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 Mauvaises Motivations • Implémenter les compétences Cure rafraichissante loin des frustrations de la pratique médicale européenne. des professionels locaux Recherche de satisfactions plus intenses Retour aux motivations initiales de nos choix • Améliorer les infrastructures professionels. locales et l’organization locale Amélioration des compétences Recherches de compétences connexes. Implémenter sa créativité. • Mettre en route des Repenser nos choix des couts / bénéfices programmes de soins Soigner des personnes qui autrement ne le seraient pas

Humanitarin Efforts <> Humanitarian Colonialism • No operations abroad that one would not do on one’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 • Discrète • Sponsorisable • Financement réduit • Politiquement pervertis • Rarement perverties • Peu d’interactions locales • Importante interaction locale • Follow up discutable • Résultats mieux quantifiables • Pas d’implementation locale • Importante amélioration locale • One shot • Suivie • Efficacité a cours terme • Efficacité sur le long terme • Plus égalitaire mais manipulable • Privilégie une institution • Limitée a certaines pathologie • 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, on 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.

Outcomes Assessments The importance of metrics hopes to be able to do this type of research once 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.

Evaluation of f Outcomes : the scientific Method

. Humanitarian otologic missions: long-term surgical results. 0tolaryngology-Head and Neck Surgery (2009)140, 559 Horlbeck D 1 , 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.