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At least 253 records · Page 14Linked to original sources
PubMed2006

Hospital services for children in the Solomon Islands: rebuilding after the civil conflict.

AIMS: The Solomon Islands health service, infrastructure and economy were severely affected by the civil conflict that occurred between 1998 and 2003. In 2002 plans to rebuild health services for children, especially those provided in provincial hospitals, were developed by paediatricians, in collaboration with the World Health Organization. We aimed to inform this process by an assessment of the strengths and weaknesses of the child health service, particularly in provincial hospitals. METHODS: A systematic assessment of the quality of hospital care for children in Solomon Islands was conducted in November 2003. The study used a WHO assessment tool, modified for use in the Asia-Pacific region. RESULTS: The assessment highlighted several problems in clinical care, human resources, health financing, referral systems, and training, and has been used as a basis for several interventions for improving the quality of paediatric care. CONCLUSION: This study and the initiatives that have followed it demonstrate the link between such assessments, child health policy and quality improvement activities. Such programs can be implemented even where resources are very limited. Sustaining initiatives based on this assessment will be important for the Solomon Islands if it is to achieve the Millennium Development Goals for child survival by 2015.

Child↗
PubMed1996

Surgery in the conflict region of Sri Lanka.

BACKGROUND: Médecins Sans Frontières provides medical support to Batticaloa, a town on the east coast, which is in the conflict region of Sri Lanka. METHODS: Information on the range of pathology, the services provided and the diseases treated was collected from a 25 day assignment in mid-1995. RESULTS: Services and facilities are limited and the amount of work is extensive, as indicated by the 248 patients who had one or more operations and 814 surgical cases who were admitted. Ten per cent of the work was with conflict-injured patients and the remainder covered a wide range of specialties. Complications were surprisingly few. CONCLUSIONS: The surgical support supplied through Médecins Sans Frontières gives the people of Batticaloa much needed medical care and allows surgeons the opportunity to have an enormously satisfying experience.

Adolescent↗
PubMed2005

Back to basics: managing gunshot injuries in East Timor.

BACKGROUND: The management of patients following severe trauma requires a combination of skills. Among these are accurate clinical assessment, basic resuscitation measures, basic general surgical skills and techniques, good decision making and team leadership. More technically advanced imaging and investigations are often useful and can enhance clinical assessment but should not replace the basic elements. In situations where more advanced investigations are not available good outcomes can be achieved by application of the basic principles in trauma management and surgery. This article describes a mass casualty situation of gunshot wounds managed with limited resources and the outcomes. METHODS: A series of gunshot wounds managed in a single day at Dili National Hospital, Dili, East Timor is described. The presentation of the patients, initial assessment of injuries and haemodynamic stability are detailed in addition to the subsequent surgical treatment, complications and outcomes. The information was obtained from hospital records and personal recollection of the treating doctors. All injuries were documented with digital photography. All patients were managed by two surgeons who also supervised their postoperative course and reported on their outcomes. Surgical procedures on all of the patients were performed by the named two consultant surgeons and one basic surgical trainee. RESULTS: Fourteen patients were treated for gunshot injuries. All were single bullet injuries. Six trajectories involved the thoracic or abdominal cavity (one trajectory traversed both). Eight injuries were to limbs or soft tissue of the pelvis and included four compound fractures. Surgical intervention was needed for all patients ranging from emergency laparotomy for haemodynamic instability through to wound debridements. Thirteen patients survived and were discharged from hospital within 3 weeks. One patient died of uncontrolled haemorrhage. CONCLUSIONS: In the present series of gunshot injuries managed with limited resources a good outcome was achieved with the application of basic principles. The present series emphasizes the importance of basic trauma management as outlined in courses such as Emergency Management of Severe Trauma and the use of basic surgical techniques as taught during the Advanced Surgical training program.

Adolescent↗
PubMed1996

From relief to development: the long-term effects of 'temporary' accommodation on refugees and displaced persons in the Republic of Croatia.

The increasing scale of international intervention in conflict is generating new pressures on the humanitarian community. Increased expenditure on emergency relief, static levels of overseas development aid and subsequent lack of funds for development are dictating that agencies design relief projects that positively effect developmental reconstruction. This paper examines the provision of shelter for refugees and displaced persons in the Republic of Croatia and identifies ways in which it has encouraged and discouraged sustainable reconstruction. It argues that to promote lasting reconstruction, programmes must focus on saving livelihoods as well as lives, thus minimising the long-term psychological and physical impacts of aid on refugees, displaced persons and host communities.

Adaptation, Psychological↗
PubMed1996

Children: ethnic and political violence.

Violence stemming from ethnic and political tensions is a problem of increasing proportions throughout the world, and many indicators show that large numbers of children are directly or indirectly exposed to war, political repression, torture, and terrorism. There is growing evidence to suggest that children are at risk under these conditions, and that the consequences of growing up amid danger, chaos, and deprivation can be severe. The articles contained in this special section were assembled to foster greater awareness of this important topic among the readers of Child Development and, hopefully, stimulate new research on ethnic and political violence in many of the disciplines that are represented within the Society for Research in Child Development.

Adaptation, Psychological↗
PubMed1997

Israeli and Palestinian families in the peace process: sources of stress and response patterns.

The Israeli-Palestinian peace process is characterized by its unknown outcomes and consequences for the families involved. The purpose of this study was to identify family processes under conditions of prolonged uncertainty. Data were collected from both Israeli and Palestinian families in the West Bank by means of semi-structured interviews. Qualitative and quantitative analyses showed cross-cultural differences in the perception of the situation; different kinds of concerns and sources of stress; different coping responses; and differences in dyadic interaction patterns and intrafamily processes. The findings are discussed in social-contextual terms, particularly the ways in which political and cultural contexts shape the perception of the situation and family processes under prolonged stressful conditions.

Adaptation, Psychological↗
PubMed1994

Posttraumatic stress reactions after single and double trauma.

This study evaluated the severity and symptom profile of posttraumatic stress reactions of 202 adults exposed in 1988 to political violence in Azerbaijan and/or the earthquake in Armenia. High rates of severe posttraumatic stress reactions were found among the most highly exposed individuals, irrespective of the type of trauma. There was no difference in symptom profile for subjects exposed to earthquake versus violence. These similarities in severity and symptom profile may be attributable to common features of the exposures, which included experiencing life-threat and witnessing injury, multilation and death. Recent prior exposure to violence contributed to the severity of reaction to the earthquake. The high rates of chronic and severe posttraumatic stress reactions in Armenia constitute a major public mental health problem.

Adult↗