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Providing surgical care in Somalia A model of task shifting 英文参考文献.doc

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Providing surgical care in Somalia A model of task shifting 英文参考文献

Chuetal.ConflictandHealth2011,5:12 /content/5/1/12 RESEARCH OpenAccess ProvidingsurgicalcareinSomalia:Amodel oftaskshifting KathrynMChu1,2*,NathanPFord1,3 andMiguelTrelles4 Abstract Background:Somaliaisoneofthemostpoliticalunstablecountriesintheworld.Ongoinginsecurityhasforced aninconsistentmedicalresponsebytheinternationalcommunity,withlittledatacollection.Thispaperdescribes the“remote”modelofsurgicalcarebyMedecinsSansFrontieres,inGuri-El,Somalia.Thechallengesofproviding thenecessaryprerequisitesforsafesurgeryarediscussedaswellasthesuccessesandlimitationsoftaskshifting inthisresource-limitedcontext. Methods:InJanuary2006,MSFopenedaprojectinGuri-EllocatedbetweenMogadishuandGalcayo.The objectivesweretoreducemortalityduetocomplicationsofpregnancyandchildbirthandfromviolentandnon- violenttrauma.Atthestartoftheprogram,expatriatesurgeonsandanesthesiologistsestablishedsafesurgical practicesandperformedsurgicalprocedures.AfterJanuary2008,expatriateswereevacuatedduetoinsecurityand surgicalcarehasbeenprovidedbylocalSomaliandoctorsandnurseswithperiodicsupervisoryvisitsfrom expatriatestaff. Results:BetweenOctober2006andDecember2009,2086operationswereperformedon1602patients.The majority(1049,65%)weremaleandthemedianagewas22(interquartilerange,17-30).1460(70%)of interventionswereemergent.Traumaaccountedfor76%(1585)ofallsurgicalpathology;gunshotwounds accountedfor89%(584)ofviolentinjuries.Operativemortality(0.5%ofallsurgicalinterventions)wasnothigher whenSomalianstaffprovidedcarecomparedtowhenexpatriatesurgeonsandanesthesiologists. Conclusions:Thedeliveryofsurgicalcareinanyconflict-settingsisdifficult,butinsituationswhereinternational supportislimited,thechallengesaremoreextreme.Inthismodel,taskshifting,ortheprovisionofservicesbyless trainedcadres,wasutilizedandperi-operativemortalityremainedlowdemonstratingthatsafesurgicalpractices canbeaccomplishedevenwithoutthepresenceoffullytrainedsurgeonandanesthesiologists.Ifsecurityimproves inSomalia,on-sitetrainingbyexpatriatesurgeons