Publications (15) View all
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Article: Measuring Global Surgical Disparities: A Survey of Surgical and Anesthesia Infrastructure in Bangladesh.
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ABSTRACT: BACKGROUND: Surgically treatable diseases weigh heavily on the lives of people in resource-poor countries. Though global surgical disparities are increasingly recognized as a public health priority, the extent of these disparities is unknown because of a lack of data. The present study sought to measure surgical and anesthesia infrastructure in Bangladesh as part of an international study assessing surgical and anesthesia capacity in low income nations. METHODS: A comprehensive survey tool was administered via convenience sampling at one public district hospital and one public tertiary care hospital in each of the seven administrative divisions of Bangladesh. RESULTS: There are an estimated 1,200 obstetricians, 2,615 general and subspecialist surgeons, and 850 anesthesiologists in Bangladesh. These numbers correspond to 0.24 surgical providers per 10,000 people and 0.05 anesthesiologists per 10,000 people. Surveyed hospitals performed a large number of operations annually despite having minimal clinical human resources and inadequate physical infrastructure. Shortages in equipment and/or essential medicines were reported at all hospitals and these shortages were particularly severe at the district hospital level. CONCLUSIONS: In order to meet the immense demand for surgical care in Bangladesh, public hospitals must address critical shortages in skilled human resources, inadequate physical infrastructure, and low availability of equipment and essential medications. This study identified numerous areas in which the international community can play a vital role in increasing surgical and anesthesia capacity in Bangladesh and ensuring safe surgery for all in the country.World Journal of Surgery 10/2012; · 2.36 Impact Factor -
Article: Surgical and anesthesia capacity in bolivian public hospitals: results from a national hospital survey.
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ABSTRACT: Underdeveloped nations suffer from significant deficiencies in surgical and anesthesia care. Although surgical inequities are a pressing issue internationally, the extent of these inequities is unknown due to a lack of data. The aim of this study was to assess surgical and anesthesia capacity in Bolivia as part of a multinational study assessing surgical and anesthesia infrastructure in Africa, Latin America, and South Asia. A standardized survey tool was used to obtain national-level health-care data at the Bolivian Ministry of Health. Hospital-specific data were obtained through interviews with key administrators and providers at 18 public basic and general hospitals in Bolivia. There are 1,270 obstetrician/gynecologists and 1,807 surgeons in Bolivia. In contrast, there are 500 anesthesiologists, placing a large anesthesia burden on the country. Basic hospitals and general hospitals performed an average of 730 and 2,858 operations per year, respectively. One basic hospital was unable to perform any surgeries due to a lack of surgical manpower. All but two hospitals reported some lack of infrastructure, equipment, or pharmaceutical capacity. The ability to collect health outcomes was inconsistent in most hospitals. Surgical capacity varies throughout Bolivia. There are relatively large numbers of surgery providers but an insufficient number of anesthesiologists, suggesting a specific need for further development in anesthesia. Though there are many areas of strength within the Bolivian public health-care system, this survey identified several areas to which national policy and international collaboration can contribute in order to more adequately address major causes of surgical morbidity and mortality.World Journal of Surgery 08/2012; 36(11):2559-66. · 2.36 Impact Factor -
Article: The Provision of Surgical Care by International Organizations in Developing Countries: A Preliminary Report
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ABSTRACT: ObjectiveEmerging data demonstrate that a large fraction of the global burden of disease is amenable to surgical intervention. There is a paucity of data related to delivery of surgical care in low- and middle-income countries, and no aggregate data describe the efforts of international organizations to provide surgical care in these settings. This study was designed to describe the roles and practices of international organizations delivering surgical care in developing nations with regard to surgical types and volume, outcomes tracking, and degree of integration with local health systems. MethodsBetween October 2008 and December 2008, an Internet-based confidential questionnaire was distributed to 99 international organizations providing humanitarian surgical care to determine their size, scope, involvement in surgical data collection, and integration into local systems. ResultsForty-six international organizations responded (response rate 46%). Findings reveal that a majority of organizations that provide surgery track numbers of cases performed and immediate outcomes, such as mortality. In general, these groups have mechanisms in place to track volume and outcomes, provide for postintervention follow-up, are committed to providing education, and work in conjunction with local health organizations and providers. Whereas most organizations surveyed provided fewer than 500 surgical procedures annually, more than half had the capacity to provide emergency services. In addition, a great diversity of specialized surgical care was provided, including obstetrics, orthopedic, plastic, and ophthalmologic surgery. ConclusionsInternational organizations providing surgical services are diverse in size and breadth of surgical services provided yet, with consistency, provide rudimentary analysis, postoperative follow-up care, and both education and integration of health services at the local level. The role of international organizations in the delivery of surgery is an important index, worthy of further evaluation.World Journal of Surgery 04/2012; 34(3):397-402. · 2.36 Impact Factor -
Article: Challenges of surgery in developing countries: a survey of surgical and anesthesia capacity in Uganda's public hospitals.
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ABSTRACT: There are large disparities in access to surgical services due to a multitude of factors, including insufficient health human resources, infrastructure, medicines, equipment, financing, logistics, and information reporting. This study aimed to assess these important factors in Uganda's government hospitals as part of a larger study examining surgical and anesthesia capacity in low-income countries in Africa. A standardized survey tool was administered via interviews with Ministry of Health officials and key health practitioners at 14 public government hospitals throughout the country. Descriptive statistics were used to analyze the data. There were a total of 107 general surgeons, 97 specialty surgeons, 124 obstetricians/gynecologists (OB/GYNs), and 17 anesthesiologists in Uganda, for a rate of one surgeon per 100,000 people. There was 0.2 major operating theater per 100,000 people. Altogether, 53% of all operations were general surgery cases, and 44% were OB/GYN cases. In all, 73% of all operations were performed on an emergency basis. All hospitals reported unreliable supplies of water and electricity. Essential equipment was missing across all hospitals, with no pulse oximeters found at any facilities. A uniform reporting mechanism for outcomes did not exist. There is a lack of vital human resources and infrastructure to provide adequate, safe surgery at many of the government hospitals in Uganda. A large number of surgical procedures are undertaken despite these austere conditions. Many areas that need policy development and international collaboration are evident. Surgical services need to become a greater priority in health care provision in Uganda as they could promise a significant reduction in morbidity and mortality.World Journal of Surgery 03/2012; 36(5):1056-65. · 2.36 Impact Factor -
Article: Surgery, public health, and Pakistan.
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ABSTRACT: Surgical healthcare is rapidly gaining recognition as a major public health issue. Surgical disparities are large, with poorest populations receiving the least amount of emergency and essential surgical care. In light of recent evidence, developing countries, such as Pakistan, must acknowledge surgical disease as a major public health issue and prioritize research and intervention accordingly. We review information from various sources and describe the current situation of surgical health care in Pakistan and highlight areas of neglect. Pakistan suffers an annual deficit of 17 million surgeries. Surgical disease kills more people than infectious diseases inclusive of tuberculosis, HIV/AIDS, diarrheal disease, and childhood infections. The incidence of trauma and maternal mortality ratio are staggeringly high. There is a severe dearth of surgical and anesthesia-related epidemiological data. Important information that would help to drive policy and planning is not available. Corruption and neglect have led to a dilapidated health care infrastructure. Surgical care is largely inaccessible to the poor, especially those living in rural areas. The country faces a dearth of healthcare professionals, especially paramedics, anesthetists, and surgeons. Unsafe surgery and anesthesia poses a significant risk to patients. There is no national policy on surgical illness and the preventive aspects of surgery are nonexistent. Consistent with other underdeveloped countries, surgical care in Pakistan is dismal. Neglecting surgery and safe anesthesia has led to countless deaths and disability. Physicians, researchers, policy makers, and the government health care system must engage and commit to provide access to emergency, essential, and safe surgical care.World Journal of Surgery 10/2011; 35(12):2625-34. · 2.36 Impact Factor
