A New Approach for Humanitarian Missions

Sir: Numerous humanitarian missions are targeted toward the correction of hare lip and cleft palate. During these missions, the main shortcoming is the difficulty of organizing patient follow-up in such a way as to render local medical services autonomous. If we analyze the situation of the health systems in areas where these humanitarian missions are being carried out, what becomes clear is the difficulty in identifying worthy health systems that are capable of offering an adequate level of safety in both surgery and anesthesia and that meet those standards that are almost universally accepted and followed. It is this which should be the focus of future humanitarian missions, changing pure surgical operations, which are limited to working in the present day, and making true medical and surgical centers where patient follow-up is ensured over time. It was in this frame of mind that we recently created a highly functional surgical center in Nassirya, working in collaboration with the governments of both Italy and Iraq. Thanks to the availability of a specific task force that was set up within the Italian Ministry of Foreign Affairs to help the people of Iraq, a mobile surgical center has been donated to the southern region of Iraq and has been transported overland from Virginia, through Kuwait, to the Iraqi base at Talill. The mobile surgical center (Fig. 1) is transportable thanks to an accompanying lorry, and provides adequate space for an operating theater (Fig. 2) and a postoperative recovery room.Fig. 1.: The mobile surgical unit.Fig. 2.: The surgical room.In this context, a group of 16 staff that includes surgeons, anesthetists, and nurses has managed to carry out 66 surgical operations and 88 surgical procedures on patients aged between 5 months and 17 years, according to the protocol, for anesthesia and surgery, of the Smile Train organization. Throughout this 11-day mission, 15 Iraqi doctors and nurses played an active role during both the surgical and the preoperative and postoperative phases. The involvement of surgeons and anesthetists was made more concrete by means of the activation of a program of telemedicine that we believe to be of such extreme importance that it should become part of the resource bank of all humanitarian missions. The ideal scenario would certainly be that of creating such a highly specialized health model in an existing hospital, but this seems unrealizable in the current political climate, which does not permit humanitarian missions to work freely and with the necessary security. However, this freedom and security are available at the Iraqi base of Talill and are allowing us to make this ambitious project a reality over a 3-year time period. We believe that the best way for humanitarian organizations to proceed is by the promotion of training and support for local medical personnel and the provision and maintenance of equipment for these centers with the overall aim of developing their autonomy. Our model, using a mobile unit, may be one that can be used in other situations of specific difficulty, such as that in Iraq, where it is dangerous to work in the field. Fabio Massimo Abenavoli, M.D. “San Pietro” Hospital Fatebenefratelli Smile Train Onlus Italia Rome, Italy