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


METHODS
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 components to strengthen local capacity and ownership. Our experience identified strategies for fair patient selection and might provide a model for potentially sustainable surgical system building in postconflict environments.
Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.|Health for the Caucasus e.V., Cottbus, Germany.
Fatima I
FI
Lunze
Health for the Caucasus e.V., Cottbus, Germany.|Department of Medicine, Boston University School of Medicine, Boston, MA, USA; karsten.lunze@post.harvard.edu.
Karsten
K
Lunze
Department of Surgery, Vladikavkaz Children's Hospital, Vladikavkaz, Russian Federation.
Zemfira M
ZM
Tsorieva
Department of Surgery, Vladikavkaz Children's Hospital, Vladikavkaz, Russian Federation.
Constantin T
CT
Esenov
Ministry of Health North Ossetia, Vladikavkaz, Russian Federation.|Federal Hospital Beslan, Beslan, Russian Federation.
Alexandr
A
Reutov
Health for the Caucasus e.V., Cottbus, Germany.|ENT Department, Carl Thiem Hospital Cottbus, Cottbus, Germany.
Thomas
T
Eichhorn
Health for the Caucasus e.V., Cottbus, Germany.|ENT Department, Freiburg University, Freiburg im Breisgau, Germany.
Christian
C
Offergeld
D000293:Adolescent; D000328:Adult; D001469:Barotrauma / Q000150:complications / Q000601:surgery*; D057191:Capacity Building / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D004432:Ear, Middle / Q000293:injuries / Q000601:surgery*; D005107:Explosions; D005260:Female; D005858:Germany; D014943:Global Health; D006297:Health Services Accessibility; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007391:International Cooperation; D007393:International Educational Exchange; D008297:Male; D016730:Program Development / Q000379:methods*; D012426:Russia; D013514:Surgical Procedures, Operative / Q000193:education*
capacity building; ear–nose–throat surgery; humanitarian surgery; mid-income countries; otologic surgery; otologic trauma; terrorism