Identifying the Health Needs and Barriers for Local Surgical Care in Rural India

By: Dr. William Bolton, Mr. Noel Aruparayil and Dr. J. Gnanaraj

AIMS

Our primary goal was to collaborate with our stakeholders in India – Karunya University, TRIMHS (Tomo Riba Institute of Health & Medical Science), Association of Rural Surgeons of India (ARSI) and Lancet Commission of Global Surgery – India. Identify local health needs and barriers to surgical care and unmet surgical needs. Build local health network, connect local researchers, healthcare providers and policy makers. Assess ways of implementation of innovative technologies to provide high quality surgical care.

COLLABORATIVE WORKSHOP

In February 2018, the National Institute of Health Research (NIHR) Global Health Research Group in Surgical Technologies (GHRG-ST) from the University of Leeds UK jointly hosted an Innovation Workshop at Karunya University Coimbatore, in collaboration with Harvard Medical School’s Programme for Global Surgery and Social Change. This 3-day workshop was a huge success and over one hundred students worked on engineering projects to address healthcare needs.

SURGICAL CAMPS

In Dimapur, Nagaland surgical lists were run focusing on gynaecological and urological conditions. The team worked on delivering vital surgical care for patients in need. Alongside the delivery of care, the surgeons engaged in training the local surgical workforce to enhance local surgical capacity and ensure sustainability of the surgical service locally. High quality surgical care was provided by employing low-resource specific techniques where required, such as the gasless lift laparoscopic technique (GLLS). This has particularly proven to be useful for elective abdominal conditions, and provides all the benefits of minimally invasive surgery such as quicker time to recovery, reduced post-operative pain and better cosmetic results, all without increasing the cost of the procedure. From Dimapur the camps moved north to Arunachal Pradesh. Here the camp visited several healthcare facilities from referral hospitals to remote rural village healthcare facilities.

TRIHMS

In Itanagar, the capital of Arunachal Pradesh, the (TRIHMS) was visited which is a 250-bedded referral hospital. The team was shown the current infrastructure and future development plans for a 500-bedded facility. Several wards and operating theatres were visited, seeing first-hand high quality clinical care provided by the teams there. TRIHMS is in final stages of establishing the state’s first Medical College, with the first intake of students expected to be in the Autumn of 2018.

RURAL CLINICS

Visits were made to interior districts, mainly hospitals in Bhalukpong and primary healthcare facilities in Singchung. Bhalukpong is home to a small facility which provides surgical care to a population of more than 1 lakh. Here, elective urological and GLLS procedures are provided, as well as emergency lifesaving surgery such as caesarean section and laparotomy. Visits were made to remote centres in Singchung and several rural villages to really understand the lives of the people, as well as gain an appreciation for the extensive unmet surgical need. Thousands lack access to safe and affordable surgical care when needed. At one primary healthcare facility in Singchung, we gained a good appreciation of the way healthcare is delivered at this level and how surgical care may be improved by developing further diagnostic camps at these centres, as well as robust referral systems to secondary care facilities.

FUTURE PLANNING

GHRG-ST is collaborating with the Surgical Camp team and are busily planning clinical studies to improve the delivery of surgical care for rural population in the North East. Primary focus remains on provision of GLLS as a minimally invasive technique for abdominal conditions, as well as using innovative platforms to improve education and diagnosis of surgical disease for the most remote populations.

Dr William Bolton MBChB, BSc (Hons) is a NIHR Clinical Research Fellow with Global Health Research Group - Surgical technologies at the University of Leeds.

Mr Noel Aruparayil M.D (Honours), MRCSEd, PGCert in Health Research is a NIHR Clinical Research Fellow with Global Health Research Group - Surgical technologies at the University of Leeds.

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.