在索马里提供外科护理：任务转移模式。
Providing surgical care in Somalia: A model of task shifting.
机构信息
Médecins sans Frontières, 49 Jorrisen St, Braamfontein 2017, Johannesburg, South Africa.
出版信息
Confl Health. 2011 Jul 15;5:12. doi: 10.1186/1752-1505-5-12.
BACKGROUND
Somalia is one of the most political unstable countries in the world. Ongoing insecurity has forced an inconsistent medical response by the international community, with little data collection. This paper describes the "remote" model of surgical care by Medecins Sans Frontieres, in Guri-El, Somalia. The challenges of providing the necessary prerequisites for safe surgery are discussed as well as the successes and limitations of task shifting in this resource-limited context.
METHODS
In January 2006, MSF opened a project in Guri-El located between Mogadishu and Galcayo. The objectives were to reduce mortality due to complications of pregnancy and childbirth and from violent and non-violent trauma. At the start of the program, expatriate surgeons and anesthesiologists established safe surgical practices and performed surgical procedures. After January 2008, expatriates were evacuated due to insecurity and surgical care has been provided by local Somalian doctors and nurses with periodic supervisory visits from expatriate staff.
RESULTS
Between October 2006 and December 2009, 2086 operations were performed on 1602 patients. The majority (1049, 65%) were male and the median age was 22 (interquartile range, 17-30). 1460 (70%) of interventions were emergent. Trauma accounted for 76% (1585) of all surgical pathology; gunshot wounds accounted for 89% (584) of violent injuries. Operative mortality (0.5% of all surgical interventions) was not higher when Somalian staff provided care compared to when expatriate surgeons and anesthesiologists.
CONCLUSIONS
The delivery of surgical care in any conflict-settings is difficult, but in situations where international support is limited, the challenges are more extreme. In this model, task shifting, or the provision of services by less trained cadres, was utilized and peri-operative mortality remained low demonstrating that safe surgical practices can be accomplished even without the presence of fully trained surgeon and anesthesiologists. If security improves in Somalia, on-site training by expatriate surgeons and anesthesiologists will be re-established. Until then, the best way MSF has found to support surgical care in Somalia is continue to support in a "remote" manner.
背景
索马里是世界上政治最不稳定的国家之一。持续的不安全局势迫使国际社会作出不一致的医疗应对，很少收集数据。本文介绍了无国界医生组织在索马里古里-埃尔采用的“远程”外科护理模式。本文讨论了在资源有限的情况下提供安全手术所需前提条件所面临的挑战，以及任务转换在此类环境中的成功和局限性。
方法
2006 年 1 月，无国界医生组织在摩加迪沙和加勒卡约之间的古里-埃尔开设了一个项目。项目目标是降低孕产妇和分娩并发症以及暴力和非暴力创伤导致的死亡率。在项目开始时，外籍外科医生和麻醉师建立了安全的手术操作规范，并进行了手术。2008 年 1 月以后，由于局势不安全，外籍人员被撤离，当地索马里医生和护士提供外科护理，定期有外籍工作人员进行监督访问。
结果
2006 年 10 月至 2009 年 12 月期间，对 1602 名患者进行了 2086 次手术。大多数患者（1049 例，65%）为男性，中位数年龄为 22 岁（四分位间距，17-30 岁）。1460 次干预（70%）为紧急情况。创伤占所有外科病理的 76%（1585 例）；枪伤占暴力伤害的 89%（584 例）。与由外籍外科医生和麻醉师提供护理相比，当由索马里工作人员提供护理时，手术死亡率（所有外科手术的 0.5%）并未升高。
结论
在任何冲突环境中提供外科护理都很困难，但在国际支持有限的情况下，挑战更加极端。在这种模式下，利用了任务转换，即由训练程度较低的医务人员提供服务，并且围手术期死亡率仍然较低，这表明即使没有完全训练有素的外科医生和麻醉师，也可以实现安全的手术操作。如果索马里的安全状况得到改善，将重新由外籍外科医生和麻醉师进行现场培训。在那之前，无国界医生组织发现支持索马里外科护理的最佳方式是继续以“远程”方式提供支持。
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