The Impact of Natural Disaster on Pediatric Surgical Delivery: A Review of Haiti Six Months Before and After the 2010 Earthquake

Abstract

Little is known about pediatric surgical disease in resource-poor countries. This study documents the surgical care of children in central Haiti and demonstrates the influence of the 2010 earthquake on pediatric surgical delivery. Methods . We conducted a retrospective review of operations performed at Partners in Health/Zanmi Lasante hospitals in central Haiti. Results . Of 2,057 operations performed prior to the earthquake, 423 were pediatric (20.6%). Congenital anomalies were the most common operative indication (159/423 operations; 33.5%). Pediatric surgical volume increased significantly after the earthquake, with 670 operations performed (23.0% post-earthquake v . 20.6% pre-earthquake, p=.03). Trauma and burns became the most common surgical diagnoses after the disaster, and operations for non-traumatic conditions decreased significantly (p<.01). Conclusion . Congenital anomalies represent a significant proportion of baseline surgical need in Haiti. A natural disaster can change the nature of pediatric surgical practice by significantly increasing demand for operative trauma care for months afterward.

Surgery for children in low-income countries affected by humanitarian emergencies from 2008 to 2014: The Médecins Sans Frontières Operations Centre Brussels experience

“…However, most of these refer to specialty- and/or country-specific projects in cardiac surgery, neurosurgery, otolaryngology, and ophthalmology during non-disaster, non-conflict time periods [16,26–32]. Recently, descriptions of surgical care in post-earthquake Haiti and during Operation Iraqi Freedom and Operation Enduring Freedom have also been published [32,33,36]. However, large, multi-country descriptions of pediatric surgical care from humanitarian surgical assistance projects during crisis have not been published.…”

“…Partners in Health/Zanmi Lasante-run hospitals in Haiti reported on procedures before and after the earthquake. About 21% of operations completed between July 2009 and July 2010were for children [33]. In pre-earthquake Haiti, congenital anomalies accounted for 34% of procedures, hernia 21%, and genitourinary and obstetric causes 14% each, while trauma and burns accounted for only 3% of pediatric operations [33].…”

“…About 21% of operations completed between July 2009 and July 2010were for children [33]. In pre-earthquake Haiti, congenital anomalies accounted for 34% of procedures, hernia 21%, and genitourinary and obstetric causes 14% each, while trauma and burns accounted for only 3% of pediatric operations [33]. In post-earthquake Haiti, trauma and burns accounted for 39% of pediatric operations [33].…”

“…In pre-earthquake Haiti, congenital anomalies accounted for 34% of procedures, hernia 21%, and genitourinary and obstetric causes 14% each, while trauma and burns accounted for only 3% of pediatric operations [33]. In post-earthquake Haiti, trauma and burns accounted for 39% of pediatric operations [33]. These reports demonstrate that the scope of humanitarian surgical care during and after crisis differs significantly from that in usual LMIC settings.…”

“…However, the existing literature supports a role for surgical assistance programs to reduce this burden when not operating during crisis and when specialist care is available [4,19,33,44]. Higashi and colleagues described a significant burden of disease from common congenital anomalies in LMICs (e.g., cleft lip and palate, intestinal atresia, neural tube defects) [19], wherein 57% of the 21.6 million DALYs incurred by congenital anomalies may potentially be addressed by access to surgical care [19].…”