Innovations in Surgical Care for the Poor: Presented at the Canadian Conference on Global Health 2014

Objective

Advanced surgical care is not available to most people in rural areas because of reasons related to “Accessibility, Availability and Affordability.” We describe how the Surgical Services Initiative helped to address these problems and make advanced surgical care available to the poor and the needy over three decades, in remote and rural areas of India.

Methods

outside clinicDiagnostic camps take all the diagnostic facilities available at the hospital to remote rural areas. They include ultrasonography, cystoscopy, gastroscopy and the entire laboratory. They are arranged by local churches and NGOs. Surgical camps are arranged in nearby mission or rural hospitals.

The surgical camp model takes modern surgical facilities to remote areas and deals with the problem of accessibility. This is a self-sustaining, cost-effective model. These camps make highly specialized care available by taking experts and consultants in the field and using the opportunity to train local and other surgeons. Online training programs with live streaming of surgical procedures and hands-on training during surgical camps can help many rural surgeons learn new techniques.

Advanced surgical care is made affordable with innovations like Gasless Lift Laparoscopic surgeries and low-cost vacuum therapy. The research projects are carried out with the help of staff and students of Karunya University, which has good engineering institutions.

Outcomes

exam1The initial article about the surgical camp model received the Barker Memorial Prize by Tropical Doctor in 1997. On average, about 1,000 patients benefited from advanced surgical procedures in rural areas every year for the last two decades. Several innovative, low-cost procedures were published in national and international journals.

In a study published in the Australian New Zealand Journal of Surgery in 2007, it was found that in three districts of Mizoram, with 3 to 4 diagnostic camps a year, more than 50% of the estimated patients with bladder outflow obstruction due to benign prostatic hyperplasia were evaluated and treated.

A study published in the Indian Journal of Surgery in 2007 showed that it was possible to offer high-quality surgical services while charging only [s2If !is_user_logged_in()]…

[/s2If][s2If is_user_logged_in()] INR 1000, in addition to the patients paying for medicines and investigations. The analysis showed that it was a cost-effective model.

A study published in the CHRISMED Journal of Health and Research in 2014 showed that it was possible to take a wide variety of advanced and modern surgeries to the poor and marginalized at a very affordable cost, involving surgeons who come for working holidays.

surgery 1Several publications in mdCurrent-India in 2013 and 2014 showed that a wide variety of innovative surgical methods came about because of the needs that arose during these surgical camps. During the last decade, 3,628 laparoscopic surgeries were carried out during the surgical camps, and analysis of the data showed that parameters like surgical site infection, etc. were comparable with the surgeries carried out at one center. None of these surgeries would have been possible, had it not been for the surgical camps.

Lack of follow-up with surgeons is a significant problem because most of them are visiting surgeons, and this has contributed to increased morbidity in some patients.

Discussion

It is a win–win situation for all concerned:

  • The rural patients benefit from advanced and minimally-invasive procedures
  • It is a cost-effective and self-sustaining model, thus making the administrators happy
  • It helps consultants and specialists from all over the world to train the rural surgeons who carry on the work
  • The innovations of equipment help the engineering students do useful projects while studying and help cut down costs dramatically

Conclusion

The Surgical Services Initiative addresses the major problems of rural surgery and offers an innovative means of training to surgeons from all over the world. It is a cost effective method.

Gnanaraj-64 Dr. J. Gnanaraj MS, MCh [Urology], FICS, FARSI, FIAGES is a urologist and laparoscopic surgeon trained at CMC Vellore. He has been appointed as a Professor in the Electronics and Instrumentation Engineering Department of Karunya University and is the Director of Medical Services of the charitable organization SEESHA. He has a special interest in rural surgery and has trained many surgeons in remote rural areas while working in the mission hospitals in rural India. He has helped 21 rural hospitals start minimally invasive surgeries. He has more than 150 publications in national and international journals, most of which are related to modifications necessary for rural surgical practice. He received the Barker Memorial award from the Tropical Doctor for the work regarding surgical camps in rural areas. He is also the recipient of the Innovations award of Emmanuel Hospital Association for health insurance programs in remote areas and the Antia Finseth innovation award for Single incision Gas less laparoscopic surgeries. During the past year, he has been training surgeons in innovative gas less single incision laparoscopic surgeries.

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