Abstract: A mass casualty incident (MCI) occurs when a disaster involves a large number of injured people, overwhelming the capacity of local emergency medical services. This article describes the planning and execution of a MCI workshop created for use in Sierra Leone, a low-income country.
Abstract: Interest in global health among surgical residents and medical students is growing. There are numerous opportunities worldwide for both short- and long-term experiences. In order to maximize the learning potential, the authors present a practical guide for residents and students to prepare for a surgical visit, elective, rotation, or mission to an underserved region. The following steps will be outlined:
Abstract: Risk-adjusted analyses are critical in evaluating trauma outcomes. The National Trauma Data Bank (NTDB) is a statistically robust registry that allows such analyses; however, analytical techniques are not yet standardized. In this study, we examined peer-reviewed manuscripts published using NTDB data, with particular attention to characteristics strongly associated with trauma outcomes. Our objective was to determine if there are substantial variations in the methodology and quality of risk-adjusted analyses and therefore, whether development of best practices for risk-adjusted analyses is warranted.
Abstract: Chronic kidney disease (CKD) is a public health problem in sub-Saharan Africa (SSA) but there is limited data to guide programs or plan interventions. To help set priorities and understand the needs for renal replacement therapy a baseline assessment is required. World Health Organization (WHO) databases and Medline were searched to determine the number of physicians, nephrologists, and dialysis centers and patients in SSA. Data on renal transplant (RTx) programs were collected from the WHO Global Observatory on Donation & Transplantation database for deceased-donor and living-donor RTx. Of the 47 countries in SSA only 15 had recent data with most rates of physicians per 10,000 population under 2.0. Nigeria and South Africa had the greatest absolute numbers of physicians and nephrologists but Mauritius had the greatest proportion to population. South Africa had the most dialysis patients. Kenya, Nigeria and South Africa were the only countries with RTx programs and reported rates per million population of 0.60, 0.23 and 5.12, respectively. Treatment for patients with CKD in SSA is limited by a lack of physicians, nephrologists, and dialysis centers. Few countries are performing RTx. Resources are needed to increase the health workforce and increase RTx programs in SSA.
Abstract: Objective  To determine the indications for using ultrasound, in low- and middle-income countries (LMICs) and to assess whether its use alters clinical management. Methods  Literature review. We conducted a Pubmed search on the clinical use of ultrasound in LMIC for articles published between January 2000 and December 2010, recording country of origin, speciality and whether ultrasound use led to a change in management. Results  Fifty-eight articles were identified from 32 countries and represented nine specialties. Ultrasound was most commonly used for assisting with the diagnosis of obstetrical conditions, followed by intra-abdominal conditions such as liver abscesses and intussusceptions. Clinical management was altered in >30% of cases. Conclusion  Ultrasound is a highly valuable diagnostic tool in LMICs and its use should be considered essential for all district medical facilities. The use could be applied more widely, eg., for tropical and non-communicable diseases. Additional research is needed to further characterize the impact of task shifting on ultrasound use in LMICs.
Abstract: Surgeons OverSeas (SOS), a New York-based organization with a mission to save lives in developing countries, conducted a surgical needs assessment in Sierra Leone in 2008 which identified a large gap in surgical knowledge. We hypothesized that knowledge transfer could be improved by conducting workshops with significant local faculty participation.
Abstract: The value of surgical research is increasingly recognised by undergraduate medical students interested in pursuing a surgical career. This article describes how an undergraduate medical student from Monash University built upon his surgical research experience from the Eastern Health Surgical Research Group in Australia, by undertaking a 9-week research elective at the Johns Hopkins Center of Surgery Trials and Outcomes Research. Practical issues encountered, such as visa and housing, are outlined. Differing attitudes and trends in surgical research among Australian and American medical students, means of assessing surgical research productivity and the benefits of surgical research are discussed. Surgical research should be encouraged and supported in young trainee surgeons; a short-term surgical research elective can be productive provided the student is focused and realistic about expectations.
Abstract: Objective  In view of the substantial incidence of bloodborne diseases and risk to surgical healthcare workers in low- and middle-income countries (LMICs), we evaluated the availability of eye protection, aprons, sterile gloves, sterilizers and suction pumps. Methods  Review of studies using the WHO Tool for the Situational Analysis of Access to Emergency and Essential Surgical Care. Results  Eight papers documented data from 164 hospitals: Afghanistan (17), Gambia (18), Ghana (17), Liberia (16), Mongolia (44), Sierra Leone (12), Solomon Islands (9) and Sri Lanka (31). No country had a 100% supply of any item. Eye protection was available in only one hospital in Sri Lanka (4%) and most abundant in Liberia (56%). The availability of sterile gloves ranged from 24% in Afghanistan to 94% in Ghana. Conclusion  Substantial deficiencies of basic protective supplies exist in low- and middle-income countries.
Abstract: Interest is growing in global health among surgical residents and medical students. This article explores the newly developing concept of "global surgery." Providing surgical care to resource-limited populations, often found in low- and middle-income countries, has numerous professional and personal developmental benefits. A significant interest is found among most general surgical residents; however, it is necessary to formalize more exchange programs and fellowships like some institutions have done. Medical schools also should establish similar global clinical electives to channel the exuberance of students, develop properly their global health interests, and expose them early to the realities and health needs of the global population. Current opportunities for medical students and residents are reviewed along with the relevant literature.
