When International Humanitarian or Medical Missions Go Wrong: An Ethical Analysis.

Recent decades have seen a significant increase in physicians participating in international short-term missions to regions with limited or no access to health care by virtue of natural disaster or lack of resources. Recent publications in the ethics literature have explored the potential of these missions for unintentional harm to the intended beneficiaries. Less has been discussed about how to respond when harm actually occurs. The authors review the ethical issues raised by short-term medical and humanitarian missions and the literature on responding to unintended error to provide guidelines for avoiding harm to the intended beneficiaries of missions and an appropriate response when harm occurs. Two cases demonstrating an analysis and response to unintended harm are presented.

Cooperación internacional ¿en qué estamos y hacia dónde vamos? / International cooperation. Where are we, and where are we heading to?

Unmet needs in global health are important issues, not yet solved by the international community. A variety of individuals, non-governmental organizations (NGO) and government institutions have tried to address this situation, developing multiple types of international cooperation (IC), such as humanitarian aid (HA), cooperation for development (CD) and medical missions (MM). In the last decades, we have witnessed an exponential growth in the creation and participation of these projects. Moreover, in the last 20 years, Chile has experimented a real paradigm switch, from a receiver to a provider of IC. Due to the recent surge in interest and relevance of the topic, we performed a narrative revision of the literature related with IC. In the present article, we characterize the different types of IC, with emphasis in MM: we address the risks, controversies and ethical problems associated with these activities. We finally propose some guidelines for the future development and promotion of MM.

Providing Anesthesia Care in Resource-limited Settings: A 6-year Analysis of Anesthesia Services Provided at Médecins Sans Frontières Facilities.

BACKGROUND: Anesthesia is integral to improving surgical care in low-resource settings. Anesthesia providers who work in these areas should be familiar with the particularities associated with providing care in these settings, including the types and outcomes of commonly performed anesthetic procedures. METHODS: The authors conducted a retrospective analysis of anesthetic procedures performed at Médecins Sans Frontières facilities from July 2008 to June 2014. The authors collected data on patient demographics, procedural characteristics, and patient outcome. The factors associated with perioperative mortality were analyzed. RESULTS: Over the 6-yr period, 75,536 anesthetics were provided to adult patients. The most common anesthesia techniques were spinal anesthesia (45.56%) and general anesthesia without intubation (33.85%). Overall perioperative mortality was 0.25%. Emergent procedures (0.41%; adjusted odds ratio [AOR], 15.86; 95% CI, 2.14 to 115.58), specialized surgeries (2.74%; AOR, 3.82; 95% CI, 1.27 to 11.47), and surgical duration more than 6 h (9.76%; AOR, 4.02; 95% CI, 1.09 to 14.88) were associated with higher odds of mortality than elective surgeries, minor surgeries, and surgical duration less than 1 h, respectively. Compared with general anesthesia with intubation, spinal anesthesia, regional anesthesia, and general anesthesia without intubation were associated with lower perioperative mortality rates of 0.04% (AOR, 0.10; 95% CI, 0.05 to 0.18), 0.06% (AOR, 0.26; 95% CI, 0.08 to 0.92), and 0.14% (AOR, 0.29; 95% CI, 0.18 to 0.45), respectively. CONCLUSIONS: A wide range of anesthetics can be carried out safely in resource-limited settings. Providers need to be aware of the potential risks and the outcomes associated with anesthesia administration in these settings.

Proyecto Mozambique / Mozambique project

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La colaboración cubana en Argelia en el área materno-infantil durante los años 2007-2010 / Cuban collaboration in Algeria in maternal-infant field during the years 2007 to 2010

La misión médica en la República de Argelia entre los años 2007 y 2010 tuvo como propósito desarrollar una estrategia de trabajo para reducir los indicadores relacionados con la morbimortalidad materno-infantil, existentes cuando llegaron los médicos cubanos. Se utilizaron alternativas para enfrentar las barreras y limitaciones que suponían las costumbres propias de un país árabe, con práctica de la religión islámica en el 99 por ciento de su población y un elevado componente nómada, con el objetivo de modificar paulatinamente algunas costumbres en el terreno de lo asistencial, e incluso social, que estaban reñidas con nuestros procedimientos. Se logró intervenir con el ánimo de reducir la morbimortalidad materna-infantil en esta región, introducir el quehacer de especialidades novedosas en ese medio, e instaurar el sistema de guardia física para los especialistas. Este trabajo tiene como propósito dejar testimonio del aporte de un grupo de cubanos pertenecientes a una brigada médica en la República de Argelia(AU)

The medical mission in the Republic of Algeria between 2007 and 2010 was aimed at developing a strategy to reduce indicators related to maternal and infant morbidity and mortality rates that already existed when Cuban doctors arrived in. Alternatives were used to address barriers and constraints posed by the typical customs of an Arabic country, with Islamic religious practice in 99 percent of its population and a large nomadic component, in order to gradually change some habits in the field assistance or even in social behavior that were at odds with our procedures. It was possible to intervene with the aim of reducing maternal and infant morbidity and mortality in this region, introducing the work of innovative specialties in that environment and establishing physical guard system for specialists, etc.. This paper is aimed at providing a testimony of the contribution of a group of Cubans working in a medical brigade in the Republic of Algeria(AU)

Colaborar con África: la experiencia del retorno / Work with Africa: The experience of returning

El Hospital de San Juan de Dios colabora desde 2002 con el St. John of God Hospital en Mabesseneh (Sierra Leona) cuando éste retoma la actividad asistencial tras la guerra civil del 1991. Parte de la colaboración consiste en enviar cada dos meses un pediatra y una enfermera. Todos estos profesionales inician el proyecto con un concepto de salud occidental, con ideas de cambio... Al volver ¿Qué ha sucedido? ¿Han cambiado el mundo africano o éste les ha cambiado? De estos interrogantes parte nuestra investigación. Metodología: Se realizaron entrevistas no directivas a siete enfermeras colaboradoras con el programa. El enfoque utilizado en esta investigación es el fenomenológico. Los datos se analizaron mediante el enfoque de Taylor y Bogdan para el análisis de datos cualitativos.Resultados: las personas entrevistadas dicen que aprendes a valorar lo que existe en el mundo occidental. La práctica enfermera al principio parece que cambia, pero el ser humano se adapta al entorno tanto cuando uno llega a África como cuando retorna. La impregnación de estas experiencias construye la persona. Encontramos escasas diferencias en personas que han ido más de una vez.Conclusiones: Las experiencias de cada persona pueden ser muy distintas teniendo en cuenta los objetivos de los que se parte. Al igual que la impregnación de lo vivido. Pero sí se hace evidente que, tras el tiempo pasado, el cambio en la práctica asistencial no es significativo (AU)

The Hospital de San Juan de Dios collaborates since 2002 with the Hospital from St. John of God Hospital in Mabesseneh (Sierra Leone) when the last resumed its activity after the Civil war of 1991. A part of this collaboration consists in sending a nurse and a paediatrician every two months. All these professional start the project with a "Western" concept of Health, with some ideas of change.... When they are back at home... What has happened? Have they changed the African world or has it changed then? These are the main questions where our investigation comes from.Methodology: Non-directive interviews to seven nurses who had collaborated with the program. The obtained data were analysed by using The Taylor and Bogdan's method for the analysis of qualitative data.Results: The interviewed people affirm that, after the experience, one learns to appreciate what is available in the Western World. At the beginning it looks as if the nursery practice changes but, indeed, the human beings can adapt themselves to the environment either when arriving to Africa or when departing from. The imprint of these experiences makes the person. Very little differences are observed for people who have travelled more than once.Discussion-Conclusions: The experiences of each individual can be very different having in mind the objectives initially planned. The same can be said for the imprint of these experiences. But it is clear that, after a quite short time, any change in the nursing practice is not significant (AU)

El Comité Internacional de Medicina Militar / The International Committee of Military Medicine

En este artículo se expone la historia y actividades desarrolladas por el Comité Internacional de Medicina Militar, organización apolítica y neutral que reúne más de 100 países, y cuyo objetivo es facilitar el trabajo conjunto de los sanitarios militares en el ámbito multinacional (AU)

In this article the history and activities of the International Committee of Military Medicine are presented. The International Committee is a neutral and apolitical organization joined by more than 100 countries, whose aim is to facilitate the joint work of military medics in the multinational environment (AU)

Paliativos sin fronteras / No disponible

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Ser médico... donde más lo necesitan / Being a doctor... where it is most needded

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[Afghanistan--ophthalmology in a state of emergency]. / Afghanistan--Ophthalmologie im Ausnahmezustand.

BACKGROUND: During the ISAF mission the authors want to accompany the colleagues on their daily duties in the outpatient clinics, the wards and theatre to have an overview about handling the different and some specialised diseases in the only ophthalmic centre for northern and central Afghanistan. At least we want to answer the question, is there a possibility of cooperation and support? HISTORY: In Afghanistan the ophthalmologist population ratio was 1:200 000. More than about 2/3 are working in urban areas and less than 1/2 in rural areas. There were no eye sub-specialists like retina or paediatric ophthalmologists at all. The reason for the lack of eye doctors and ophthalmic technicians is the prolonged war conditions in Afghanistan as well as professional migrations and missing good management. PRESENT SITUATION: One of two clinics in Northern Afghanistan was able to practice intraocular operations. Because of the incredible situation in old reconstructed buildings, there was no evidence of clinical hygiene, but nevertheless they performed mainly cataract and glaucoma surgery. Despite the ridiculous situation of hygiene in the theatre, there was not a higher rate of intraocular infections. The international assistance mission (IAM) NOOR project has been the most successful programme in eye care in Afghanistan since war started 30 years ago. There is a need for more support in Government centres with the help of ISAF initiating funds and technical equipment.

De la incompletitud de Gödel a la Sanidad Militar del futuro / From Gödel’s incompleteness to the future of the Military Health Corps

Se analizan – a la luz de la lógica moderna – algunas posibles medidas de implementación de la futura sanidad militar, insistiendo en ciertas necesidades básicas, de utilidad especial para el buen gobierno de las misiones internacionales y situaciones de emergencia. Se sugiere un cambio notable de actitud frente a esta nuestra gran crisis (AU)

Some possible measures ar suggested to deal with the Military Health Corps implementation for the future, analysed by a modern logics focusing. These basic needs result nested on our special interest for the sanitary efficiency achievement at international missions and emergencies. A notorius change of attitude is suggested in the great crisis we’re living (AU)

[Childhood blindness. VISION 2020 and experiences in an African city]. / Kinderblindheit. VISION 2020 und Erfahrungen in einer afrikanischen Grossstadt.

The struggle against childhood blindness is being given high priority by the WHO. In regions of the world countries where the income per head is low there are 5 times as many blind children as in wealthy countries (1.5/1000 vs 0.3/1000 children). In developing countries cataract is regarded as the main cause of blindness in both childhood and adulthood. If all cataracts that would lead to blindness were operated on, despite a comparatively smaller number of affected persons a similar number of sighted life-years could be achieved throughout the world to that for patients with senile cataract. The partnership between the Rostock Ophthalmological Department and St. Joseph's Hospital in Kinshasa focuses on the analysis and treatment of avoidable blindness in children. Its main concern is the introduction of appropriate procedures for cataract surgery, in most cases combined with the implantation of injectable synthetic intraocular lenses. In the last 7 years about 600 procedures have been jointly performed, including 400 of congenital cataract, mostly bilateral.

En estos tiempos de Guerra. Enfermeras ante los conflictos internacionales / In this "war-time". Nurses facing International conflicts

La guerra o los conflictos son situaciones que se han presentado desde la existencia de la misma humanidad. La búsqueda de mejores oportunidades, ampliación de territorios o la retaliación de venganzas tribales son algunos de los motivos que han llevado a su presencia y que aún hoy se presentan en el mundo. Se podría decir que a escala mundial, el contexto o panorama para algunos países es claramente de enfrentamiento. Colombia no se escapa de ello y no lo ha hecho hace casi 50 años que lleva en esta situación. Quiérase o no, esto afecta a la salud de múltiples formas con consecuencias directas o indirectas. De esta manera, mal que bien a los que somos profesionales de salud nos ha tocado de alguna forma enfrentar o desenvolvernos trabajando en un contexto un tanto diferente al estandarizado. Hace unos meses cuando estuve de nuevo en "casa", me surgieron varias inquietudes: ¿Cuántos de nosotros realmente conocemos acerca de esta situación, en el mundo o en nuestros países? ¿Qué tanto se afecta el ejercicio de la enfermería en estos contextos difíciles? ¿Cuál podría ser nuestro papel? Si bien, este podría ser un tema de investigación, aquí es desarrollado como una revisión de tema y actualidad, aterrizado a la realidad de mi país, Colombia

The war or conflicts have been present since the beginning of the humanity. The search of better chances, gaining of lands or tribal revenges are some causes of it and they are still present in the world. Nowadays the landscape for some countries is conflict. Colombia is one of them and it has taken around 50 years of its existence. One or other way, it affects the health in different way with either direct and no-direct consequences. Those who are health professionals have been exposed to work in this kind of context, a little bit different to the standard one. Some months ago, when I arrived home, some doubts and questions arose about this topic: How many of us (health professionals) know about the world's situation or even our countries' themselves? How it affects the nursing performance? Which one can be our role? Maybe, it is a research issue but here it is treated like a topic revision, using like reference my country's reality