RESUMO

Introduction: On January 12, 2010, a 7.0 magnitude earthquake struck the Republic of Haiti. The human cost was enormous-an estimated 316,000 people were killed, and a further 300,000 were injured. The scope of the disaster was matched by the scope of the response, which remains the largest multinational humanitarian response to date. An extensive scoping review of the relevant literature was undertaken, to identify studies that discussed the civilian and military disaster relief efforts. The aim was to highlight the key-lessons learned, that can be applied to future disaster response practise. Methods: Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidance was followed. Seven scientific databases were searched, using consistent search terms-followed by an analysis of the existent Haitian literature. This process was supplemented by reviewing available grey literature. A total of 2,671 articles were reviewed, 106 of which were included in the study. In-depth analysis was structured, by aligning data to 12 key-domains, whilst also considering cross-sector interaction (Civilian-Civilian, Military-Military, and Civilian-Military). Dominant themes and lessons learned were identified and recorded in an online spreadsheet by an international research team. This study focuses on explicitly analysing the medical aspects of the humanitarian response. Results: An unpreceded collaborative effort between non-governmental organisations, international militaries, and local stakeholders, led to a substantial number of disaster victims receiving life and limb-saving care. However, the response was not faultless. Relief efforts were complicated by large influxes of inexperienced actors, inadequate preliminary needs assessments, a lack of pre-existing policy regarding conduct and inter-agency collaboration, and limited consideration of post-disaster redevelopment during initial planning. Furthermore, one critical theme that bridged all aspects of the disaster response, was the failure of the international community to ensure Haitian involvement. Conclusions: No modern disaster has yet been as devastating as the 2010 Haiti earthquake. Given the ongoing climate crisis, as well as the risks posed by armed conflict-this will not remain the case indefinitely. This systematic analysis of the combined civilian and military disaster response, offers vital evidence for informing future medical relief efforts-and provides considerable opportunity to advance knowledge pertaining to disaster response.

Assuntos

RESUMO

Abstract The aim of this article is to describe the bases and general aspects of the design and implementation process of the Comprehensive model for the humanization of health care of the Faculty of Medicine at the Universidad Nacional de Colombia, which began to be developed in 2016 and is also being implemented at the Hospital Universitario Nacional (HUN). Through this model, the Humanizing Health Care Research Group of the Faculty of Medicine seeks to produce a cultural change, from a biopsychosocial approach, in the perception of the humanization of health care in the country, the training of health care professionals, the provision of health care, and the working conditions of health care personnel. The model is based on three axes: humanization of health care, focused on the patient, their family and caregivers; humanization of health sciences education processes, with an emphasis on students; and humanization of the quality of life and working conditions of health professionals. Likewise, the model considers humanistic education, music and sports as means to achieve such cultural change in the Faculty of Medicine of the Universidad Nacional de Colombia.

Resumen El objetivo de este artículo fue describir las bases y generalidades del proceso de diseño e implemen-tación del Modelo de humanización integral en salud de la Facultad de Medicina de la Universidad Nacional de Colombia, el cual empezó a desarrollarse en 2016 y en la actualidad también se ha implementado en el Hospital Universitario Nacional (HUN). Con este modelo, el Grupo de Investigación en Humanización en Salud de la Facultad de Medicina de la Universidad Nacional de Colombia busca generar un cambio cultural en la percepción de la humanización de la salud en el país, de la formación de los profesionales de la salud, de la prestación de atención en salud y de las condiciones laborales del personal de salud, a partir de una aproximación biopsicosocial. El modelo se fundamenta en tres ejes: la humanización en la atención en salud, enfocada en el paciente, la familia y los cuidadores; la humanización en los procesos de educación en ciencias de la salud, con énfasis en los estudiantes, y la humanización en la calidad de vida y las condiciones laborales de los profesionales de la salud. Asimismo, el modelo considera la formación humanística, la música y el deporte como medios para lograr dicho cambio cultural en la Facultad de Medicina de la Universidad Nacional de Colombia.

RESUMO

RESUMEN El objetivo del artículo es describir y analizar la trayectoria de vida y las contribuciones humanitarias del Dr. Zambrano, médico egresado de la Escuela de Medicina de San Fernando, quién fue presidente del Centro de Estudiantes de Medicina en una época políticamente álgida en la educación universitaria pública. Emigró a los Estados Unidos en 1970, bajo el contexto de crisis sociopolítica económica en el Perú y en el mundo, donde se convirtió en un renombrado médico internista y cardiólogo del St. Luke's Hospital. A pesar de su lejanía, mantuvo un lazo estrecho con el Perú organizando múltiples misiones médicas para el beneficio de poblaciones vulnerables, capacitación al personal médico e implementación tecnológica del Hospital Regional de Cajamarca. En 2011 se inauguró el Centro Médico Educativo en Chincha, siendo Zambrano uno de los líderes para su construcción. A pesar de padecer una enfermedad invalidante dedicó hasta los últimos días de su vida a brindar ayuda a los más necesitados. Su trayectoria de vida nos muestra un ejemplo de compromiso con el Perú y de un ejercicio de la medicina comprometida con la solidaridad y el desarrollo de la medicina en su país de origen.

ABSTRACT The objective of the article is to describe and analyze the life trajectory and the humanitarian contributions of Dr. Zambrano, a physician who graduated from San Fernando Medical school, and was president of the Center for Medical Students at a politically critical time in public university education. He emigrated to the United States in 1970, in the context of sociopolitical crisis in Peru and the world, where he became a renowned internist and cardiologist at St. Luke's Hospital. Despite the distance, he maintained a close relationship with Peru, organizing multiple medical missions for underserved populations, training medical personnel, and providing technological implementation to Cajamarca Regional Hospital. In 2011, the Educational Medical Center was inaugurated in Chincha, with Zambrano being one of the leaders for its construction. Despite suffering from a disabling illness, he dedicated until the last days of his life, providing help for those most in need. His life trajectory shows us an example of commitment to Peru and practice of Medicine committed to solidarity and the development of Medicine in his country of origin.

RESUMO

This paper questions the pertinence of the humanitarian aid localization agenda in Latin America, at least in the narrow sense embraced by the 2016 World Humanitarian Summit. Localized support has been the standard practice in the region for decades, thanks to at least two correlated factors: the Monroe Doctrine limiting intervention to the USA and regional efforts to resist such intervention. Instead, humanitarian action in the region is an example of a particular way of understating localization, mainly specialized support to specific issues, no distinction between humanitarian or development divisions, and coexistence of different response approaches, synthesizing international and local experiences that intermingle with community practices and traditions, under national government leadership. Governments, together with NGOs, civil protection, and other relevant actors from international cooperation and development, engage in crises based on a long-standing tradition of risk management at national and regional levels. Fears of abuses hidden behind the non-interference principle, human rights activism, and disaster risk management approaches to emergencies created a complex ecosystem for humanitarian localization.

RESUMO

ABSTRACT Introduction: forensic science involves diverse scientific disciplines that apply their particular expertise to the legal and judicial system. However, in the last decades this science has been linked to humanitarian actions and human rights proceedings. Forensic dentistry plays a vital role in personal identification. The lip print analysis is a relatively a simple procedure used in this discipline. It consists of patterns evaluation of cracks in the elevations and depressions on the labial mucosa. The aim of this study was to determine the lip print patterns of a southern Colombian population in order to add evidence of preconditions for forensic issues as part of a humanitarian forensic action. Methods: a total of 384 participants ≥ 35 years old were included in this study. The lip prints were analyzed through Suzuki and Tsuchihashi's classification in order to identify the predominant lip prints in males and females. Descriptive analysis was used to determine the sample characteristics and a χ2 test was performed to analyze independence according to sex variable for these categorical data. Results: the analyses showed that Type I and I' together were the most commonly lip prints seen in this sample, followed by Type II. There were not statistical differences between males and females. Conclusions: the evaluation of lip prints is a cost-effective method, and it could be an alternative in developing countries, especially in those that address massive violations of human rights.

RESUMEN Introducción: la ciencia forense involucra diversas disciplinas científicas que aplican su experiencia particular al ámbito legal y judicial. Sin embargo, en las últimas décadas esta ciencia se ha relacionado con acciones humanitarias y procesos de derechos humanos. La odontología forense juega un papel vital en la identificación personal. El análisis de la huella labial es un procedimiento relativamente sencillo utilizado en esta disciplina. Éste consiste en la evaluación de patrones de fisuras en elevaciones y depresiones de la mucosa labial. El objetivo de este estudio fue determinar patrones de huella labial en una población del sur de Colombia, con el fin de agregar evidencia de precondiciones para problemas forenses como parte de una acción forense humanitaria. Métodos: en este estudio se incluyó un total de 384 participantes ≥ 35 años. Las huellas labiales se analizaron mediante la clasificación de Suzuki y Tsuchihashi para identificar el predominio en hombres y mujeres. Se utilizó un análisis descriptivo para identificar las características de la muestra y se realizó una prueba de χ2 para analizar la independencia en la variable sexo para estos datos categóricos. Resultados: los análisis mostraron que los Tipos I y I' en conjunto fueron las huellas labiales más comunes que se observaron, seguidas del Tipo II. No existieron diferencias estadísticas entre hombres y mujeres. Conclusiones: la evaluación de las huellas labiales es un método económico y podría ser una alternativa en países en desarrollo, especialmente en aquellos que sustentan violaciones masivas de derechos humanos.

Assuntos

RESUMO

PURPOSE: Humanitarianism is by definition a moral of kindness, benevolence and sympathy extended to all human beings. In our view as surgeons working in underserved countries, humanitarianism means performing the best operation in the best possible circumstances with high income country (HIC) results and training in-country surgeons to do the same. Hernia Repair for the Underserved (HRFU), a not for profit organization, is developing a long term public health initiative for hernia surgery in Western Hemisphere countries. We report the progress of HRFUs methods to render humanitarian care. METHODS: In a collaborative effort, Creighton University and the Institute for Latin American Concern developed an outpatient surgery site for hernia surgery in Santiago, Dominican Republic. Based on this experience, we developed a sustainable care model by recruiting American and European Hernia Society expert surgeons, staff members they recommended, building relationships with local and industry partners, and selecting local surgeons to be trained in mesh hernioplasty. HRFU then extended the care model to other Western Hemisphere countries. RESULTS: Between 2004 and 2015, the HRFU elective hernia morbidity and mortality rates for 2052 hernia operations were 0.7 and 0%, respectively. This is consistent with outcomes from HICs and confirms the feasibility of a public health initiative based on the principles of the Preferential Option for the Poor. CONCLUSIONS: HRFU has recorded HIC morbidity and mortality rates for hernia surgery in low and middle income countries and has initiated a new surgical training model for sustainability of effect.

Assuntos

RESUMO

In order to better prepare the medical, graduate and undergraduate students participating in our international medical mission trip to Nicaragua, we prepared and presented a discussion on Oral Rehydration Therapy (ORT) prior to the international experience. Additionally, a clinical simulation experience was incorporated into our pre-departure training to instruct the students on basic clinical skills, medical interviewing and teamwork. As a tool to measure the students' prior knowledge on the topic of ORT, we designed a questionnaire, which was distributed and collected prior to the training and simulation experience. Finally, one day after the ORT training and simulation experience, we distributed the same questionnaire and collected the results in order to measure the efficacy of the training and simulation on the students' perspective of confidence, as well as the students' retention of the information and skills taught. Our study population consisted of 9 first-year medical students, 1 graduate student, and 16 pre-medical students, all of whom participated in all aspects of the study. In the pre-training survey, only five of the students indicated that they could confidently and effectively explain or administer ORT to someone else. After collecting the results from the post-training survey, all of the students indicated that they could confidently and effectively explain or administer ORT to someone else. We concluded that the ORT training and clinical simulation experience, wherein students could actively apply the knowledge they gained on the administration of ORT to patients, are effective tools to aid in the preparation of medical, graduate and undergraduate students by way of increasing students' level of confidence in the subject material prior to embarking on international medical mission trips.

RESUMO

Criticisms lodged at humanitarian relief often include the belief that professionalisation is needed. The problems associated with humanitarianism would end, it is assumed, if the delivery of aid, and relief workers themselves, were more professional and 'business like'. To explore this further, the paper asks what comprises a profession, and offers four criteria: (1) specialisation of knowledge; (2) establishment of the profession as a livelihood; (3) organisation and institutionalisation; and (4) legitimacy and authority. A model for understanding professionalisation, as developed by the author, is then presented. The analysis compares six other professions against the same criteria to argue that the humanitarian community already constitutes a profession. Finally, three potential downsides of professionalisation are offered: the distance of the relief worker from the beneficiary, barriers to entry into the humanitarian sector, and adding to risk aversion and a decline in innovation. Based on these findings, professionalisation should be approached with some caution.

Assuntos

RESUMO

OBJECTIVES: The proportion of US medical students participating in global health has increased by 24%. These experiences are generally self-directed and lack a formal educational component. This article describes a structured, comprehensive, community-driven global surgery elective for senior-year students. DESIGN: "Surgery and Global Health" is a monthlong elective during which students shadow in the university hospital, lead discussions of an assigned text, attend lectures, and participate in a clinical rotation in rural Haiti. The first week is didactic and takes place in Atlanta, GA. Weeks 2 through 4 are clinical and are conducted in Haiti. Urological and general surgery procedures are performed during weeks 2 and 3, while the final week is reserved for follow-up care. This experience was institutionally supported. SETTING: Emory University Hospital, Atlanta, GA; L'Hôpital St. Thérèse, Hinche, Centre, Haiti. PARTICIPANTS: Emory University School of Medicine students, years 2 through 4, supervised by faculty from the departments of Urology, General Surgery, and Anesthesiology. Senior-year students spent 21 days in central Haiti working in a rural clinical setting. RESULTS: Students participated in all facets of surgical care including preoperative clearance, postanesthesia care, discharge planning, and follow-up. Students felt a level of supervised responsibility that was not afforded at their home institution and were able to take on more advanced clinical roles. CONCLUSIONS: Students planned and executed this innovative experience with multidisciplinary, departmental, and institutional support. Stateside components introduced students to Haitian culture, global surgery ethics, and humanitarian surgical trip logistics. Structured global health experiences such as this give students practical skills and incentive to pursue careers involving global surgery.

Assuntos

RESUMO

This article focuses on current trends in scholarly literature concerning the evaluation of short-term medical missions. The paucity of information on short-term medical missions in general has contributed to the lack of sufficient frameworks for evaluating them. While examples in the scholarly literature are sparse, in those rare cases where missions are evaluated, they tend to (1) produce their own criteria for evaluation, and (2) evaluate themselves based on metrics that emphasize their perceptions of accomplishments. I draw on interviews (n=31) as well as participant-observation regarding medical missions, to critique these trends. The data analyzed derive from an on-going ethnographic study began in Sololá, Guatemala in 1999, which since 2011 has been directly focused on short-term medical missions. More specifically, my data suggest potential conflict of interest inherent to both volunteering and hosting a short-term medical mission. NGO hosts, who maintain long-term residence in Sololá, may differ from short-term volunteers in both how they understand volunteer obligations as well what they consider helpful volunteer activity. These same organizations may remain financially tied to volunteer labour, limiting their own perceptions of what missions can or should do. I argue that these conflicts of interest have created an evaluation environment where critical questions are not asked. Unless these hard questions are addressed, short-term medical mission providers cannot be certain that their own activities are consonant with the moral imperatives that purportedly drive this particular humanitarian effort. This study demonstrates how ethnographic methods can be instrumental in attempts to evaluate humanitarian endeavours.

Assuntos

RESUMO

Exclusionary practices in dominant market-based systems are recognized as contributing to global health inequities. Undocumented immigrants are particularly vulnerable to unequal access to healthcare. Humanitarian NGOs strive to respond meaningfully to these health inequities among migrants and undocumented immigrants. Few studies describe the work of humanitarian NGOs that advocate for the right to health of undocumented immigrants in high-income countries. This paper discusses immigration, health, and human rights while examining solidarity, spirituality, and advocacy using a U.S.-based example of medical humanitarianism: the 'Our Lady of Guadalupe Free Clinic.' In 2011, the Free Clinic began in the basement of a Catholic parish in Minnesota in response to the lack of access to medical services for undocumented immigrants. Run by a local grassroots organization, it is held every six weeks and offers free primary healthcare to Latino immigrants and the uninsured. In this article, we examine the tricky relationship between humanitarianism and human rights in the U.S. Using ethnography, we draw on participant observation and interviews with 30 clinic volunteers, including health professionals, administrators, language interpreters, and spiritual leaders. The study was conducted September 2012-December 2013 in southern Minnesota. We examine how notions of solidarity, spirituality, and advocacy structure faith-based medical humanitarianism in the U.S. and explore the underlying tensions between the humanitarian mandate, spiritual teachings (social justice, solidarity), and political advocacy. Examining a moment of "crisis" in the Clinic, our study shows that volunteers experience the alliance between spirituality and advocacy with uneasiness. While a spiritual calling may initially motivate volunteers to serve, an embrace of human rights advocacy is important in a sustained effort to provide humanitarian medical care to individuals who fall outside of the political and moral community in the U.S.

Assuntos