대한구순구개열학회의 글로벌 자선 수술 활동 : 케냐에서의 자선 수술 활동 Global Charity Operations of Cleft Lip and Palate by Korean Cleft Lip and Palate Association ; Charity Operations in Kenya, east Africa원문보기
Korean Cleft Lip and Palate Association (KCLPA) was founded in 1996. The first overseas charity operation was in Karachi, Pakistan, 2002 and our association has visited fourteen times in six countries for the free cleft surgery: Pakistan, Egypt, Kenya, Morocco, Jordan and Vietnam. The cumulated numb...
Korean Cleft Lip and Palate Association (KCLPA) was founded in 1996. The first overseas charity operation was in Karachi, Pakistan, 2002 and our association has visited fourteen times in six countries for the free cleft surgery: Pakistan, Egypt, Kenya, Morocco, Jordan and Vietnam. The cumulated number of operated patients reaches to 280. Before our association, many Korean oral and maxillofacial surgeons have performed charity operations individually since 1964. It was started from Vietnam but the activity is now carried on in Africa, middle-east Asia, south-east Asia, China, and Korea as an official team. LG electronics, a Korean company helped to propagate our team's activity to middle-east Asia to Africa. This paper is a report concerning about the results of our association's charity activities especially in Kenya, east Africa. We provided free cleft surgery for 30 patients in 2004 and 27 patients in 2005, in Nairobi. As the blood test for HIV of the cleft patients was not allowed before and during surgery, our surgeons and nurses were cautious about every movement during the surgeries. Thus the operation time for each patient was longer than any other time. The attitude of the local hospital and the doctors seemed to be accustomed to this situation. They helped us in case of needle injuries. Safety of medical staff and patients is more important than the number of the patients operated in charity operation. This belief should be approached being parallel and multidisciplinary as an international cooperation, focusing on international funding for medical support and continuous education for local doctors who are willing to devote to their people.
Korean Cleft Lip and Palate Association (KCLPA) was founded in 1996. The first overseas charity operation was in Karachi, Pakistan, 2002 and our association has visited fourteen times in six countries for the free cleft surgery: Pakistan, Egypt, Kenya, Morocco, Jordan and Vietnam. The cumulated number of operated patients reaches to 280. Before our association, many Korean oral and maxillofacial surgeons have performed charity operations individually since 1964. It was started from Vietnam but the activity is now carried on in Africa, middle-east Asia, south-east Asia, China, and Korea as an official team. LG electronics, a Korean company helped to propagate our team's activity to middle-east Asia to Africa. This paper is a report concerning about the results of our association's charity activities especially in Kenya, east Africa. We provided free cleft surgery for 30 patients in 2004 and 27 patients in 2005, in Nairobi. As the blood test for HIV of the cleft patients was not allowed before and during surgery, our surgeons and nurses were cautious about every movement during the surgeries. Thus the operation time for each patient was longer than any other time. The attitude of the local hospital and the doctors seemed to be accustomed to this situation. They helped us in case of needle injuries. Safety of medical staff and patients is more important than the number of the patients operated in charity operation. This belief should be approached being parallel and multidisciplinary as an international cooperation, focusing on international funding for medical support and continuous education for local doctors who are willing to devote to their people.
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제안 방법
2차 방문 때 1차에 비해 구개 성형술 증례가 줄어든 이유는 현지 병원의 마취과의 사정에 크게 의존된 이유이다. 따라서 2차 방문 때는 구개 성형술은 세 증례만 실시하기로 하고 이후에는 구순 성형술만을 시행하기로 하였다.
아프리카 대륙의 먼 국경지대에서 찾아온 환자들의 연고지 문제로 술 후 추적 및 진료는 거의 불가능한 것으로 보였다. 따라서 현지 의사들은 피부봉합을 흡수성 봉합사로 해 줄 것과 구순 성형술과 구개 성형술을 동시 시행하는 1-visit 수술법을 제시했다. 이는 환자들의 경제적 연고지적 문제 때문이기도 하지만 현지 의사들의 편의 및 경제논리에도 영향을 받는 것으로 생각된다.
수술의 난이도와 소요시간, 환자의 연령을 고려하여 수술 스케줄을 작성했다. 현지 의료진에게 스케줄 미리 공고하여 술 전 준비를 시행할 수 있도록 하는 것이 중요하다(그림 3, 4).
대상 데이터
2004년과 2005년에 두 번에 걸쳐 총 57명의 구순구개열 환자를 수술하였으며 1차 2차 합계, 구순성형술 42증례, 구개성형술 10증례, 기타 반흔성형술 4증례 및 치조골 성형술 1증례를 실시했다(표 2).
자선 수술활동이 시작되었고 환자들의 증례는 다양했다. 불완전, 완전, 편측성, 양측성 및 치조열 등의 환자들을 대상으로 수술이 진행되었다.
성능/효과
모든 환자를 잠재적인 감염자로 가정하고 수술할 수 밖에 없었기에 수술 시 최대한 주의를 기울였으며 이로 인해 환자당 수술 시간이 길어졌다. 수술용 보호안경, 마스크 수술 가운 등 기본적인 보호 장비는 물론이고 수술용 글러브를 두개 내지 세 개를 착용하고 한국에서 미리 준비해간 골무를 착용하는 외과의도 있었다(그림 8).
다음으로 현지 외과 의사와 봉사 방문 외과 의사 사이의 의견차이 문제를 들 수 있다. 아프리카 대륙의 먼 국경지대에서 찾아온 환자들의 연고지 문제로 술 후 추적 및 진료는 거의 불가능한 것으로 보였다. 따라서 현지 의사들은 피부봉합을 흡수성 봉합사로 해 줄 것과 구순 성형술과 구개 성형술을 동시 시행하는 1-visit 수술법을 제시했다.
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