Humanitarian assistance in Afghanistan: A prospective evaluation of clinical effectiveness

Abstract

Objective: To examine the clinical effectiveness of patient encounters during humanitarian assistance (HA) missions performed by the 48th Combat Support Hospital in Afghanistan. Methods: Data were prospectively gathered from missions in the villages of Aroki (January 21, 2003), Tangee (March 25, 2003), and Turkman (April 22, 2003). Health care providers evaluated the effectiveness of each patient encounter using a data-gathering instrument with clearly defined outcome measures. Results: A total of 1,887 patients were seen during the three missions. Forms were incomplete for 112 patients and not used for 33 dental patients. For the remaining 1,742 individuals, probable cures were achieved as follows: adult males, 31%; adult females, 52%; male children, 46%; and female children, 54% (all patients, 46%, p < 0.001). After adjusting for acute care that was supportive in nature during the final mission, probable cures were achieved as follows: adult males, 22%; adult females, 16%; male children, 34%; and female children, 27%. During this final operation, 73% (p < 0.001) of patients received care that was unnecessary, unlikely to produce a cure, or was merely supportive in nature. Conclusions: During HA missions performed by the 48th Combat Support Hospital, the majority of patient encounters did not result in curative treatments. The effectiveness of medical care during HA missions cannot be assumed and future operations should include assessments of outcomes to optimize their value.