Global surgery in a postconflict setting - 5-year results of implementation in the Russian North Caucasus

• Published in: Global Health Action
• Main Authors: Fatima I. Lunze, Karsten Lunze, Zemfira M. Tsorieva, Constantin T. Esenov, Alexandr Reutov, Thomas Eichhorn, Christian Offergeld
• Format: Article in Journal/Newspaper
• Language: English
• Published: Taylor & Francis Group 2015
• Subjects: humanitarian surgery; capacity building; mid-income countries; terrorism; ear–nose–throat surgery; otologic surgery; otologic trauma; Public aspects of medicine; RA1-1270; Russian North
• Online Access: https://doi.org/10.3402/gha.v8.29227; https://doaj.org/article/53e8840f897043e7869dbce8227216ff

Background: Collaborations for global surgery face many challenges to achieve fair and safe patient care and to build sustainable capacity. The 2004 terrorist attack on a school in Beslan in North Ossetia in the Russian North Caucasus left many victims with complex otologic barotrauma. In response, we implemented a global surgery partnership between the Vladikavkaz Children's Hospital, international surgical teams, the North Ossetian Health Ministry, and civil society organizations. This study's aim was to describe the implementation and 5-year results of capacity building for complex surgery in a postconflict, mid-income setting. Design: We conducted an observational study at the Children's Hospital in Vladikavkaz in the autonomous Republic of North Ossetia-Alania, part of the Russian Federation. We assessed the outcomes of 15 initial patients who received otologic surgeries for complex barotrauma resulting from the Beslan terrorism attack and for other indications, and report the incidence of intra- and postoperative complications. Results: Patients were treated for trauma related to terrorism (53%) and for indications not related to violence (47%). None of the patients developed peri- or postoperative complications. Three patients (two victims of terrorism) who underwent repair of tympanic perforations presented with re-perforations. Four junior and senior surgeons were trained on-site and in Germany to perform and teach similar procedures autonomously. Conclusions: In mid-income, postconflict settings, complex surgery can be safely implemented and achieve patient outcomes comparable to global standards. Capacity building can build on existing resources, such as operation room management, nursing, and anesthesia services. In postconflict environments, substantial surgical burden is not directly attributable to conflict-related injury and disease, but to health systems weakened by conflicts. Extending training and safe surgical care to include specialized interventions such as microsurgery are integral ...