[The professional functions and competences of personnel of medical public organizations].

The article considers role and specifics of professional competencies of employees of medical public organizations providing vital medical and social services to vulnerable groups of population having no access to necessary care due to financial difficulties, geographical isolation, natural disasters and other causes. It is noted that employees of such organizations have unique set of professional competencies permitting them to effectively function in conditions of limited resources and unstable circumstances. The importance of interdisciplinary interaction, cultural competence, ethicality and legal awareness of employees.

Humanitarian missions and visual outcomes in cataract surgery: A literature review.

The limited accessibility to ophthalmological services in remote regions of developing countries poses a significant challenge in visual healthcare. Cataracts and refractive errors are prominent causes of visual impairment, and surgery, despite being an efficient option, faces barriers in developing countries due to financial and geographical constraints. Humanitarian missions play a vital role in addressing this issue. The improvement in the accuracy of calculating IOL power through techniques such as keratometry and biometry is a fundamental step towards optimizing surgical outcomes and the quality of life for patients in these underserved regions. In this context, the consideration of keratometry and immersion ultrasound biometry as preoperative assessment standards in cataract surgeries in developing countries is presented as a pertinent and advisable strategy.

Team Dynamics and Nontechnical Skills Perception During the Disaster Response in Mozambique in 2019: A Survey Study Among the Italian Emergency Medical Team.

OBJECTIVE: Team dynamics and nontechnical skills in general are crucial for emergency medical teams (EMT). No study has ever examined these important issues during a real mission in the field. This study aimed to better investigate team dynamics and nontechnical skills for EMTs; it tried to understand if a real mission, when the people are obliged to work together for the first time, without a prior specific training focused on teamwork, is enough or not to work as an effective team in the field. METHODS: The study is designed as a pre-test/post-test survey study, and it collected data from 51 people deployed to Mozambique in 2019. Three indexes (the self-efficacy (SE), the teamwork (TW), and the overall team's performance (TW12)) were calculated as the average value of the rating given by all the participants. Open text feedback was also collected. RESULTS: A positive trend was observed comparing the "post" data to the "pre" data, but results did not show a statistical significance, with the only exception of stratified analyses showing a P-value less than 0.05 for SE and TW12 for some categories. CONCLUSIONS: According to the study findings, humanitarian workers feel good but not at their best; training programs focused on team dynamics can be really useful to improve self-confidence of people leaving for a mission.

Management of a Long-Standing Huge Goiter During a Humanitarian Mission: A Case Report.

Giant goiters are still encountered in low-income countries where diagnosis and management remain challenging. The authors report a case of an endemic giant goiter, treated during a humanitarian mission. A 50-year-old female with no particular history presented during a humanitarian mission with a giant nontoxic goiter evolving for 30 years. She underwent a total thyroidectomy removing a 3 kg thyroid gland. The postoperative period was uneventful. Giant goiters are not exceptional in goiter-endemic areas. Diagnostic and surgical management do not require particular technology. Surgery remains feasible even in countries with limited resources.

How to attract our future? - Perception of plastic surgery among medical students.

BACKGROUND: There is a mounting body of evidence that underscores the worldwide and US national need for increased plastic surgery recruitment of trainees. Thus, plastic surgery must attract more applicants while maintaining the high-level qualifications of residency candidates. METHODS: A total of 250 (w = 197) medical students rated the prototypical plastic surgeon (PS), general practitioner (GP), and craniomaxillofacial surgeon (CMF) with respect to traits derived from a literature review on the general perception of surgery, favorability, and their intention to pursue a respective career. RESULTS: Factor analysis yielded two overarching dimensions of prototype perception in addition to femininity and resilience, one reflecting a coldhearted, narcissistic, competitive character (status primacy; SP), and one reflecting role-model-like traits (hard-working, healthy, admired, and empathetic). Prototypical PSs scored significantly higher on SP than GPs (t(249) = 18.72, p < 0.001, d = 1.26) and CMFs (t(249) = 5.73, p < 0.001, d = 0.36), while receiving significantly less positive evaluations (GP: t(249) = -9.93, p < 0.001, d = -0.63; CMF: t(249) = -3.52, p < 0.001, d = -0.22). The higher participants rated PSs on SP, the more likely a career in plastic surgery was excluded (OR = 0.71, p = 0.03). An opposite relationship with femininity approached significance (OR = 1.32, p = 0.06). CONCLUSIONS: Given the growing need for PSs, worldwide and US national task fields have to overcome the outdated traits and highlight the field's pro-bono engagement. Furthermore, plastic surgery should further expand its leading role in promoting female trainees.

Promising results in a 3-year follow-up for adults undergoing a one-stage surgery for residual talipes equinovarus as part of a humanitarian mission in Vietnam.

BACKGROUND: Rigid talipes equinovarus (TEV) is a complex foot deformity in which the foot is fixed in a plantarflexed, inverted, and adducted position. This pathology has the potential to severely limit basic life activities, which can be devastating for patients in developing countries. The objective of this study was to present the outcomes of patients with mature bones presenting with severe rigid TEV deformity who were operated on during a humanitarian mission to Vietnam using a single lateral approach and a simple and inexpensive fixation technique. METHODS: This is a retrospective analysis of prospectively collected data. We analyzed the outcomes of patients who underwent surgery for a severe rigid TEV that prevented them from walking minimal distances unaided. All feet were fixed in a non-plantigrade position. The surgeries were conducted as part of two International Extremity Project (IEP) missions in Can Tho, Vietnam (2013 and 2018). Pre- and post-operative AOFAS scores were compared using the paired sample t-test. RESULTS: We operated on 14 feet of 12 patients, 6 (50%) of whom were males, aged 34.42 ± 11.7 (range 12 to 58). Four patients were followed for three months, two patients were followed for 12 months, and eight patients were followed for three years. On the final follow-up visit of each patient, all 14 operated feet were plantigrade with good alignment, and patients reported an improvement in daily activity. After 3 years of follow-up, the mean AOFAS score of eight patients with available data improved by 42.88 ± 3.91 points (95% CI 39.61 to 46.14, P < 0.01). Our patients also reported an improvement in mobility. At the final follow-up examination, no recurrence of the deformity was observed in any of the patients. CONCLUSIONS: Using low-technical surgical modalities, we were able to achieve plantigrade and walkable feet in patients with mature bones who had fixed rigid equinovarus. LEVEL OF EVIDENCE: Level IV- Case Series.

Pediatric Surgery and Anesthesia in Low-Middle Income Countries: Current Situation and Ethical Challenges.

Low-middle income countries (LMICs) are currently experiencing an important population growth, leading to a substantial raise in the number of children living in those areas. As a consequence, the existing gap between the need for surgical and anesthetic care and the available therapeutic options will increase. To overcome this, an improvement in the available expertise, infrastructures, and supplies will be mandatory. The implementation of educational and training programs for local healthcare providers should be a top priority. Alongside, the population's awareness on the necessity to seek for medical care should be deployed, together with an eased access to health facilities. Based on the existing literature and our 20-years' experience in humanitarian missions, our article aims to investigate the status of pediatric surgery in LMICs, and the role of western aids in the implementation of this ever-increasing field of expertise.

Self-care and Wellness Checks in Emergency Field Hospitals During COVID-19 Pandemic: A New Self-check Tool for Military Personnel and Civilians.

The authors explore the impact of cumulative stress on United States (US) military service members (SM), including soldiers and medical personnel, deployed to serve in New York City (NYC) communities. Their mission was to assist in establishing emergency field hospitals during the COVID-19 pandemic. Causative biopsychosocial factors are presented, as well as the impact of wellness checks, which were utilized to monitor the mood and morale of frontline healthcare providers, military personnel, and infected patients in a 2,500-bed emergency field hospital and a 1,000-bed Naval hospital ship operating in the metropolitan NYC area. The authors introduce a self-care and wellness tool, which assesses five core domains (physical, mental, emotional, social, and spiritual) for the purpose of assessing and improving individual overall well-being during periods of heightened stress. This instrument could aid attending medical personnel in identifying patients at risk of suicide. Likewise, the utility of this self-care tool is applicable to both military SM and civilians, and includes soldiers and medical personnel.

Military Working Dogs Operating in Afghanistan Theater: Comparison between Pre- and Post-Mission Blood Analyses to Monitor Physical Fitness and Training.

The intergovernmental organization known as the United Nations (UN) was born "to maintain international peace and security" through different operations and tasks, including "mine action" and "explosive detection". Explosives are the most frequent cause of injuries in military personnel and an enormous danger for civilians. The role of explosive detection dogs (EDDs) and mine detection dogs has gained great consideration over time, leading to their intense use in military operations. Literature regarding working injuries reported by EDDs during missions is limited. The aim of the present study is to investigate the hematological changes that occurred between pre- and post-mission blood analyses in military working dogs deployed to Afghanistan in order to evaluate signs of health problems or physical adjustments. Examining the clinical records, only three dogs reported a medical issue, one with gastric dilatation-volvulus (GDV), and two with lameness episodes. Lack of health issues occurring during the missions was reflected by the absence of significant differences between pre- and post-mission blood analyses. Blood results were also examined by dividing the EDDs into groups considering age at departure, sex, breed and mission length. A few categories demonstrated significant changes in some parameters; however, the mean values were always included in the ranges of normality, indicating that their physical fitness and training were adequate for the required tasks.

Diversity and Cultural Competency in Oral and Maxillofacial Surgery.

Health disparities in the United States have been well documented over the past several decades and continue to affect the American population. As the world becomes more diverse, it is imperative that the health care professional workforce is trained to care for the diversifying patient population, striving to improve health disparities in the United States and worldwide. Improving the diversity within the health care professional workforce likely will aid in emphasizing the importance of cultural competency of health care professionals, with the development of programs aimed at cultural competency training and assessment.

Naval Medicine's Involvement in Global Health: The Participation of Women's Healthcare Providers in Continuing Promise 2017.

INTRODUCTION: This is a retrospective review of information collected during operation Continuing Promise 2017 from the Wayuu population in Colombia, South America. MATERIALS AND METHODS: Team objective was to present an overview of women's health care needs in an isolated underserved population of Colombia by a humanitarian mission of health care providers from the U.S. Navy. We analyzed demographics, contraceptive selection, presenting complaint, diagnosis, and disposition of those female patients presenting for care. RESULTS: The acute care clinics of this mission saw patients for 10 full clinic days in each of the countries of Guatemala, Honduras, and Colombia. In the Wayuu clinic of Colombia, 356 patients were seen in the acute care women's clinic. These women averaged 36 years of age with an age range of 9-77 years of age and a gravidity of 3 ± 3.3 and a range of 0-18. Of the women less than the age of 50, not permanently sterilized, 186/220 (84.5%) were not using any form of contraception. The most common chief complaints were vaginal discharge and pelvic pain and the most common final diagnosis was bacterial vaginosis. The two most common secondary diagnoses of the pregnant women were urinary tract infection and anemia. Other significant diagnoses included uterine cancer, preterm labor, and fetal posterior urethral valve syndrome. CONCLUSIONS: A majority of Wayuu women presenting to an acute clinic setting in Colombia, South America were in their mid-thirties having had three pregnancies and the majority were not using any form of contraception. The most common diagnoses were straightforward diagnoses such as vaginal infections, urinary tract infections, and abnormal uterine bleeding. Our findings suggest a need for access to routine gynecologic care, general hygiene education, and increased availability of birth control among the Wayuu population.

Safe and sustainable: the extracranial approach toward frontoethmoidal meningoencephalocele repair.

OBJECTIVE Although rare, frontoethmoidal meningoencephaloceles continue to pose a challenge to neurosurgeons and plastic reconstructive surgeons. Especially when faced with limited infrastructure and resources, establishing reliable and safe surgical techniques is of paramount importance. The authors present a case series in order to evaluate a previously proposed concise approach for meningoencephalocele repair, with a focus on sustainability of internationally driven surgical efforts. METHODS Between 2001 and 2016, a total of 246 patients with frontoethmoidal meningoencephaloceles were treated using a 1-stage extracranial approach by a single surgeon in the Department of Neurosurgery of the Yangon General Hospital in Yangon, Myanmar, initially assisted by European surgeons. Outcomes and complications were evaluated. RESULTS A total of 246 patients (138 male and 108 female) were treated. Their ages ranged from 75 days to 32 years (median 8 years). The duration of follow-up ranged between 4 weeks and 16 years (median 4 months). Eighteen patients (7.3%) showed signs of increased intracranial pressure postoperatively, and early CSF rhinorrhea was observed in 27 patients (11%), with 5 (2%) of them requiring operative dural repair. In 8 patients, a decompressive lumbar puncture was performed. There were 8 postoperative deaths (3.3%) due to meningitis. In 15 patients (6.1%), recurrent herniation of brain tissue was observed; this herniation led to blindness in 1 case. The remaining patients all showed good to very good aesthetic and functional results. CONCLUSIONS A minimally invasive, purely extracranial approach to frontoethmoidal meningoencephalocele repair may serve well, especially in middle- and low-income countries. This case series points out how the frequently critiqued lack of sustainability in the field of humanitarian surgical missions, as well as the often-cited missing aftercare and dependence on foreign supporters, can be circumvented by meticulous training of local surgeons.

Feasibility and limits of inguinal hernia repair under local anaesthesia in a limited resource environment: a prospective controlled study.

PURPOSE: Local anaesthesia (LA) has proven effective for inguinal hernia repair in developed countries. Hernias in low to middle income countries represent a different issue. The aim of this study was to analyse the feasibility of LA for African hernia repairs in a limited resource environment. METHODS: Data from patients who underwent herniorrhaphy under LA or spinal anaesthesia (SA) by the 6th and 7th Forward Surgical Team were prospectively collected. All of the patients benefited from a transversus abdominis plane (TAP) block for postoperative analgesia. Primary endpoints concerned the pain response and conversion to general anaesthesia. Secondary endpoints concerned the complication and recurrence rates. Predictors of LA failure were then identified. RESULTS: In all, 189 inguinal hernias were operated during the study period, and 119 patients fulfilled the inclusion criteria: 57 LA and 62 SA. Forty-eight percent of patients presented with inguinoscrotal hernias. Local anaesthesia led to more pain during surgery and necessitated more administration of analgesics but resulted in fewer micturition difficulties and better postoperative pain control. Conversion rates were not different. Inguinoscrotal hernia and a time interval <50 min between the TAP block and skin incision were predictors of LA failure. Forty-four patients were followed-up at one month. No recurrence was noted. CONCLUSIONS: Local anaesthesia is a safe alternative to SA. Small or medium hernias can easily be performed under LA in rural centres, but inguinoscrotal hernias required an ultrasound-guided TAP block performed 50 min before surgery to achieve optimal analgesia, and should be managed only in centres equipped with ultrasonography.

Management of complex pediatric burn scars in a humanitarian collaboration.

Burn scars still represent a challenge to the reconstructive surgeon. Their management requires a specific expertise and set up involving the possibility of long term rehabilitation and follow up. Cases encountered in humanitarian missions present additional issues. Often the local environment is not suitable for an appropriate treatment plan, requiring the case to be transferred to a foreign country for surgical care as part of an integrated international and multidisciplinary management. We present the case of a three year-old patient injured in a bomb explosion during the Arab Spring and suffering from severe scar contracture limiting thoracic and upper limb movement. After initial consultation at distance, transfer to our country was organized and an intensive surgical and rehabilitative program was carried out over three months. After five months, the patient returned to his home country where a supportive network had been set up for continued rehabilitation, ensuring follow up for over a year and ultimate success.

Les cicatrices de brûlures représentent toujours un défi pour le chirurgien de reconstruction. Leur gestion nécessite une expertise spécifique et la possibilité de réhabilitation à long terme, y compris le suivi. Les cas rencontrés dans les missions humanitaires présentent des problèmes supplémentaires. Souvent l'environnement local n'est pas adapté pour un plan de traitement approprié, et donc il faut transféré le patient dans un pays étranger pour des soins chirurgicaux dans le cadre d'une gestion internationale et multidisciplinaire intégrée. Nous présentons le cas d'un patient de trois ans blessé à cause de l'explosion d'une bombe pendant le printemps arabe. Ce patient souffrait de contractures graves qui limitaient le mouvement du membre thoracique et supérieure. Après une consultation initiale à distance, il a été transferé à notre pays où il a subi un programme de chirurgie et de réadaptation intensive qui a duré trois mois. Après cinq mois, le patient est retourné à son pays d'origine où un réseau de soutien a été mis en place pour continuer la réhabilitation, assurer un suivi de plus d'un an et le succès final.

Preparation of medical personnel for an early response humanitarian mission - lessons learned from the Israeli defense forces field hospital in the Philippines.

INTRODUCTION: Humanitarian aid provision and early medical response missions to areas ravaged by natural disasters are as essential nowadays as in the past, and medical personnel play a pivotal role in these delegations. CASE DESCRIPTION: In November 2013, tropical cyclone Haiyan (Yolanda) slammed the Philippines archipelago, leaving more than an estimated 6000 dead in its wake while demolishing vital infrastructure and affecting the life of an estimated 25 million locals. The Israeli Defense Forces (IDF) rapidly constructed and sent a humanitarian aid delegation which included a field hospital deployment with medical capabilities from diverse specialty fields. DISCUSSION AND EVALUATION: The purpose of this article is to summarize our experience in the preparation process of medical personnel before and during deployment. We offer a simple, practical and structured checklist that will assist the medical specialist in preparation for his mission. CONCLUSION: Preparation of medical personnel for humanitarian aid medical missions is a complex and vital task that might be better accomplished with thorough briefing and structured checklists which begin with addressing of personal safety and other daily needs of the staff.

Building clinical practice in the Palestine Red Crescent operation theatres in Lebanon: reflections from the perspective of an expatriate nurse.

AIM: This paper, based on the experience of the first author as an expatriate nurse, aims to describe and discuss some aspects of collaboration that contributed to the building of clinical practice when implementing an operating theatre programme in the Palestine Red Crescent Society (PRCS) hospitals in Lebanon. BACKGROUND: The operation theatre programme lasted for 8 months: 6 months in 2008 and 2 months in 2009. The programme was part of the partnership project 'Quality of care in the five PRCS hospitals in Lebanon' between the International Committee of the Red Cross and the PRCS Lebanon (PRCS-L) branch. FINDINGS: The essential aspects that may have contributed to the building of clinical practice in the operation theatre programme included the expatriate nurse and the Palestine Red Crescent operating theatre nurses working together over time as colleagues, the socio-cultural pedagogic perspective selected for the implementation and the collaboration with the management of the hospitals and counterparts in the PRCS-L branch. One should also note the human and structural issues that seemed to influence the implementation of the programme in a more negative way. CONCLUSIONS: This experience may provide insight for other nurses into the importance of working as colleagues, selecting an appropriate pedagogic perspective and establishing productive collaboration with all partners when building clinical practice during a humanitarian mission.