外科医生和麻醉师进行的现场培训。在此之前，无国界医生在索马里找到的支持外科护理的最佳方式是继续以“远程”方式提供支持。
BACKGROUND: Somalia is one of the most political unstable countries in the world. Ongoing insecurity has forced an inconsistent medical response by the international community, with little data collection. This paper describes the "remote" model of surgical care by Medecins Sans Frontieres, in Guri-El, Somalia. The challenges of providing the necessary prerequisites for safe surgery are discussed as well as the successes and limitations of task shifting in this resource-limited context.METHODS: In January 2006, MSF opened a project in Guri-El located between Mogadishu and Galcayo. The objectives were to reduce mortality due to complications of pregnancy and childbirth and from violent and non-violent trauma. At the start of the program, expatriate surgeons and anesthesiologists established safe surgical practices and performed surgical procedures. After January 2008, expatriates were evacuated due to insecurity and surgical care has been provided by local Somalian doctors and nurses with periodic supervisory visits from expatriate staff.RESULTS: Between October 2006 and December 2009, 2086 operations were performed on 1602 patients. The majority (1049, 65%) were male and the median age was 22 (interquartile range, 17-30). 1460 (70%) of interventions were emergent. Trauma accounted for 76% (1585) of all surgical pathology; gunshot wounds accounted for 89% (584) of violent injuries. Operative mortality (0.5% of all surgical interventions) was not higher when Somalian staff provided care compared to when expatriate surgeons and anesthesiologists.CONCLUSIONS: The delivery of surgical care in any conflict-settings is difficult, but in situations where international support is limited, the challenges are more extreme. In this model, task shifting, or the provision of services by less trained cadres, was utilized and peri-operative mortality remained low demonstrating that safe surgical practices can be accomplished even without the presence of fully trained surgeon and anesthesiologists. If security improves in Somalia, on-site training by expatriate surgeons and anesthesiologists will be re-established. Until then, the best way MSF has found to support surgical care in Somalia is continue to support in a "remote" manner.