title: Ethical and Surgical Dilemmas in Patients with Neglected Surgical Diseases Visiting a Field Hospital in a Zone of Recent Disaster.
abstract: The massive typhoon Haiyan (Yolanda) ripped across the central Philippines on November 8, 2013, and damaged infrastructure including hospitals. The Israeli Defense Forces field hospital was directed by the Philippine authorities to Bogo City in the northern part of the island of Cebu, to assist the damaged local hospital. Hundreds of patients with neglected diseases sought for medical treatment which was merely out of reach for them. Our ethical dilemmas were whether to intervene, when the treatment we could offer was not the best possible.
  
  
  
  Each patient had an electronic medical record that included diagnosis, management and aftercare instructions. We retrospectively reviewed all charts of patients.
  
  
  
  Over 200 patients presented with neglected chronic diseases (tuberculosis, goiter, hypertension and diabetes). We limited our intervention to extreme values of glucose and blood pressure. We had started anti-tuberculosis medications, hoping that the patients will have an option to continue treatment. We examined 85 patients with a presumed diagnosis of malignancy. Without histopathology and advanced imaging modality, we performed palliative operations on three patients. Eighteen patients presented with inguinal hernia. We performed pure tissue repair on seven patients with large symptomatic hernias. We examined 12 children with cleft lip/palate and transferred two of them to Israel. We operated on one child with bilateral club feet. Out of 37 patients with pterygium, our ophthalmologist repaired the nine patients with the most severe vision disturbance.
  
  
  
  Medical delegations to disaster areas should prepare a plan and appropriate measures to deal with non-urgent diseases.
authors.affiliation: The Surgical Division, Kaplan Medical Center, Rehovot, Israel. ofralin@gmail.com.
authors.forename: Guy
authors.initials: G
authors.lastname: Lin
authors.affiliation: Department of Otolaryngology, Assaf Harofeh Medical Center, Zerifin, Israel.
authors.forename: Tal
authors.initials: T
authors.lastname: Marom
authors.affiliation: Office of the Surgeon General, The Israel Defense Forces, Tel Hashomer, Israel.
authors.forename: David
authors.initials: D
authors.lastname: Dagan
authors.affiliation: The Trauma Unit, Shaare Zedek Medical Center, Jerusalem, Israel.
authors.forename: Ofer
authors.initials: O
authors.lastname: Merin
mesh_terms: D002648:Child; D002908:Chronic Disease / Q000453:epidemiology / Q000628:therapy; D055867:Cyclonic Storms; D004190:Disasters; D005260:Female; D006801:Humans; D008507:Medically Underserved Area; D008952:Mobile Health Units; D058069:Neglected Diseases / Q000453:epidemiology / Q000628:therapy*; D010679:Philippines / Q000453:epidemiology; D011204:Poverty Areas; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000941:ethics / Q000706:statistics & numerical data*