Médecine tropicale : revue du Corps de santé colonial
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Comparative Study
[Emergency care in tropical areas: status report based on surgical emergencies in Senegal].
Management of surgical emergencies in Senegal is characterized by a mismatch between supply of facilities and demand for care. The situation has been complicated by runaway urban growth. Two situations can be distinguished in rural zones and in the major city of Dakar. ⋯ The main differences between urban and rural areas involve the volume and type of surgical emergencies with a constantly increasing number of trauma emergencies in cities. Solving these problems will require a specific national plan to develop emergency care services in general. This plan will require coordination of funding, re-organisation of hospital facilities, and hiring and training of qualified personnel (surgeons and paramedical staff).
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Organization of emergency care services prior to hospital admission has progressed at a satisfactory pace in developed countries. A performance model in this field is the French emergency service called service d'aide médicale d'urgence (SAMU). ⋯ As a result, it may be asked if emergency care services is really a luxury. The authors base their conclusion on analysis of the conditions and outcome of emergency patient care in three African countries in which it is essentially a requirement.
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Epidemiological data from the French National Reference Center for Imported Diseases showed that the estimated number of cases of imported malaria in France increased from 5,940 in 1998 to 7,127 in 1999 and 8,056 in 2000. This three-year progression ended in 2001 when the number of estimated cases fell back to 7,223. It was due mainly to the concomitant increase in the number of people traveling to endemic zones especially in Africa. ⋯ Less than 10% of the 45% of patients claiming use of prophylaxis complied properly. Analysis of the drugs used for curative treatment in 2000 showed an increase in the use of quinine and mefloquine and decrease in the use of halofantrine. The main objectives remain reduction of mortality and improvement of prevention.
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The authors in the special issue devoted to humanitarian action use their own experience, analysis, and thought as a basis for identifying the challenges and stakes facing humanitarian action in the twenty-first century. They present their thoughts on the relevance of humanitarian intervention, on the need to combine emergency aid with development assistance, and on the development of governmental humanitarian action. In today's world there is a compelling obligation for communities with resources and means to undertake humanitarian action in the name of human dignity. ⋯ The need to coordinate action in the field is emphasized. Humanitarian actions are increasingly complex operations carried out in fast-changing situations by numerous players. As a result it has become more and more important that actors in the field know each other in order to work together efficiently and thus better reach their common goal of relieving and preventing human suffering in accordance with ethical principles.
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This article beckons readers to reflect on the extreme acts of violence inflicted on populations when civil warfare degenerates into war against civilians. The authors raise the issue of political, media, and humanitarian choices determining the response of industrial countries to crisis situations in economically challenged countries. They advocate an approach based on the "assist and testify" principle of Médecins Sans Frontières.