title: Surgical skills needed for humanitarian missions in resource-limited settings: common operative procedures performed at Médecins Sans Frontières facilities.
abstract: BACKGROUND
  Surgeons in high-income countries increasingly are expressing interest in global surgery and participating in humanitarian missions. Knowledge of the surgical skills required to adequately respond to humanitarian emergencies is essential to prepare such surgeons and plan for interventions.
  
  
  METHODS
  A retrospective review of all surgical procedures performed at Médecins Sans Frontières Brussels facilities from June 2008 to December 2012 was performed. Individual data points included country of project; patient age and sex; and surgical indication and surgical procedure.
  
  
  RESULTS
  Between June 2008 and December 2012, a total of 93,385 procedures were performed on 83,911 patients in 21 different countries. The most common surgical indication was for fetal-maternal pathologies, accounting for 25,548 of 65,373 (39.1%) of all cases. The most common procedure was a Cesarean delivery, accounting for a total of 24,182 or 25.9% of all procedures. Herniorrhaphies (9,873/93,385, 10.6%) and minor surgeries (11,332/93,385, 12.1%), including wound debridement, abscess drainage and circumcision, were also common.
  
  
  CONCLUSIONS
  A basic skill set that includes the ability to provide surgical care for a wide variety of surgical morbidities is urgently needed to cope with the surgical need of humanitarian emergencies. This review of Médecins Sans Frontières's operative procedures provides valuable insight into the types of operations with which an aspiring volunteer surgeon should be familiar.
authors.affiliation: Centre for Global Surgery, McGill University Health Centre, Montreal, QC, Canada; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Surgeons OverSeas (SOS), New York, NY. Electronic address: evan.wong@mail.mcgill.ca.
authors.forename: Evan G
authors.initials: EG
authors.lastname: Wong
authors.affiliation: Surgery, Anesthesia, Gynecology, and Emergency Medicine Unit, Médecins Sans Frontières, Brussels, Belgium.
authors.forename: Miguel
authors.initials: M
authors.lastname: Trelles
authors.affiliation: Surgery, Anesthesia, Gynecology, and Emergency Medicine Unit, Médecins Sans Frontières, Brussels, Belgium.
authors.forename: Lynette
authors.initials: L
authors.lastname: Dominguez
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Surgeons OverSeas (SOS), New York, NY; Department of Surgery, University of California San Francisco-East Bay, Oakland, CA.
authors.forename: Shailvi
authors.initials: S
authors.lastname: Gupta
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Burnham
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Surgeons OverSeas (SOS), New York, NY; Department of Surgery, Columbia University, New York, NY.
authors.forename: Adam L
authors.initials: AL
authors.lastname: Kushner
mesh_terms: D000533:Altruism; D000556:Ambulatory Surgical Procedures; D002983:Clinical Competence / Q000592:standards*; D003906:Developing Countries; D054597:Disaster Medicine / Q000592:standards / Q000706:statistics & numerical data; D004630:Emergencies; D005260:Female; D006295:Health Resources; D006801:Humans; D008297:Male; D008493:Medical Missions; D009938:Organizations; D011247:Pregnancy; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000592:standards* / Q000706:statistics & numerical data; D014838:Volunteers