2008 Publications
-Topics in Global Public Health.
-Nongovernmental Organizations in Musculoskeletal Care, Orthopaedic Overseas.
-Cost-Effectiveness of a District Trauma Hospital in Battambang, Cambodia.
-Open Versus Closed Management of Burn Wounds in a Low-Income Developing Country.
The Burden of Musculoskeletal Injuries in Low and Middle Income Countries: Challenges and Opportunities.
Spiegel D.A., Gosselin R.A., Coughlin R.R., et. al. The Burden of Musculoskeletal Injuries in Low and Middle Income Countries: Challenges and Opportunities. Journal of Bone & Joint Surgery, April 2008: Vol, 90, Issue 4, pp. 915-23.
Abstract
The global burden of injury is substantial, and injuries are predicted to be a leading cause of death and disability over the next few decades1-6. The majority of this burden will be borne by low and middle-income countries, where preventive strategies are often nonexistent and barriers to the timely and appropriate care of the injured include absent or inefficient systems for the delivery of trauma care, inadequacies in the number and the distribution of health-care facilities and workers, a lack of infrastructure and/or physical resources, and a lack of education and training. Addressing the burden of injury in low and middle-income countries has become a public health priority. So-called essential services, which are low-cost, high-yield, and target major health problems, should be made available to every person in the world7-10. While surgery has been traditionally viewed as a high-cost treatment lying outside the realm of the traditional public health model, evidence is emerging that the burden of surgical diseases such as trauma is substantial, and that essential surgery may be a cost-effective addition to the health system in low and middle-income countries11,12. The goals for this review were (1) to provide a public health perspective on the burden of injury in low and middle-income countries, (2) to discuss the delivery of musculoskeletal trauma care in resource-challenged environments, (3) to highlight deficiencies in physical resources and human resources for health care, (4) to outline approaches to teaching and training, and (5) to describe the information flow between economically developed and underdeveloped regions.
Topics in Global Public Health.
Spiegel D., Gosselin R., Coughlin R. Topics in Global Public Health. Clinical Orthopaedics and Related Research, October 2008, Vol. 466, Issue 10, pp. 2377.
Abstract
Deficiencies in the delivery of musculoskeletal trauma care in low- and middle-income countries can be attributed to a variety of causes, all of which can be linked to failure of the health system to deliver the necessary services to prevent death and disability. As such, a "systems" approach will be required to improve the delivery of services. The goal of this review is to familiarize the orthopaedic surgeon with selected topics in public health, including health systems, burden of disease, disability adjusted life year (DALY), cost-effective analysis, and related concepts (eg, met versus unmet need, access, utilization, effective coverage).
Nongovernmental Organizations in Musculoskeletal Care, Orthopaedic Overseas.
Coughlin R. R., Kelly N., Berry W. Nongovernmental Organizations in Musculoskeletal Care, Orthopaedic Overseas. Clinical Orthopaedics and Related Research, October 2008, Vol. 466, pp. 2438-2442.
Abstract
Injuries are a major worldwide contributor to morbidity and mortality. The negative impact caused by such injuries is disproportionately heavy in developing countries. Such disparities are caused by a complex array of problems, including a lack of physical resources, poor infrastructure, and a shortage of trained health professionals. Overcoming such deficits in care will require the involvement of organizations that can offer broad-based solutions. These organizations must bridge the gap between private and public institutions to establish a systems-based approach to program development and institution-building. They must provide not just an adequate level of care, but a transfer of knowledge that leads to sustainable and cost-effective intervention. Orthopedics Overseas is an example of such an organization. We examine the development of Orthopedics Overseas and describe their interventions in Uganda as a case-study to show the unique position they have to affect change.
Cost-Effectiveness of a District Trauma Hospital in Battambang, Cambodia.
Gosselin R.A., Heitto M. Cost-Effectiveness of a District Trauma Hospital in Battambang, Cambodia. World Journal of Surgery, 2008, Vol. 32, Issue 11, pp.2450-2453.
Abstract
The Emergency Hospital in Battambang, Cambodia, is essentially a surgical center for victims of injuries. Using methods previously described, operating costs were calculated, and effectiveness of treatment was estimated for 957 patients undergoing 895 surgical procedures over a 3 month period (October--December 2006). Results of the cost-effectiveness analysis are compared to the few existing ones in the literature. At $77.4 per DALY averted, surgery for trauma in such a context is deemed very cost-effective and compares favorably to other non-surgical public health interventions.
Open Versus Closed Management of Burn Wounds in a Low-Income Developing Country.
Gosselin R.A., Kuppers B. Open Versus Closed Management of Burn Wounds in a Low-Income Developing Country. Burns, 2008, Vol 34., Issue 5, pp. 644-647.
Abstract
Over a 38 month period, 264 patients were admitted for management of burns at the Emergency referral hospital in the resource-poor West African country of Sierra Leone. 244 charts and records were available for review, and 196 met the study's inclusion criteria. For the first 27 months, 158 patients were treated with the closed method and for the last 11 months of the study, 86 patients were treated with the open (exposure) method. Overall, the open method had as good or better early outcomes than the closed method, at significantly lower costs, and is the recommended treatment for burns in this particular type of environment.
