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The truck bringing surgery to remotest Ecuador
The truck bringing surgery to remotest Ecuador
Access to surgery could save millions of lives, so a mobile clinic is showing how doctors can reach rural communities
Two billion people worldwide do not have access to safe, timely and affordable surgery. And around double the number of people die from injuries that could be treated by surgery than die from HIV/Aids, tuberculosis and malaria combined. The magnitude of this problem was not fully appreciated until recently, when research established the significant burden of surgical conditions. Many initiatives are now trying to combat this.
Access to surgery is a major problem in Ecuador, home to the Andes, the Amazon River and rainforest. Many of those in poorer and remote areas cannot travel to seek surgical care in larger cities for many reasons, including the cost of travel and the impact of leaving their jobs and families at home. Dr Edgar Rodas, Ecuador’s general surgeon and previous minister of health, had a vision to deliver surgery through a truck converted into a mobile operating theatre.
After a 15-year-quest to obtain the necessary resources, equipment and team, Cinterandes was established in 1994, and has now been successfully delivering surgery in remote areas for over 20 years, completing over 7,500 operations. It is a non-governmental organisation, functioning on donations, with a team of seven core members delivering free care to the patients.
Cinterandes’ surgical team have become adept at performing surgery in a compact operating theatre Photograph: Cinterandes
Operating in a truck may seem risky. However, the Cinterandes team prefer it over working in temporary rural clinics, as they are familiar with the truck’s layout and equipment, and can function very efficiently. In fact, their complication rates are on par with most tertiary surgical centres in the developed world.
Various operations, from simple to more complex and laparoscopic, are conducted on the truck. Patients are selected to ensure that the local community and family-based post-operative care is appropriate. As missions are condensed into four-day trips, a structured programme is essential. At least two pre-operative assessments for each patient are conducted, one through a key local contact prior to arrival. After departure, post-operative care is continued through a local medical contact, as well as telemedicine. Thus, a continuum of care is delivered.
Yearly costs for Cinterandes is approximately $200,000 to treat 200 patients, many of whom simply could not have received surgery otherwise. The biggest challenge for the Ecuadorian mobile surgical unit is regular funding and resources to allow it to function and deliver care. There are also environmental challenges, including terrain, road networks, electricity and water infrastructure, as well as local safety and security.
Lack of patient trust during project conception was initially a barrier, mainly from unfamiliarity. But trust quickly developed when genuinely high-quality care was delivered. That build-up of trust now plays an important role as many people seek surgical care who would have otherwise been too reluctant or afraid.
Mobile surgery can be found in many developed and developing countries. For instance Vanguard delivers mobile healthcare in UK. In Thailand a successful project in 2008 delivered ear procedures via a mobile surgery clinics and in India a mobile clinic was funded to deliver cataract surgery in remote areas. Mercy Ships bring surgical medicine to west Africa and other port locations around the world. As well as Ecuador, Cinterandes works in Honduras.
Robust evidence now exists for mobile surgery’s success and ample guidance is available. Considering the unique benefits in reaching the inaccessible, there’s no excuse for more countries not to deliver this alternative form of surgery.
Haadi Tarek Shalabi is a doctor at King’s Mill Hospital in the UK who volunteered with Cinterandes in Ecuador. Saggah Tarek Shalabi is a surgical trainee at Queen’s Medical Centre in the UK.
Read more stories like this:
Going under the knife: surgery access should be available to all
The future of healthcare: life-saving innovations for the bottom billion
Vaccine development: thinking out of the cold box
Advertisement feature: Harnessing innovation for health around the world
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Why you can rely on the Guardian not to bow to Trump – or anyone
I hope you appreciated this article. Before you move on, I wanted to ask whether you could support the Guardian’s journalism as we begin to cover the second Trump administration.
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Telemedicine in Surgical Care in Low- and Middle-Income Countries: A Scoping Review
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