Investing in Knowledge for Those Most in Need
Authors: Krieger Stefan 
Published: September 2016

Background: Worldwide, increasing numbers of violence and trauma victims are to perceive. Humanitarian surgery is treating an essential part of the global burden of disease. As an international humanitarian aid organization, we are aiming to save life, reduce suffering, and support social reintegration of our patients. Humanitarian surgery is a fundamental pillar of our humanitarian medical assistance. Acute or chronic sequelae of hand trauma are very frequent in this field, affecting the victim’s social and/or economic life substantially negative in a long term. In the absence of highly specialized surgeons, support is predominately provided by general and visceral surgeons. Due to the specification of surgeons within their qualification trajectory, many surgeons are lacking specific knowledge in orthopedic and hand surgery, which is urgently requested in the day-to-day business in humanitarian aid. Objective: How do surgeons, working in the humanitarian aid, benefit from a context-tailored training activity? Method: Conduction of a 4-day “International Surgical Workshop,” held in the anatomy lab of a German University Hospital, open for surgeons working in the humanitarian field. The training activity consists of 9 different modules. Participants receive 16 hours’ lecturing and 16 hours’ practical teaching on corpses. The course is evaluated 2 times: (1) overall evaluation (e.g. set up, timing, content), conducted in the end of the course, using focus group discussions and formulized questionnaires and (2) evaluation regarding its sustainability, conducted 6 month back after training, with the support of a formalized online questionnaire (return rate 69% in 2014). Results: Since 2009, 181 surgeons, from 41 nationalities participated in the training. The training’s content, timing, and format met highly the requirements of the target group. The overall evaluation was 3.6 points out of 4. Among other modules (e.g. craniotomy, gynecology, vascular, external fixation, reconstructive surgery), participants were qualified on most common hand-surgical traumata seen in the field of humanitarian crisis (e.g. machete and explosive/gunshot lesions, burn, contractures) by experienced hand surgeons. The practical focus was hereby on tendon repair, tendon transposition, nerve repair, contracture release, local flaps for soft tissue repair, infection, and bone trauma management. The theoretical and practical knowledge gained in hand and reconstructive surgery and external fixation had the highest practical relevance and usefulness for humanitarian work (4.7-5.1 out of 6) in the evaluation 6 months after training. As all surgeons went back to the field after training, this activity has a high degree of sustainability. Conclusion: Hand surgery is an essential part of humanitarian surgery. A context-tailored training activity, incorporating theoretical and hands-on training in hand surgery for humanitarian surgeons is fundamental. The training activity has a great benefit for the humanitarian surgeons and the victims in humanitarian crisis with a high degree of sustainability. However, the conduction of the activity remains as a high challenge for humanitarian aid organizations.