Challenge of Goodness II: new humanitarian technology, developed in croatia and bosnia and Herzegovina in 1991-1995, and applied and evaluated in Kosovo 1999.
This paper presents improvements of the humanitarian proposals of the Challenge of Goodness project published earlier (1). In 1999 Kosovo crisis, these proposals were checked in practice. The priority was again on the practical intervention - helping people directly - to prevent, stop, and ease suffering. Kosovo experience also prompted us to modify the concept of the Challenge of Goodness. It should include research and education (1. redefinition of health, 2. confronting genocide, 3. university studies and education, and 4. collecting experience); evaluation (1. Red Cross forum, 2. organization and technology assessment, 3. Open Hand - Experience of Good People); activities in different stages of war or conflict in: 1. prevention (right to a home, Hate Watch, early warning), 2. duration (refugee camps, prisoners-of-war camps, global hospital, minorities), 3. end of conflict (planned, organized, and evaluated protection), 4. post conflict (remaini ng and abandoned populations, prisoners of war and missing persons, civilian participation, return, and renewal). Effectiveness of humanitarian intervention may be performed by politicians, soldiers, humanitarian workers, and volunteers, but the responsibility lies on science. Science must objectively collect data, develop hypotheses, check them in practice, allow education, and be the force of good, upon which everybody can rely. Never since the World War II has anybody in Europe suffered in war and conflict so much as peoples in Croatia, Bosnia and Herzegovina, and Kosovo. We should search for the meaning of their suffering, and develop new knowledge and technology of peace. (+info)
Clinical and legal significance of fragmentation of bullets in relation to size of wounds: retrospective analysis.
OBJECTIVE: To examine the relation between fragmentation of bullets and size of wounds clinically and in the context of the Hague Declaration of 1899. DESIGN: Retrospective analysis of prospectively collected data on hospital admissions. SETTING: Hospitals of the International Committee of the Red Cross. SUBJECTS: 5215 people wounded by bullets in armed conflicts (5933 wounds). MAIN OUTCOME MEASURES: Grade of wound computed from the Red Cross wound classification and presence of bullet fragments on radiography. RESULTS: Of the 347 wounds with fragmentation of bullets, 251 (72%) were large wounds (grade 2 or 3)-that is, those with a clinically detectable cavity. Of the 5586 wounds without fragmentation of bullets, 2915 (52.1%) were large wounds. Only 7.9% (251/3166) of large wounds were associated with fragmentation of bullets. CONCLUSIONS: Fragmentation of bullets is associated with large wounds, but most large wounds do not contain bullet fragments. In addition, bullet fragments may occur in wounds that are not defined as large. Fragmentation of bullets is neither a necessary nor sufficient cause of large wounds, and surgeons should not diagnose extensive tissue damage because of the presence of fragments on radiography. Such findings also do not necessarily represent the use of bullets which contravene the law of war. Future legislation should take into account not only the construction of bullets but also their potential to transfer energy to the human body. (+info)
Effect of type and transfer of conventional weapons on civilian injuries: retrospective analysis of prospective data from Red Cross hospitals.
OBJECTIVE: To examine the link between different weapons used in modern wars and their potential to injury civilians. DESIGN: Retrospective analysis of prospectively collected data about hospital admissions. SETTING: Hospitals of the International Committee of the Red Cross. SUBJECTS: 18 877 people wounded by bullets, fragmentation munitions, or mines. Of these, 2012 had been admitted to the hospital in Kabul within six hours of injury. MAIN OUTCOME MEASURES: Age and sex of wounded people according to cause of injury and whether they were civilians (women and girls, boys under 16 years old, or men of 50 or more). RESULTS: 18.7% of those injured by bullets, 34.1% of those injured by fragments, and 30.8% of those injured by mines were civilians. Of those admitted to the Red Cross hospital in Kabul within six hours of injury, 39.1% of those injured by bullets, 60.6% of those injured by fragments, and 55.0% of those injured by mines were civilians. CONCLUSIONS: The proportion of civilians injured differs between weapon systems. The higher proportion injured by fragments and mines is explicable in terms of the military efficiency of weapons, the distance between user and victim, and the effect that the kind of weapon has on the psychology of the user. (+info)
Primary health care in complex humanitarian emergencies: Rwanda and Kosovo experiences and their implications for public health training.
In a complex humanitarian emergency, a catastrophic breakdown of political, economic, and social systems, often accompanied by violence, contributes to a long-lasting dependency of the affected communities on external service. Relief systems, such as the Emergency Response Units of the International Federation of Red Cross and Red Crescent Societies, have served as a sound foundation for fieldwork in humanitarian emergencies. The experience in emergencies gained in Rwanda in 1994 and Kosovo in 1999 clearly points to the need for individual adjustments of therapeutic standards to preexisting morbidity and health care levels within the affected population. In complex emergencies, public health activities have been shown to promote peace, prevent violence, and reconcile enemies. A truly democratic and multi-professional approach in all public health training for domestic or foreign service serves as good pattern for fieldwork. Beyond the technical and scientific skills required in the profession, political, ethical, and communicative competencies are critical in humanitarian assistance. Because of the manifold imperatives of further public health education for emergency assistance, a humanitarian assistance competence training center should be established. Competence training centers focus on the core competencies required to meet future needs, are client-oriented, connect regional and international networks, rely on their own system of quality control, and maintain a cooperative management of knowledge. Public health focusing on complex humanitarian emergencies will have to act in prevention not only of diseases and impairments but also of political tension and hatred. (+info)
Perfluorooctanesulfonate and other fluorochemicals in the serum of American Red Cross adult blood donors.
Perfluorooctanesulfonyl fluoride-based products have included surfactants, paper and packaging treatments, and surface protectants (e.g., for carpet, upholstery, textile). Depending on the specific functional derivatization or degree of polymerization, such products may degrade or metabolize, to an undetermined degree, to perfluorooctanesulfonate (PFOS), a stable and persistent end product that has the potential to bioaccumulate. In this investigation, a total of 645 adult donor serum samples from six American Red Cross blood collection centers were analyzed for PFOS and six other fluorochemicals using HPLC-electrospray tandem mass spectrometry. PFOS concentrations ranged from the lower limit of quantitation of 4.1 ppb to 1656.0 ppb with a geometric mean of 34.9 ppb [95% confidence interval (CI), 33.3-36.5]. The geometric mean was higher among males (37.8 ppb; 95% CI, 35.5-40.3) than among females (31.3 ppb; 95% CI, 30.0-34.3). No substantial difference was observed with age. The estimate of the 95% tolerance limit of PFOS was 88.5 ppb (upper limit of 95% CI, 100.0 ppb). The measures of central tendency for the other fluorochemicals (N-ethyl perfluorooctanesulfonamidoacetate, N-methyl perfluorooctanesulfonamidoacetate, perfluorooctanesulfonamidoacetate, perfluorooctanesulfonamide, perfluorooctanoate, and perfluorohexanesulfonate) were approximately an order of magnitude lower than PFOS. Because serum PFOS concentrations correlate with cumulative human exposure, this information can be useful for risk characterization. (+info)
Unrelated umbilical cord blood transplantation in children: experience of the Hong Kong Red Cross Blood Transfusion Service.
OBJECTIVE: To review the outcome of unrelated umbilical cord blood transplantation in children using cord blood from the Hong Kong Red Cross Blood Transfusion Service. DESIGN: Retrospective study. PATIENTS: Records of eight patients who received unrelated umbilical cord blood transplants between 1999 and 2003 were reviewed. MAIN OUTCOME MEASURES: Engraftment of haematopoietic cells and graft-versus-host disease after transplantation. RESULTS: The median age of the patients was 4.9 years (range, 1.0-9.4 years). Five patients had acute leukaemia, one had non-Hodgkin's lymphoma, one had X-linked adrenoleukodystrophy, and one had mucolipidosis. The infused umbilical cord blood units contained a median of 6.7 x 10(7) /kg nucleated cells and 4.0 x 10(5) /kg CD34-positive cells. Neutrophil engraftment was achieved at a median of 13 days (range, 11-19 days) and, for seven patients, platelet engraftment was achieved at a median of 39 days (range, 24-98 days). Acute graft-versus-host disease occurred in all patients (grades I to III). One of the patients died because of encephalitis; of the other seven, five developed chronic graft-versus-host disease of the skin. At a median follow-up of 2 years, the four patients with leukaemia and the one with non-Hodgkin's lymphoma remained in continuous complete remission; the patient with adrenoleukodystrophy showed stabilisation of neurological condition. CONCLUSION: The Hong Kong Red Cross Blood Transfusion Service Cord Blood Bank stored cord blood units of good quality for transplantation, the outcome of which was comparable to that of bone marrow transplantation. (+info)
Simulated post-exposure rabies vaccination with purified chick embryo cell vaccine using a modified Thai Red Cross regimen.
OBJECTIVES: Currently, two intradermal regimens for the administration of cell culture rabies vaccines are approved by the WHO for rabies post-exposure prophylaxis: the two site Thai Red Cross regimen (TRC) and the eight site regimen. For the TRC regimen the volume of vaccine recommended per dose is 0.1 ml of purified Vero cell rabies vaccine (PVRV) and 0.2 ml of purified chick embryo cell vaccine (PCEC). The objective of the present study was to evaluate comparatively the immune response to PCEC and PVRV vaccines administered by the TRC regimen using a uniform dose of 0.1 ml of vaccine. METHODS: Forty-two subjects received TRC regimen (2-2-2-0-1-1) with 0.1 ml of PCEC vaccine and 38 subjects received the same regimen with PVRV. The rabies neutralizing antibody response in these subjects on days 10, 28, 90 and 180 was determined by the standard mouse neutralization test (MNT). RESULTS: There was adequate antibody response with both the vaccines and 100% seroconversion was observed by day 10. Furthermore, the antibody titers obtained with PCEC did not differ significantly from those obtained with PVRV on all days tested (p > 0.05). CONCLUSIONS: It can be concluded from the results that an adequate antibody response can be obtained with PCEC vaccine when administered by the TRC regimen even after reducing the quantity of vaccine from 0.2 ml to 0.1 ml per intradermal dose. The feasibility of using this regimen in true post-exposure cases needs to be further evaluated. (+info)
Quality improvement programme on the frontline: an International Committee of the Red Cross experience in the Democratic Republic of Congo.
BACKGROUND: Majority of research in Quality Improvement, focuses on developed countries or development programs. Humanitarian organisations frequently work in developing countries, often in emergency situations with rapid staff turnover. Objectives of this study are twofold: first to develop a methodology of motivation and restoration of collapsed health structures through the creation of community based QI indicators; second, to implement these indicators to improve quality of care. METHODOLOGY: Using a community-based approach, the International Committee of the Red Cross (ICRC) team together with local health committee and nurses developed quality indicators divided into six different categories. Of 16 community primary health centers and four hospitals supported by ICRC, six health centers and one hospital were chosen to follow quality indicators for three of six indicator categories. Initial data were collected in January 2003 and compared with data serially gathered throughout the year. RESULTS: In the category rational prescription, all health facilities except for one showed improvement in every category. In the hygiene category, four of seven health structures showed 100% improvement in their score. Three of seven facilities showed impressive improvement in the category pharmacy management. CONCLUSION: Involving the community to design population based indicators helped communities take ownership of the indicators. Our findings that poor performance on indicators prompted communities to seek training and assistance to improve quality of care emphasized this. Continued adherence and improvement in each category confirmed the long term effects of teaching sessions in the areas of rational prescription, hygiene and pharmacy maintenance. (+info)