2009 Publications
-Injuries: The Neglected Burden in Developing Countries.
-Quantifying Surgical Capacity in Sierra Leone: a Guide for Improving Surgical Care.
Injuries: The Neglected Burden in Developing Countries.
Gosselin R.A. Spiegel D.A., Coughlin R.R., Zirkle K.G. Injuries: The Neglected Burden in Developing Countries. World Health Organization Bulletin, 2009, Vol. 87, Issue 4, pp. 246-47.
Link: http://www.who.int/bulletin/volumes/87/4/08-052290/en/index.html
Abstract
Injuries are a neglected epidemic in developing countries,1,2 causing more than five million deaths each year, roughly equal to the number of deaths from HIV/AIDS, malaria and tuberculosis combined. The seminal Global burden of disease and risk factors study estimated that injuries accounted for more than 15% of all ill-health in the world in 1990 and forecast this to increase to 20% by 2020. More recent calculations have corroborated this alarming trend.2 There are no definitive data on the number of people who survive with some form of permanent disability for every injury-related death, but estimates run between 10 and 50 times more.1 More than 90% of injury deaths occur in low- and middle-income countries, where preventive efforts are often nonexistent, and health-care systems are least prepared to meet the challenge. As such, injuries clearly contribute to the vicious cycle of poverty and the economic and social costs have an impact on individuals, communities and societies. The socioeconomic impact of injury-related disability is magnified in low-income countries, where there are often poorly developed trauma care and rehabilitation systems and little or no social welfare infrastructure. Of all categories of injury, road traffic crashes have appropriately received the greatest attention. Economic development in low-income countries is accompanied by an increase in the number of vehicles, with the associated rise in traffic-related crashes, injuries and deaths. The estimated annual cost of road traffic injuries is more than US$ 500 billion, which far exceeds the total global expenditures in developmental assistance. For every death from a road traffic crash, there are many more hospitalizations, emergency department visits and injuries, often leading to permanent disability.
Quantifying Surgical Capacity in Sierra Leone: a Guide for Improving Surgical Care.
Kingham T.P., Kamara T.B., Cherian M.N., Gosselin R.A., et. al. Quantifying Surgical Capacity in Sierra Leone: a Guide for Improving Surgical Care. Archives of Surgery, 2009, Vol. 144, Issue 2, pp. 122-27.
Abstract
Lack of access to surgical care is a public health crisis in developing countries. There are few data that describe a nation's ability to provide surgical care. This study combines information quantifying the infrastructure, human resources, interventions (ie, procedures), emergency equipment and supplies for resuscitation, and surgical procedures offered at many government hospitals in Sierra Leone. Site visits were performed in 2008 at 10 of the 17 government civilian hospitals in Sierra Leone. The World Health Organization's Tool for Situational Analysis to Assess Emergency and Essential Surgical Care was used to assess surgical capacity. There was a paucity of electricity, running water, oxygen, and fuel at the government hospitals in Sierra Leone. There were only 10 Sierra Leonean surgeons practicing in the surveyed government hospitals. Many procedures performed at most of the hospitals were cesarean sections, hernia repairs, and appendectomies. There were few supplies at any of the hospitals, forcing patients to provide their own. There was a disparity between conditions at the government hospitals and those at the private and mission hospitals. There are severe shortages in all aspects of infrastructure, personnel, and supplies required for delivering surgical care in Sierra Leone. While it will be difficult to improve the infrastructure of government hospitals, training additional personnel to deliver safe surgical care is possible. The situational analysis tool is a valuable mechanism to quantify a nation's surgical capacity. It provides the background data that have been lacking in the discussion of surgery as a public health problem and will assist in gauging the effectiveness of interventions to improve surgical infrastructure and care.
Population Health Metrics for Surgery: Effective Coverage of Surgical Services in Low-Income and Middle-Income Countries.
Ozgediz D., Hsia R., Weiser T., Gosselin R.A., et. al. Population Health Metrics for Surgery: Effective Coverage of Surgical Services in Low-Income and Middle-Income Countries. World Journal of Surgery, January 2009, Vol. 33, Issue 1, pp. 1-5.
Abstract
Lack of access to surgical care is a public health crisis in developing countries. There are few data that describe a nation's ability to provide surgical care. This study combines information quantifying the infrastructure, human resources, interventions (ie, procedures), emergency equipment and supplies for resuscitation, and surgical procedures offered at many government hospitals in Sierra Leone. Site visits were performed in 2008 at 10 of the 17 government civilian hospitals in Sierra Leone. The World Health Organization's Tool for Situational Analysis to Assess Emergency and Essential Surgical Care was used to assess surgical capacity. There was a paucity of electricity, running water, oxygen, and fuel at the government hospitals in Sierra Leone. There were only 10 Sierra Leonean surgeons practicing in the surveyed government hospitals. Many procedures performed at most of the hospitals were cesarean sections, hernia repairs, and appendectomies. There were few supplies at any of the hospitals, forcing patients to provide their own. There was a disparity between conditions at the government hospitals and those at the private and mission hospitals. There are severe shortages in all aspects of infrastructure, personnel, and supplies required for delivering surgical care in Sierra Leone. While it will be difficult to improve the infrastructure of government hospitals, training additional personnel to deliver safe surgical care is possible. The situational analysis tool is a valuable mechanism to quantify a nation's surgical capacity. It provides the background data that have been lacking in the discussion of surgery as a public health problem and will assist in gauging the effectiveness of interventions to improve surgical infrastructure and care.
