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Surgical Burn Care by Médecins Sans Frontières-Operations Center Brussels: 2008 to 2014
Barclay T Stewart1, Miguel Trelles, Lynette Dominguez
1From the *Department of Surgery, University of Washington, Seattle; †Surgery, Anaesthesia, Gynaecology, and Emergency Medicine (SAGE) Unit, Médecins sans Frontières-Operational Centre Brussels, Surgical Unit, Brussels, Belgium; ‡Centre for Global Surgery, McGill University Health Centre, Montreal, QC, Canada; §Surgeons Over Seas (SOS), New York, New York; ‖General Referral Hospital, Médecins sans Frontières, Batangafo, Central African Republic; ¶Boost General Hospital, Médecins sans Frontières, Lashkar-Gah, Afghanistan; #General Referral Hospital, Médecins sans Frontières, Lubutu, Democratic Republic of the Congo; **District Headquarters Hospital, Médecins sans Frontières, Dargai, Pakistan; ††General Referral Hospital, Médecins sans Frontières, Masisi, Democratic Republic of the Congo; and ‡‡Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Abstract:
Humanitarian organizations care for burns during crisis and while supporting healthcare facilities in low-income and middle-income countries. This study aimed to define the epidemiology of burn-related procedures to aid humanitarian response. In addition, operational data collected from humanitarian organizations are useful for describing surgical need otherwise unmet by national health systems. Procedures performed in operating theatres run by Médecins Sans Frontières-Operations Centre Brussels (MSF-OCB) from July 2008 through June 2014 were reviewed. Surgical specialist missions were excluded. Burn procedures were quantified, related to demographics and reason for humanitarian response, and described. A total of 96,239 operations were performed at 27 MSF-OCB projects in 15 countries between 2008 and 2014. Of the 33,947 general surgical operations, 4,280 (11%) were for burns. This proportion steadily increased from 3% in 2008 to 24% in 2014. People receiving surgical care from conflict relief missions had nearly twice the odds of having a burn operation compared with people requiring surgery in communities affected by natural disaster (adjusted odds ratio, 1.94; 95% confidence interval, 1.46-2.58). Nearly 70% of burn procedures were planned serial visits to the theatre. A diverse skill set was required. Unmet humanitarian assistance needs increased US$400 million dollars in 2013 in the face of an increasing number of individuals affected by crisis and a growing surgical burden. Given the high volume of burn procedures performed at MSF-OCB projects and the resource intensive nature of burn management, requisite planning and reliable funding are necessary to ensure quality for burn care in humanitarian settings.