The writing of this comment coincided with the tragic earthquake in Haiti, so the focus of it rapidly became a bit more passionate. Chu et al1 summarize the surgical work done by Médecins Sans Frontières–Belgium, analyzing operative mortality as a proxy for the ability to deliver safe surgery. This is about as short-term follow-up as can be measured, since long-term follow-up under the circumstances in which they practice medicine is impossible. Chu et al demonstrate that basic general surgery can be performed in difficult, resource-poor settings with minimal associated mortality. Not surprisingly, areas of conflict, emergency surgery, abdominal surgery, and American Society of Anesthesiologists score were risk factors for death. While the Médecins Sans Frontières mission is to give care in regions of conflict, these data imply that elective surgery and emergency care for trauma, peritonitis, and maternal hemorrhage may be done safely in nonconflict areas and we can expect even better results.
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