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Annual report

Troms Mine Victim Resource Center

Annual report 2012 Published by Troms Mine Victim Resource Center Editor: Margit Steinholt Executive editor: Hans Husum Layout: Ole Kristian Losvik, Damp media Print: Hustrykkeriet, University Hospital North Norway

www.traumacare.no facebook.com/traumacare.no twitter.com/traumacare

Milestones in 2012
The war in Iraq: The Troms Model stands test Since 1997 the chain-of-survival model has
been implemented in the minefields and war zones of Iraq. A material covering ten years of experience published in 2012 documents that death rates have been reduced from 40% to 5%.

Troms Mine Victim Resource Centre (TMC)

TMC is a medical action research centre at the University Hospital of North-Norway. In collaboration with local partners TMC form trauma systems including care for mothers and new-borns in rural and remote areas in the South. TMC coordinates networks of thousands of care providers in Iraq and Cambodia. TMCs main aim is to develop feasible and sustainable evidence-based models for trauma and health care in low-income countries. All interventions are designed and implemented, analysed and reported according to scientific standards.

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Limb salvage surgery: Break-through in open fracture treatment With partners in European

trauma centres we are developing new methods to rescue severely damaged limbs with low-tech surgery. The new treatment protocol for open fractures was presented in 2012.

Cambodian surgical instruments of high standard A small workshop in Sompouv Lun, CamTrauma Care Foundation (TCF) Hans Husum
Save lives, save limbs

bodia, produces fixators needed for open fracture management. Evaluation in 2012 documents success rate comparable to European standards.

Ass.is prof. surgery TCF a Norwegian humanitarian foundation working for people caught in wars and mineCenter Head, TMC fields they did not ask for and are unable to call a halt to. TCF develops trauma manuals, Tel: +47 77 62 62 27 teaching aids and documentaries for low-resource settings and operates TMCs book- and Mob: +47 95 17 17 10 E-mail:projects. tmc@unn.no media www.traumacare.no

Delivery Life Support saves lives Traditional birth attendants (TBAs) and rural midwives in
Cambodia have since 2005 been trained to manage complicated deliveries. Data analysis in 2012 of more than 10 000 deliveries shows a reduction of maternal mortality by 85%.

TROMSOE MINE VICTIM RESOURCE CENTER Box 80, N-9038 University Hospital North Norway Front:P.O. Advanced limb Many people says this is not warzone. Maybe It is not, however it is life in Iraq. saving surgery in Cambodia

A new model for screening blood donors Trauma victims and mothers bleeding after delivery
need urgent blood transfusion. TMC and partners are breaking new ground: A new model for risk assessment based on low-tech screening tests was developed in 2012.

Hans Husum

Ass. prof. surgery Center Head, TMC

Up and going again with local technology At a small jungle workshop the amputees themTel: +47 77 62 62 27 Mob: +47 95 17 17 10 E-mail: tmc@unn.no www.traumacare.no

selves have developed a new type of prosthesis made from local materials the Farmer Leg. In 2012 they started to serve their fellow amputees with the new design.

TROMSOE MINE VICTIM RESOURCE CENTER

P.O. Box 80, N-9038 University Hospital North Norway

Research Centre for Rural Health in Cambodia In 2012 the research students reached a mile-

stone. They selected a study problem from their own clinical practice, wrote the research protocol and gathered and analysed data from their own databases.

Trauma Care Foundation: In 2012 the new revised edition og the field manual War Surgery was
published in CD format. No Time to Lose a documentary of grassroots rehabilitation is under production.

Publications Troms Mine Victim Resource Centre aims to evaluate scientifically all interventions. This has resulted in an fast growing list of publications, and several among them are new publications in 2012.

Partners Without our partners we would be nothing. Through the years we have found friends
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Troms Mine Victim Resource Center

from all over the world working with saving lives and limbs. So thank you donors, researchers, professional partners, and board members. Annual report 2012

The Troms model stands the test in Iraq

Read more Murad KM, Larsen S, Husum H. What makes a survivor? Tenyear results from a time-cohort study of prehospital trauma care in Iraq. Scand J Trauma Resusc Emerg Med 2012.

Saving limbs at the District Hospital

With partners in European trauma centres we are developing new methods to rescue severely damaged limbs with low-tech surgery. The new treatment protocol for open fractures was presented in 2012.
Read more Viet L, Husebekk A, Husum H, Skjerve E. A stochastic model for estimating risk of transfusion transmitted

Since 1997 the chain-of-survival model has been implemented in the minefields and war zones of Iraq. A study covering ten years of experience published in 2012 shows that death rates was reduced from 40% to 5%.

The burden of trauma is not fairly distributed; most natural disasters and local wars hit low-resource areas, and almost 90% of deaths due to injury occur in low and middle-income countries. Here Western type systems are not feasible; and low-tech models must be adapted to fit the local scenario. Since 1997 chain-of-survival systems have been built in the minefields of North Iraq. Following the 2003 invasion pre hospital trauma system has also expanded to include Central Iraq. The Iraqi system comprises of two hundred paramedics and 7,000 lay first helpers. In Iraq dailylife includes shoot-outs and bomb explosions. Surveys of post-invasion fatalities in Iraq estimate an excess death rate as a consequence of war corresponding to 2.5% of the population. Gunfire and bomb blasts are the most common cause of death. Iraq is thus a challenging test ground for TMCs pre hospital trauma system model. A comprehensive Trauma Registry of 3,500 patients was analysed in 2012. The study in Iraq is historical. This is the first time a major interventional study of pre hospital trauma care is reported from the South. The results show that the Troms Model should be recommended for the South be it wars, minefields, or natural disasters. The main findings were:

Open fractures and crushed limbs are common in war and mine accidents. These are also common injuries in traffic accidents. The surgical treatment of these injuries has traditionally been centralized to specialized centres because advanced reconstructive techniques requiring expensive technology and specialized skill have been the standard. However, high-tech hospitals are often very expensive and thus out of reach for poor people. TMC has responded to this challenge by finding new ways of soft tissue repair. Because fractures heal via soft tissue blood supply, the injured bone must be covered with skinflaps. In collaboration with surgeons at Frankfurt Trauma Centre, TMC has developed a new technique using perforator flaps, distally hinged local flaps. A perforator flap operation takes two hours and can be done by any trained surgeon at any hospital as compared to the traditional method of free flaps, which requires long operating hours and expensive technical resources. In the largest clinical study to date TMC has documented a success rate of 87% in perforator flaps reconstructions, a result equal to or better than the advances free flap interventions. In 2012 the new protocol was presented at the All-Indian conference for trauma surgeons, an audience of 150 experts. The protocol will now be further refined in cooperation with the Ganga Hospital in India, a world-leading centre for open fractures.

hepatitis B in Vietnam. Transfus Med. 2013

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The death rate was reduced from a pre-intervention level at 40% to near 5% at the end of the study period. The improved survival rate was most appearant in major trauma victims. Patients treated by local first helpers immediately after the injury stood a far better chance of survival mortality rates of 10% (first helpers) versus 16 % (non-first helpers) Simple first aid not advanced life support counts: In most patients with airway problems, in chest injured, and in patients with external bleeds, simple life support measures were sufficient to improve survival.

Troms Mine Victim Resource Center

Annual report 2012

Every mother and child count!

Traditional birth attendants (TBAs) and rural midwives in Cambodia have since 2005 been trained to manage complicated deliveries. Data analysis in 2012 of more than 10 000 deliveries shows a reduction of maternal mortality by 85%.
Despite the United Nations Millennium Goals no 4 and 5 with the aim of a substantial reduction in maternal and neonatal deaths by the year of 2015, most low income countries like Cambodia make slow progress in these matters. By 2010 the maternal mortality rate globally was high. Still more than 350 000 women die of pregnancy related complications every year. Over 4 million babies never have a chance to survive the first 24 hours of their life. Almost all maternal and neonatal fatalities take place among poor and marginalized people. Women from ethnic minority groups are especially vulnerable. The training program Delivery life support was therefore implemented in the Battambang province in 2005. The program combines theoretical lectures with hands-on teaching in obstetric and neonatal emergencies. Birth attendants in all levels are included from the traditional birth attendant in the village to the surgeon at the local hospital. Over 10 000 deliveries have been analysed, and the findings are very promising. The decline in overall maternal mortality from 2005 to 2009 is approximately 80 %. The steepest reduction was in the group of mothers using a TBA to assist her during birth. These findings underlines the usefulness of including lay health volunteers in medical first aid, and it shows that obstetric emergencies are no different from other trauma related situations. There is a huge global deficit of health workers, and the greatest gap is in rural and remote areas in poor countries. In order to reach the women most at risk of dying in childbirth, the inclusion of traditional birth attendants in maternal health program could be useful also in other countries. Articles will be published in 2013.

Locals are able the Cambodian External Fixator

When a land mine blasts one leg off, an open fracture is regularly inflicted to the opposite leg. Proper management of open fractures requires external fixation, but one set of appropriate instruments costs USD 6,000, which is far beyond reach for hospitals in the rural South.

TMCs partner in Cambodia; TCF-C, runs a rural rehabilitation-workshop and research centre in a forest area where skilled local technicians produce surgical instruments of export quality based on local technology. The Cambodian Ex Fix has been examined at SINTEF, Norway and stood the test at a cost far lower than the equivalent Western products. The products final test is in clinical practice, and a prospective clinical trial is therefore conducted at six Cambodian hospitals. The surgeons are trained in use the ExFix on animal models before they implement the new treatment protocol in their hospitals. The study is done by the Khmers for the Khmer and is one of the studies conducted by the new Resource Centre set up in Battambang, see page 12. The trial is ongoing, but the 2012 results document high success rate: Before the new method was implemented 1/3 of patients with open fractures did not heal. The ExFix study sample has a primary healing rate of 90%. This result compares well with standards at European surgical centres. 6
Troms Mine Victim Resource Center

When the ExFix is removed after 6 8 weeks, the patients start walking, the fracture supported by a nicely fitted brace made of plastic stubs bought at the local market.
Annual report 2012

Safe blood transfusion where hepatitis is endemic

Blood loss is the main killer both in trauma and for poor mothers giving birth. TMC and partners are breaking new ground: A new model for risk assessment based on low-tech screening tests was developed in 2012.
Safe blood service at local hospitals is an urgent task, but it requires accurate screening of blood donors to avoid blood-transmitted diseases. Carriers of the disease must be excluded as blood donors. With partners in Cambodia and Vietnam TMC has published scientific reports revealing that test methods recommended by WHO are too inaccurate for blood donor screening. The challenge now is to find feasible ways to set up decentralized yet safe blood banks. The particular problem with hepatitis is that the virus hides in the liver cells after the patient has recovered completely from the disease. Blood from a person with hidden hepatitis may transmit the virus. In Western countries with low prevalence of hepatitis, persons with hidden hepatitis are not accepted as blood donors. But what to do in the South? The prevalence rate of hidden hepatitis in Cambodia and Vietnam is as high as 50%; half the population has had hepatitis B infection. If half of the population were to be excluded as blood donors, it would be impossible to set up blood transfusion service. Consequently we have to find ways of identifying the risky carriers of hidden hepatitis. This can be done accurately by advanced laboratory procedures. However, this policy is not feasible simply because the testing is far too expensive for low-income countries. With the Centre of Epidemiology and Statistics at the Norwegian School of Veterinary Medicine, TMC has developed a new risk calculator, which can estimate the risk of dirty transfusions based on screening tests already in place. The new risk calculator is under publication in a world-leading journal, will be developed further and will enhance the safety in blood bank service in the South.

Three Men - One Leg

the new rehab workers in Cambodia
In 2012 a small workshop was set up in the minefields in Samlot, Cambodia. The three rehab workers running the workshop has close personal knowledge of the mines; two of them have lost both legs to the mines, and one has still one leg left.
From the workshop they coordinate at network of self-help groups. The beneficiaries are families affected by mine/ cluster accidents, poor widows and very poor families in remote villages. Savings-groups in underprivileged villages have been started after the model used by the Indian Community Aid Alliance. TMC has documented that chronic pain in mine accident survivors and other trauma victims is a main obstacle for physical and social rehabilitation. Previous studies of mine accident survivors in Cambodia indicate that poverty itself acts as a chronic stress or trauma, feeding the pain syndrome. Support for income generation to victimized families should thus be considered a pain-killer. Local networking is a key factor; new arenas of friendship, rehab support and social inclusion must be built not for them, but by themselves. The standard Western-type prosthesis is not sustainable in jungle and paddy fields it breaks and it is far too unstable under heavy weight loads. Consequently the Khmer rehab workers in cooperation with local amputees have developed an end-bearing prosthesis made from local materials the Farmer Leg. It is not very pretty, but it stands the test of tough farmer life.

Oum Ngeng, one of the three men: Since we built this workshop to help other amputees things changed people started to notice me. Before that I was nobody. I was being simply brushed aside and out of touch in the society! Now people come and say Hello to me; even farmers who live as far as Sgnut village come and ask me for advice. They even ask me to explain word community. I tell them that the community referred to growth in the villages. When we, as villagers, live together, mobilize and unite to help and support each other, that means community. Now my wife and children tell me, What a relief for you and for us, dad!

Troms Mine Victim Resource Center

Annual report 2012

Research Centre for Rural Health in Cambodia

Examples of research subjects Prevalence and Risk factors for anaemia in pregnant women in remote rural Cambodia; a prospective clinical study from Pailin. Several studies use qualitative methods, e.g. Rehabilitation provided by disabled; a qualitative study from a rural workshop in Cambodia.

Trauma Care Foundation

Trauma Care Foundation develops trauma manuals, teaching aids and documentaries for low-resource settings and operates TMCs book- and media projects.

In 2012 the research students reached a milestone. They selected a study problem from their own clinical practice, wrote the research protocol and gathered and analysed data from their own databases.

TMCs teaching concept the Village University has so far relied on Western expertise for supervision and research. However, this is a contradiction to the objective of developing sustainable and indigenous trauma systems by enabling local people to make a difference in their own community. The local account of reality is best seen by insiders not outsiders. It is therefore obvious that building a robust local research capacity is an important, but so far missing, component that must be part of the Village University. In September 2010 TMC and partner TCF-Cambodia started a research school for 16 health workers from rural and remote areas, all from the network developed over many years by TCF-C and TMC. The students have been selected on the basis of their personal experience, skills and dedication, rather than formal education and English proficiency. Although many have little formal education, the students have extensive professional experience in their respective fields. The students keep their full-time jobs while taking classes, so the studies require dedication and hard work. Six of the students are females. In 2012 the students wrote their research protocols. They have also gathered and analyzed data in their own databases. The study results are pending, but one result is very clear: The students have gained a lot confidence and also respect from colleagues at clinics and hospitals. The school is located in Battambang, Cambodia, and the students attend 2-week courses 7 times per year for 3 years. The students are introduced to research methodology and medical subjects relevant to their professional background. The teachers are carefully selected from TMCs network of dedicated and skilled researchers and teachers, from Cambodia, Thailand, India, UK and Norway. The teaching is ground-breaking; and this is the first time such a scientific curriculum is presented in written Khmer.

War surgery - 2nd revised edition on CD and Web

In 2012 the new revised edition was also produced in CD format. A webbased version for free download is under way, and production of the Arab edition is pending. War surgery is available for online reading and download at www.traumacare.no/ws

No Time to Lose a documentary of grassroots rehabilitation

Marit Gjertsen, a price awarded Norwegian filmmaker, has for years trained Cambodian health workers in filmmaking. Three year ago the team decided to document the life after injury, using mine accidents as case. In the film Khmer medics document rough evacuations of mine-injured farmers hands on. We follow the process of getting the mine victims going again seen through Khmer eyes. The film was produced in 2012 and will be released in 2013 at film festivals and on TV screens, but also by mobile outreach cinemas in the villages in Cambodia.

What are other saying about War Surgery. Field manual?

After the book Husum H, Ang SC, Fosse E. War Surgery. Field Manual, second revised edition was released in 2011 the reviews have been positive: An impressive piece of work. I do recommend this manual for anybody treating war injuries, and also for health workers in the rural areas in Africa and Asia. Journal of the Norwegian Medical Association 2012; 132: 1643. This giant manual should be found in any surgical clinic; it will teach, inspire and impress us. Journal of the Swedish Medical Association 2012; 109: 974. This work, which is beneficial even for the experienced surgeons, describes how to operate in locations where medical supplies are limited and the human population suffers major injuries. One of the features that distinguish this book is the fact that both the editors and authors have gained relevant experience in combat zones. Balkan Medical Journal 2012; 29: 228

Pain studies in Vietnam finished

In 2012 TMC finalised the collaboration with Project RENEW in Quang Tri Province, Vietnam.
The work and studies done in Vietnam have been very productive, and the findings from the pain relief studies were presented at an international workshop in Dong Ha, Vietnam, March 16th 2012. The main finding is that ketamine is as efficient as morphine, but with favourable side effects. Due to lack of funding, TMC had to terminate the work in Vietnam by the end of 2012.

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New publications in 2012

Viet L, Lan TN, Ty PX, Hoel H, Husebekk A, Gutteberg T, Larsen S, Husum H. Prevalence of hepatitis B and hepatitis C virus infections in potential blood donors in rural Vietnam. Ind J Med Res 2011 (accepted) Lejon, H, Edvardsen, O, Husum, H: A qualitative study of first level care providers in rural Cambodia: Are Traditional Birth Attendants skilled or nonskilled care providers? Soc Sci Med 2012 (submitted). Phung TK, Viet L, Husum H. The legacy of war; an epidemiological study of cluster weapon and landmine accidents in Quang Tri Province, Vietnam. SE Asian J Trop Med Publ Hlth 2012; 43: 1035-41. Mudhafar Karim Murad, MD1; Dara B. Issa, MD2; Farhad M. Mustafa, MD2; Hlwa O. Hassan, MD2; Hans Husum, MD, PhD3. Prehospital trauma system reduces mortality in severe trauma: a controlled study of road-traffic casualties in Iraq. Prehosp Disast Med 2012, 27, 36-41. Murad KM, Larsen S, Husum H. What makes a survivor? Ten-year results from a time-cohort study of prehospital trauma care in Iraq. Scand J Trauma Resusc Emerg Med 2012, 20:13. Viet L, Lan NTN, Pung TK, Bjrkvoll B, Hoel H, Gutteberg T, Husebekk A, Larsen S, Skjerve E, Husum H. Prevalence of Hepatitis B and Hepatitis C Virus Infections in Potential Blood Donors in Rural Vietnam. Indian Journal of Medical Research 2012; 136: 74-81. Le Viet, Anne Husebekk, Hans Husum, Eystein Skjerve. Stochastic model for estimating risk for transfusion transmitted hepatitis B in Vietnam. Transfusion Medicine Journal 2013 (accepted). Phung TK, Quynh N, Nuhan TX, Viet L, Phu LV, Nam M, Husum H, Losvik O. Ketamine better than morphine analgesia in prehospital trauma care: a semi-randomized controlled interventional study in Quang Tri province, Vietnam. Prehospital Emergency Care 2013 (submitted).

Our main scientific publications from previous years

Fosse E, Husum H: Surgery in Afghanistan: a light model for field surgery during war. Injury 1992; 23: 401 404. Husum H. Effects of early prehospital life support to war injured: the battle of Jalalabad, Afghanistan. Prehosp Disast Med 1999; 14: 75 80. Husum H, Gilbert M, Wisborg T. Training prehospital trauma care in low-income countries: the Village University experience. Med Teach 2003; 25: 142 48. Husum H, Strada G. Measuring injury severity. The ISS as good as the NISS for penetrating injuries. Prehosp Disast Med 2002; 17: 27 32. Husum H, Gilbert M, Wisborg T, Heng YV, Murad M. Rural prehospital trauma systems improve trauma outcome in low-income countries: a prospective study from North Iraq and Cambodia. J Trauma 2003; 55: 466 70. Husum H, Gilbert M, Wisborg T, Heng YV, Murad M. Landmine injuries: a study of 708 victims in North Iraq and Cambodia. Mil Med 2003; 168: 934 39. Husum H, Olsen T, Murad M, Heng YV, Wisborg T, Gilbert M. Preventing postinjury hypothermia during long prehospital evacuation. Prehosp Disast Med 2002; 17: 23 26. Husum H, Gilbert M, Wisborg T, Heng YV, Murad M. Respiratory rate as prehospital triage tool in rural trauma. J Trauma 2003; 55: 466 70. Husum H, Resell K, Vorren G, Heng YV, Murad M, Gilbert M, Wisborg T. Chronic pain in landmine accident survivors in Cambodia and Kurdistan. Soc Sci Med 2002; 55:1813 16. Husum H, Heger T, Sundet M. Postinjury malaria: a study of trauma victims in Cambodia. J Trauma 2002; 52: 259 66. Sundet M, Heger T, Husum H. Postinjury malaria: a risk factor for wound infection and protracted recovery. Trop Med Int Health 2003; 9: 238 42. Heger T, Sundet M, Heng YV, Rattana Y, Husum H. Postinjury malaria: experiences of doctors in Battambang Province, Cambodia. SEAsian J Trop Med 2005; 36: 811 15. Edvardsen, O. Et nettverk av frstehjelpere i det minelagte Nord-Irak: et sprsml om liv eller dd. Thesis, Master Health Science. Tromso University, 2006. Chandy H, Steinholt M, Husum H. Delivery Life Support: chain-of-survival for complicated deliveries in rural Cambodia, a preliminary report. Nurs Hlth Sci 2007; 9; 263 269. Chandy H, Ol HS, Heng YV, Husum H. Comparing two survey methods for maternal and neonatal mortality in rural Cambodia. Women Birth 2008; 21: 9-12 Tajsic N, Husum H. Reconstructive microsurgery can be done in low-resource settings: experiences from a wartime scenario. J Trauma. 2008; 65:1463-7. Heng YV, Davoung C, Husum H. Trauma surgery at the District Hospital: a controlled study of trauma training for rural non-graduate surgeons in Cambodia. Prehosp Disast Med 2008; 23: 483 90 Wisborg T, Murad M, Edvardsen O, Husum H. Trauma systems in Iraq 1997-2004: adaptation and maturation. J Trauma 2008; 64: 1342 48 Tajsic N, Winkel R, Hoffmann R, Husum H. Sural perforator flap for reconstructive surgery in the lower leg and the foot: a clinical study of 86 patients with post-traumatic osteomyelitis. J Plast Reconstr Aesthet Surg 2009: 62: 1701 8 Husum H, Edvardsen. Trauma as Poverty. Methodological problems when reality gets nasty. In: Ingstad B, Eide H. Disability and Poverty (London 2009, in press). Ol HS, Bjoerkvoll B, Sothy S, Heng YV, Hoel H, Husebekk A, Gutteberg T, Larsen S, Husum H. Prevalence of Hepatitis B and Hepatitis C virus infection in potential blood donors in rural Cambodia. Se Asian J Trop Med 2009; 40: 963 71 Heger T, Han SC, Sundet M, Larsen S, Husum H. Early diagnosis and treatment of malaria Falciparum in Cambodian trauma patients. SE Asian J Trop Med 2009; 40: 1135 47 Husum H. Severity scoring in rural trauma. Rural Remote Hlth 9 (online) 2009: 1226 Tajsiic N, Winkel R, Schlageter M, Hoffmann R, Husum H. Saphenous perforator flap for reconstructive surgery in the lower leg and the foot; a clinical study of 50 patients with post-traumatic osteomyelitis. J Trauma 2010; 68: 1200 7 Husum H. Rural trauma in Iran: are the data reliable? Rural Remote Hlth 10 (online) 2010: 1387 Heng YV, Husum H, Murad MK, Wisborg T. Improving rural prehospital care in the absence of formal emergency medical services. In: Mock C, Julliard C, Joshipura M, Goosen J (Eds). Strengthening care for the injured: Success stories and lessons learned from around the world. World Health Organization, Geneva 2010: 3 7 Murad M, Husum H. Trained lay first-helpers reduce trauma mortality: a controlled study of rural trauma in Iraq. J Prehosp Disast Med 2010; 25:533 39 Bjoerkvoll B, Viet L, Ol S, Lan TN, Sothy S, Hoel H, Husebekk A, Gutteberg T, Larsen S, Husum H.: Screening test accuracy among potential blood donors. Poor rapid test result accuracy in screening of potential blood donors of HbsAg, anti-HBc and anti-HCV to detect hepatitis B and c virus infection in rural Cambodia and Vietnam: Southeast Asian Journal of Trop Med Public Health, volume 41, September 2010.
Annual report 2012

Workshops and conferences

TMC participated at several workshops and conferences in 2012. The most important were:

Ketamine for pain-relief outside hospital

Safe Blood Transfusion where hepatitis International workshop in Vietnam with partic- is endemic
ipants from the Ministry of Health, researchers from Hanoi and Hue universities, and experts from Iraq, UK, and Norway. Results of TMCs studies in Vietnam of ketamine analgesia were presented by the research team from Quang Tri and Hans Husum, TMC. The MOH Vietnam decided to revise the national protocol for prehospital trauma care based on recommendations from the workshop. International conference in Battambang arranged by TCF Cambodia. Participants from Southeast Asia and world-leading transfusion experts. Presentations by Le Viet and Anne Husebekk, TMC.

All-Indian Conference of Orthopaedic Trauma

International conference at Ganga Hospital. Participants from India and leading trauma surgeons from UK, Austria, and Norway. Presentations by Nenad Tajsic and Hans Husum, TMC.

Post-injury malaria
International workshop in Battambang arranged by TCF Cambodia with participants from Southeast Asia and experts from University of Copenhagen. Presentations by Tove Heger, TMC. The workshop developed protocols for future studies of post-injury malaria prevention. 12 12
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Financial outline 2012 (NOK)

MFA Cambodia: Trauma system, Delivery Life Support, Research School and Cluster program Iraq: Mine & War Victim Assistance Vietnam: Mine victim assistance and maternal care programs TMC core projects: Trauma Care Foundation, teaching aids and film Total In addition we received 75 000 NOK from private donors. 820 000 7 140 000 2 400 000 320 000 4 000 000 2 000 000 Norad 2 400 000

TMC Board members in 2012

Head of board: Hans Husum, Ass. Prof. Surgery, Institute of Clinical Medicine, Troms University. Deputy head of board: Odd Edvardsen, Ass. Prof, Faculty of Health Sciences, Troms. Anne Husebekk, Prof. Immunology, Consultant Transfusion Medicine, University Hospital North Norway. Eystein Skjerve, Prof epidemiology and biostatistics, Norwegian School of Veterinarian Medicin, Oslo Helle Lejon, MD, University Hospital North Norway, Troms Inger Scheel, PhD, The Norwegian Knowledge Centre for the Health Services (NOKC) Ole-Kristian Losvik, MD, PhD research fellow, Tromsoe University. Tor Vadset, film maker, Troms.

We want to thank our partners

Economic support Norwegian Ministry of Foreign Affairs NORAD Norwegian Research Council University Hospital North Norway University of Tromso Private donors Professional partners Al Rasoul Hospital, Beirut Battambang Central Blood Bank, Cambodia Cambodian Ministry of Health Center for Preventive Medicine, Quang Tri, Vietnam Department of Health and The Peoples Committee in Quang Tri, Vietnam Directorate General for Civil Defense, Lebanon Directors of Health, Kirkuk and Baquba Mahidol University, Faculty of Public Health, Bangkok Ministry of Health, Laos Ministry of Health, Northern Iraq National Center for Maternal and Child Health, Phnom Penh National Malaria Centre and WHO, Phnom Penh NORWAC Norwegian Peoples Aid, Laos Provincial Health Department, Battambang, Cambodia Suleimaniah University Hospital, University Hospital North Norway Vellore Medical School, India. Advisors in research and trauma care Dr. Chris Giannou, Greece (former head surgeon ICRC, Geneva) Dr. Garreth Grier, Royal London Hospital (prehospital ttrauma care, pain relief) Dr. Johan Pillgram-Larsen, Ullevaal University Hospital, Oslo (trauma surgery) Dr. Reiner Winkel, Unfallklinik Frankfurt am Main (trauma surgery) Dr. Swee Chai Ang, Royal London Hospital (trauma surgery, teaching) Prof. Alvarez Cambras, Frank Pais International Trauma Center, Cuba (orthopedic trauma) Prof. Benedicte Ingstad, Oslo University (medical anthropology, qualitative methods) Prof. Derek Summerfield, London School of Psychiatry (qualitative methods, action research) Prof. Eystein Skjerve, EPI Center, NVH Oslo (research methodology and epidemiology) Prof. Fernando Vaz, Eduardo Mondlane University, Mozambique (teaching) Prof. Knut Wester, Haukeland University Hospital, Norway (head trauma) Prof. Paola Manduci, University of Genova (toxic effects of modern weapons) Prof. Rebecca Jacob, CMC Vellore, India Prof. Staffan Bergstrm, Karolinska Institute, Stockholm (maternal care, epidemiology) Prof. Stig Larsen, EPI Center, NVH Oslo (research methodology and statistics) Prof. Tore Gutteberg, University Hospital Northern Norway (microbiology)

The TMC research team

In addition to the TMC board members the research team comprises of: Mudhafar Murad, MD, PhD research fellow Tromso University Yang Van Heng, MPH Ha Sam Ol, BMA Houy Chandy, MPH and midwife Le Viet, MSci Nenad Tajsi, MD, PhD research fellow, Troms University Tove Heger, MD, PhD Hedda Hoel, MD Bjorn Bjorkvoll, bioengineer Mads Sundet MD Merete Taksdal, RN Marit Gjertsen, film maker Ahmed Zaradasht, film maker Bjorn Karlsson, orthopedic engineer.

Contact information and partner organizations

Troms Mine Victim Resource Centre (TMC) TMC is a research department at the University Hospital North Norway. P.O. Box 80 , University Hospital North Norway N-9038 Norway Norwegian registered org. no. 986 001 832 Tel Fax +47 777 54177 +47 776 28073 Head of board: Hans Husum Tel +47 951 71 710 E-mail husumhans@gmail.com Trauma Care Foundation Iraq Dr. Mudhafar Murad, Suleimaniah Tel +44 7077 522037 Email tcfiraq@yahoo.com Manager Bjrn Bjrkvoll Tel +47 938 55 194 bjorn.bjorkvoll@online.no Trauma Care Foundation Cambodia Dr. Yang Van Heng, Battambang tcfcambodia1@gmail.com Tel +855 1288 9094 www.traumacarecambodia.org Trauma Care Foundation (TCF) TCF is a humanitarian foundation developing and producing medical teaching aids and film documentaries for oppressed communities in the South. Fjebma, Skoganvarre, N-9722 Norway Norwegian registered org. no. 975 905 055

Email tmc@unn.no www.traumacare.no Center Head Margit Steinholt Tel + 47 993 55760 margit.steinholt@gmail.com

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Indeed that is probably the biggest global challenge to recognise our shared humanity that transcends national boundaries, academic disciplines and cultural heritages, and harness the power of empirical enquiry and rational debate to solve one of the most pressing of the worlds problems creating a just and equitable future for the millions of persons as yet unborn who will bear the name: disabled.
Roy McConkey (2012): Disability, Illness and Poverty: Can the winter of despair lead to a springtime of hope?, International Journal of Disability, Development and Education, 59:3, 321-323