Health

The Ponseti method

The WHO is expanding its programme to train health care staff in low– and middle–income countries in essential emergency, basic surgery and anaesthesia skills. The programme, which already exists in 22 countries, will boost the capacity of first–level health facilities (rural or district hospitals and health centres) to deal with simple but essential surgery in a growing number of developing regions.

In many cases, death and permanent disability can be avoided through simple surgical interventions following road traffic injuries, interpersonal violence or war, abdominal emergencies, pregnancy complications, congenital abnormalities, fractures, burns, or the consequences of acute infections.

Together, these conditions cause the loss of approximately 11% of total lost years of healthy life (according to the World Health Report 2002). Injuries alone kill more than 5 million people every year, accounting for nearly one in every 10 deaths worldwide.

The WHO Emergency and Essential Surgical Care Project trains health staff in simple surgical procedures, anaesthesia and emergency care. After training and with the help of basic equipment, health care staff is able to perform surgical procedures that save lives and prevent disability.

New approach to surgery: “The initiative signifies a shift in the way we think about surgery,” explains Dr Luc Noel, in charge of clinical procedures at WHO. “Until recently, surgery was a neglected health issue in developing countries because it was assumed to be too expensive and sophisticated.”

Surgical intervention has become a common component in the management of patients with HIV/AIDS. Some complications associated with HIV infection (such as abscesses, anorectal disorders, lymphadenopathies, lipoatrophy or mild forms of Kaposi sarcoma) are also diagnosed and treated with simple surgical interventions. Current evidence shows that basic surgical and anaesthetic services should be integrated into primary health–care packages.

“Why should a child die from appendicitis, or a mother and child succumb to obstructed labour, when simple surgical procedures can save their lives?” said Dr Meena Cherian, who heads the surgery programme at WHO.Barriers to surgical services

The quality of emergency and essential surgical care is often constrained by inadequate basic equipment for interventions that are simple but vital, such as resuscitation, giving oxygen, assessing anaemia and inserting a chest drain.

Other barriers to the timely and appropriate delivery of basic surgical services in low– and middle–income countries include poor infrastructure and insufficient numbers (and training) of health–care professionals.

In most developing countries, adequate surgical services are found only in tertiary centres in urban areas. Furthermore, the migration of health professionals leaves a shortage at primary–health facilities, where services are provided by non–specialist or even non-medical personnel, many of whom are inadequately trained.

However, a number of isolated, local initiatives have shown that even with only basic training and technologies, many lives can be saved or improved. For instance, clubfoot (a congenital deformity of the foot, marked by a twisted position of the ankle, heel and toes) can greatly impede mobility in children. If untreated, clubfoot can lead to severe disability and loss of productive life. Clubfoot is estimated to occur in 1–2 per 1000 live births, which translates into well over 100 000 cases worldwide per year. Clubfoot diagnosed at birth or soon after can often be treated using a minimally invasive technique called the Ponseti method.

Effective, inexpensive techniques: The Ponseti method involves multiple manipulations and plaster castings early in a child's life. Proper implementation of the Ponseti method results in a dramatic decrease in the number of clubfoot cases that require surgery. These techniques have been quite effective in the industrialized world; they require minimal resources and can be implemented by health personnel in primary health–care facilities. Recent programmes in Africa, India and South America are training local health care professionals in the Ponseti technique. In Uganda, over 100 professionals have been trained, resulting in effective treatment of 95% of new cases of clubfoot.

WHO will present future actions of the Emergency and Essential Surgical Care Project to stakeholders and partners at a meeting of the Global Initiative for Emergency and Essential Surgical Care (GIEESC) in Dar–es–Salaam, Tanzania, on 24–25 September. At the meeting, WHO will also seek support from multi–lateral donors to expand the initiative.

WHO established the GIEESC in 2005 to improve access to and quality of surgical care in the developing world. A broad partnership of internationally recognized organizations and individuals, the initiative counts 22 countries representing all WHO regions among its members.

Stakeholders include doctors (surgeons, anaesthetists, paediatricians, obstetricians, nurses), economists, donors, non–governmental organizations, professional societies. A meeting co–hosted by WHO, the World Bank, Global Health Sciences, the Rockefeller Foundation and the Karolinska Institute (Sweden) was held in June 2007 to promote access to surgical services in resource–constrained countries in sub–Saharan Africa.

Source: Basic Surgery Training To Save Lives, Prevent Disability.
http://www.emaxhealth.com/24/16501.html

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Medical Tourism for Spinal surgery

What is Discectomy?: Disk removal is one of the most common types of back surgery. Diskectomy (also called discectomy) is the removal of an intervertebral disk, the flexible plate that connects any two adjacent vertebrae in the spine. Intervertebral disks act as shock absorbers, protecting the brain and spinal cord from the impact produced by the body's movements.

Purpose of Discectomy Surgery? Removing the invertebral disk is performed after completion of unsuccessful conservative treatment for back pain that has been present for at least six weeks. Surgery is also performed if there is pressure on the lumbosacral nerve roots that causes weakness, bowel dysfunction, or bladder dysfunction. As a person ages, the disks between vertebrae degenerate and dry out, and tears form in the fibers holding them in place. Eventually, the disk can develop a blister–like bulge, compressing nerves in the spine and causing pain. This is called a “prolapsed” (or herniated) disk. If such a disk presses on a nerve root and causes muscle weakness, or problems with the bladder or bowel, immediate disk removal surgery may be needed. The goal of the surgery is to relieve all pressure on nerve roots by removing the pulpy material from the disk, or the entire disk. If it is necessary to remove material from several nearby vertebrae, the spine may become unsteady. In this case, the surgeon will perform a Spinal Fusion, removing all disks between two or more vertebrae, and roughening the bones so that the vertebrae heal together. Bone strips taken from the patient’s leg or hip may be used to help hold the vertebrae together. Spinal fusion decreases pain, but decreases spinal mobility.

Description of Discectomy surgery: The surgery is performed under general anesthesia The surgeon cuts an opening into the vertebral canal, and moves the dura and the bundle of nerves called the “cauda equina” (horse’s tail) aside, which exposes the disk. If a portion of the disk has moved out from between the vertebrae and into the nerve canal, it is simply removed. If the disk itself has become fragmented and partially displaced, or is not fragmented but bulges extensively, the surgeon removes the damaged part of the disk and the part that lies in the space between the vertebrae.

There are minimally invasive surgical techniques for disk removal, including microdiskectomy. In this procedure, the surgeon uses a magnifying instrument or special microscope to view the disk. Magnification makes it possible to remove a herniated disk with a smaller incision, causing less damage to nearby tissue. Video-assisted arthroscopic microdiskectomy has exhibited good results with less use of narcotics and a shortened period of disability.

Newer forms of discectomy are still in the research stage, and are not yet widely available. These include laser discectomy and automated percutaneous discectomy. Risks assosiated with Discectomy surger: Discectomy and microdiscectomy are generally well–tolerated and do not commonly cause complications. However, there is a slight risk of damaging the nerve roots or spinal structures during surgery. There is also some risk of infection following surgery, which may cause further damage. An infection may require high doses of antibiotics and additional surgery to control. All surgery involves some risk. Also, because there are risks with general anesthesia, your doctor and medical staff will carefully monitor you during your surgery and recovery.

What is the out come of Discectomy surgery: People with prolonged symptoms that are severe enough to interfere with normal activities and work and require strong pain medications may gain significant relief from surgery. A 2001 study reports that surgery results in the greatest improvement for people with moderate or severe sciatica caused by lower (lumbar) back disc herniation. Of 402 people included in this 5–year outcome study, 70% of those who had had surgery reported improvement in their most important symptom, as compared with 56% of those who received nonsurgical treatment.2 People with milder symptoms tend to do well without surgery

Discectomy Surgery in India–Huge Cost Savings: Spine care has become a specialty in India. They combine the latest innovations in medical electronics with unmatched expertise in leading neuro–surgeons and spine surgeons in India. These centers have the distinction of providing comprehensive spine care spanning from basic facilities in preventive back–care to the most sophisticated curative technology. The technology is contemporary and world class and the volumes handled match global benchmarks. They also specialize in offering surgery to high risk patients with the introduction of innovative techniques like minimally invasive and robotic surgery. Renowned Indian hospital is equipped to handle all phases of spine problems from the elementary to the latest clinical procedures disk replacements and radiological management of spine tumors. Their success rate at an average of 98.50% is at par with leading cardiac centers around the world.

Dheeraj Bojwani MD is an International Patient Consultant to foreign patients who want to travel to India for getting low cost medical treatment and surgery. More than 400 patients from across the globe have taken the benefits of his services till date. Forerunners Healthcare Consultants is the premier most medical tourism company of India arranging medical and health tours for International Patients in India.

Source: Dheeraj Bojwani. Discectomy Surgery Tourism to India.
http://ezinearticles.com/?expert=Dheeraj_Bojwani

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