laide humanitaire J.Daele ORL Chirurgie Cervico Faciale CHR - - PowerPoint PPT Presentation

Les enje jeux et contraintes de l’aide humanitaire

J.Daele ORL – Chirurgie Cervico Faciale CHR Citadelle 4000 Liège Belgium Jacques.daele@chrcitadelle.be drjdaele@gmail.com

Medecine humanitaire

Bonnes motivations

• Implémenter les compétences

des professionels locaux

• Améliorer les infrastructures

locales et l’organization locale

• Mettre en route des

programmes de soins

Mauvaises Motivations

Cure rafraichissante loin des frustrations de la pratique médicale européenne. Recherche de satisfactions plus intenses Retour aux motivations initiales de nos choix professionels. Amélioration des compétences Recherches de compétences connexes. Implémenter sa créativité. Repenser nos choix des couts / bénéfices Soigner des personnes qui autrement ne le seraient pas

Humanitarin Efforts <> Humanitarian Colonialism

• No operations abroad that one would not do on
• ne’s own private patients
• Residents should be supervised like at home
• The same rules (Ethic commitee and inform

consents) for technical improvements while humanitarian missions

Considérations Ethiques

• 1 Mêmes exigences éthiques qu’ ici
• 2- Connaissances préalable des conditions de

travail

• 3- Evaluation des résultats

KNOWLEDGES OF THE LOCAL CONDITIONS

• Hip prosthesis for people who are used to squatting
• Heavy equipment that goes to the rust because the

maintenance costs

• Distribution of the aids via inadequate channels
• The low hospital costs ( 3 US dollar / day )
• The priceless costs of modern techniques only

accessible for the richs

KNOWLEDGES OF THE LOCAL CONDITIONS

• Hip prosthesis for people who are used to squatting
• Heavy equipment that goes to the rust because the

maintenance costs

• Distribution of the aids via inadequate channels
• The low hospital costs ( 3 US dollar / day )
• The priceless costs of modern techniques only

accessible for the richs

We have also to recognize that the medical environments are sometimes far away from he western paradigms

So it means that you must have large surgical experience for operating in sometimes bad conditions

And surprising landscape

But sometimes approaching the western standards

But sometimes approaching the western standards

Self supporting the ultimate goal

• Surgery
• Teaching
• Health programs

EAR CAMP

Ear Camp <> Surgical missions

• Médiatique
• Sponsorisable
• Politiquement pervertis
• Peu d’interactions locales
• Follow up discutable
• Pas d’implementation locale
• One shot
• Efficacité a cours terme
• Plus égalitaire mais manipulable
• Limitée a certaines pathologie
• Discrète
• Financement réduit
• Rarement perverties
• Importante interaction locale
• Résultats mieux quantifiables
• Importante amélioration locale
• Suivie
• Efficacité sur le long terme
• Privilégie une institution
• Accessible a certaines chirurgie

Some rules for effective surgical missions

• 20 operations performed perfectly for the purposes of teaching are

beter than hundred amateurishe ones performed by volonteer surgeons

• Smaller teams of two or competent visiting surgeons staying longer,
• n par with their local colleagues and with the local medical

environment(materials,nurses).

• Money saved by no sending many people with donors money could

be used to establish funds to cover the cost of the operations performed by the local surgeons who have been trained by us

Evaluations of the outcomes and criticisms

Outcomes – Metrical measures

• Great variations according to mission location

and resources

• Expectations abroad versus those of here

differ

• An increased focus on local training will probably

have the greatest effect in the long run.

Evaluation of outcomes: 3 methods

• Empiric
• Collective
• Scientific

Evaluation of f outcomes : : the empiric method

• The ability to return to the same location and limiting the scope of

the mission by example to ear disease give the unique opportunity to collect data, evaluate results, and quantify patient benefits

• While programs are beginning to quantify their missions abroad using

data analysis, some missions continue to measure their successes through individual patient follow-up and local doctor training.

• Have long-standing relationships with providers in local countries, and

so to get feedback on the patients there as well as here. It’s not a whole lot different than how we measure outcomes here at home, which is to say we don’t apart from clinical studies

Evaluation of f outcomes : : the collective method

• approximately 10 to 15 percent of the 9,000 members of the American

Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) participate in international medical missions.

• Several groups are in the process of establishing approaches to measure

the effectiveness of their programs.

• The group met in October 2015 to discuss these issues, and plans to draft a

post-trip action survey to assess the effectiveness of their techniques abroad, such as training local doctors and involving them in the administration of treatment.

SMILE

• According to the organization’s 2010 Annual Report, between July 1,

2008 and June 30, 2009, Operation Smile volunteers travelled to 22 countries, providing free surgical treatment for 12,993 children and young adults, which resulted in 12,993 documented successful

• surgeries. All Operation Smile surgeries are evaluated internally by a

medical oversight board, and the group relies on data collected in the field to help it evaluate procedures. Follow-up is encouraged for every patient, but there are some mission sites in rural areas where the percentage of patients who return for the 6-month follow-up are low, whereas more populated areas have a follow-up rate of around 70 percent.

The importance of metrics hopes to be able to do this type of research

• nce the program has graduated out of its early stages.

Metrics would be valuable, because we need to know if what we are doing has a positive impact, and what we could do better. Outcome data will also be important for raising money if we establish a foundation, and for giving information to other physicians who might be interested in coming here.

Outcomes Assessments

Evaluation of f Outcomes : the scientific Method

.

Humanitarian otologic missions: long-term surgical results.

0tolaryngology-Head and Neck Surgery (2009)140, 559

Horlbeck D1, Boston M, Balough B, Sierra B, Saenz G, Heinichen J, Duckworth L. Abstract OBJECTIVE: The purpose of this study was to determine the efficacy of treating chronic ear disease by performing a single surgical intervention in the austere environment of a developing nation. SUBJECTS AND METHODS: Data were collected from retrospective chart reviews on 121 patients who underwent surgical treatment of chronic ear disease during humanitarian surgical missions in South and Central America. Surgical outcomes and clinical course were assessed at 10 to 12 months after the initial surgery. RESULTS: A total of 117 patients were included in the study. Follow-up records were available for 75 patients (64%). A total of 20 surgeries were performed for dry perforations (group 1), 30 for chronically draining ears (group 2), and 25 for cholesteatomas (group 3). Surgical success was determined as 60 percent, 74 percent, and 92 percent for groups 1, 2, and 3, respectively. CONCLUSIONS:

Surgical results during international otologic outreach missions to developing nations fall within the results expected in developed nations.

J Oral Maxillofac Surg. 2012 Feb;70(2):e147-57.

Survey of residents who have participated in humanitarian medical missions.

Aziz SR1, Ziccardi VB, Chuang SK. Abstract PURPOSE: To survey physicians who participated in humanitarian missions as residents to assess the value of this experience on residency training and future career choices. MATERIALS AND METHODS: An anonymous 26-question survey was electronically mailed to 45 individuals identified as having participated in a cleft lip/palate mission during residency. The survey was created and distributed, and the data were collected using the online survey engine Survey Monkey. RESULTS: Thirty-nine individuals (86.7%) completed the survey. Of these, 27 were men (69.2%) and 12 were women (30.8%). Thirty-two (82.1%) were oral and maxillofacial surgeons, 4 (10.3) were plastic and reconstructive surgeons, 1 (2.6%) was an otolaryngologist, and 2 (5.1%) were pediatric dentists. Twenty-five respondents (64.1%) stated that, before their first mission, they had not operated on a primary cleft lip; 21 (53.8%) noted that they had not operated on a primary cleft palate before their first mission. Thirty-six (92.3%) noted that their mission experience improved their ability to repair facial clefts. Thirty-seven (94.9%) believed their mission experience improved their overall surgical skill. All respondents (n = 39, 100%) believed their mission experience improved their

• verall ability to evaluate patients with cleft. Thirty-six (92.3%) believed their experience in humanitarian missions made them more

culturally sensitive/competent health care providers. Thirty-eight respondents (97.4%) believed these missions made them more socially aware of the differences in access/availability of health care globally. Thirty-eight (97.4%) believed that participation in a humanitarian mission was a high point of their residency. Thirty-seven (94.9%) planned to participate in humanitarian medical missions during their career after residency. CONCLUSION: All respondents believed that participation in a humanitarian mission during residency was a positive part of their training. In addition, these missions allowed the residents to develop as surgeons and improve their awareness of global health care and cultural competence. Given these important educational aspects, participation in a humanitarian mission should be considered a required part of residency training.

Otolaryngol Head Neck Surg 2000;123:722

Results of a humanitarian otologic and audiologic project performed outside of the United States: lessons learned from the "Oye, Amigos!" project.

Barrs DM1, Muller SP, Worrndell DB, Weidmann EW.

Abstract

From 1989 to 1993, "Oye, Amigos!" a combined group of hearing health and other medical professionals performed 18 humanitarian medical and audiologic trips to Tepic, Nayarit, Mexico. The group saw 1500 patients, issued over 800 hearing aids, and performed 150 surgeries on 123 patients. Our tympanoplasty success rate, defined as an intact tympanic membrane, was 41% during the first 2 years

• f the project but increased to 74% during the last 3 years. Two hundred eighteen patients who were

candidates for surgery did not return for care. We present the lessons learned from the surgical care and

• verall management of this project, and present suggestions to improve future projects.

• The rate of success is much higher abroad when the procedure has

been proven successful in the U.S.

• Procedures like cochlear implants are more difficult to do on

missions, although the need is there. Those are highly technical procedures with the need for a tremendous amount of peripheral support, and clearly that’s a place where you have to have that kind

• f long-term relationship and really have some good outcome

measures.

• Volunteers should avoid procedures that require ICU stays.
• One good rule should be to offer the types of procedures that are

minimally invasive, to relieve immediate discomfort, and that require little follow-up care, especially for missions that are short-term” (World J Surg. 2010 34(3):466-470).

• Training local physicians is the “major outcome variable” of the

missions abroad.

Self supporting the ultimate goal

• Surgery
• Teaching
• Health programs

Discussions informelles de cas cliniques

The most difficult hurdle to overcome in humanitarian aid is going on the first humanitarian mission It will require a sacrifice of time and money. You will be limited in your interactions within the host nation The contacts made during missions are very important

Conclusions

Le but final du travail humanitaire serait de permettre une amélioration définitive des paradigmes de soins fournis par nos collègues locaux capables de les assumer eux mêmes. Cet enjeux trancende les frontières, les politiques et les différences culturelles

Les missions chirurgicales peuvent fournir les soins necessaire a ceux qui autrement seraient incapables d’en bénéficier enraison des coûts et des ressources de leur pays

Ces missions offrent des opportunités de perfectionnement de notre aide et de nos missions A successful humanitarian surgical mission requires careful planning and coordination and can be challenging for those tasked with the responsibilities to organize and lead these missions.

Conclusions

So you are telling me that

You have so much drinkable water that you shit inside ?

• Finalement la question est: vaut-il mieux au nom de la conservation du

patrimoine de l'humanité préserver une culture minoritaire, ses croyances, ses valeurs et son organisation sociale quitte à consacrer la misère de ses adhérents,

• u au contraire la faire évoluer vers un folklore source d'un bien- être supérieur ?

Diversité <> Bonheur