Medical Department, Médecins Sans Frontières-South Africa, 49 Jorrisen St, Braamfontein 2017, Johannesburg, South Africa.
World J Surg. 2011 Jun;35(6):1169-72; discussion 1173-4. doi: 10.1007/s00268-011-1084-9.
Humanitarian surgical programs are set up de novo, within days or hours in emergency or disaster settings. In such circumstances, insuring quality of care is extremely challenging. Basic structural inputs such as a safe structure, electricity, clean water, a blood bank, sterilization equipment, a post-anesthesia recovery unit, appropriate medications should be established. Currently, no specific credentials are needed for surgeons to operate in a humanitarian setting; the training of more humanitarian surgeons is desperately needed. Standard perioperative protocols for the humanitarian setting after common procedures such as Cesarean section, burn care, open fractures, and amputations and antibiotic prophylaxis, and post-operative pain management must be developed. Outcome data, especially long-term outcomes, are difficult to collect as patients often do not return for follow-up and may be difficult to trace; standard databases for post-operative infections and mortality rates should be established. Checklists have recently received significant attention as an instrument to support the improvement of surgical quality; knowing which items are most applicable to humanitarian settings remains unknown. In conclusion, the quality of surgical services in humanitarian settings must be regulated. Many other core medical activities of humanitarian organizations such as therapeutic feeding, mass vaccination, and the treatment of infectious diseases, such as tuberculosis and human immunodeficiency virus, are subject to rigorous reporting of quality indicators. There is no reason why surgery should be exempted from quality oversight. The surgical humanitarian community should pull together before the next disaster strikes.
人道主义外科项目是在紧急或灾难情况下新设立的，通常在几天或几小时内设立。在这种情况下，确保医疗质量极具挑战性。应当建立基本的结构投入，如安全的建筑结构、电力、清洁水、血库、消毒设备、麻醉后恢复单元和适当的药物。目前，在人道主义环境中进行手术不需要特定的资质；迫切需要培训更多的人道主义外科医生。在常规剖宫产、烧伤护理、开放性骨折和截肢以及抗生素预防以及术后疼痛管理等常见手术后，必须制定人道主义环境下的围手术期标准协议。由于患者通常不返回进行随访且难以追踪，因此难以收集术后数据，特别是长期结果；应建立术后感染和死亡率的标准数据库。清单最近作为一种支持提高手术质量的工具受到了极大关注；但仍不清楚哪些项目最适用于人道主义环境。总之，必须规范人道主义环境中的外科服务质量。人道主义组织的许多其他核心医疗活动，如治疗性喂养、大规模疫苗接种以及结核病和人类免疫缺陷病毒等传染病的治疗，都需要严格报告质量指标。没有理由将手术排除在质量监督之外。在下一次灾难发生之前，外科人道主义界应该团结起来。
