Pediatric Orthopaedics in Precarious Environment Possibilities and Limits of Humanitarian Surgery

Abstract

This is a retrospective study concerning a 35 years experience of pediatric orthopedic humanitarian surgery performed in precarious situation. This account may be useful to share with younger surgeons considering initiating such a surgery in developing countries. The data of 80 surgical missions held between 1983 and 2018 in Central African Republic have been collected and analyzed. The missions were planned with authorization of the local ministry of health. Their duration was usually two weeks, one week in the capital and one week in about fifteen villages in the country having small rehabilitation centers created when poliomyelitis was devastating. Surgery was performed in the local health center or hospital, with cooperation of the local medical team, sometimes without electricity, usually without radiograph, allowing only clinical diagnosis and not aggressive surgery. Postoperative care was given in the rehabilitation center. All in all 7500 children were seen in out-patients clinics and 2 200 underwent surgery. Sequelae of poliomyelitis which included 66% of out-patients between 1983 and 2000 turned down and became very rare, replaced by a more varied pathology with predominantly congenital malformations and sequelae of intramuscular injections, as well as sequelae of burns and sequelae of neurologic suffering (cerebral palsy, neuromalaria, sequelae of poisoning by toxic cassava). These pathologies are analyzed and the therapeutic options are discussed considering the local facilities. The families often neglected the given appointments, and due to this poor cooperation 25% only out of the operated patients were reviewed, making ineffective any statistical analysis. Nevertheless numerous pieces of information concerning the postoperative result and the late follow-up could be obtained from the local teams, allowing a global evaluation of the validity of this kind of humanitarian surgery.