A quantitative analysis of surgical capacity in Santa Cruz,Bolivia |
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Authors: | Abraham Markin Roxana Barbero Jeffrey J. Leow Reinou S. Groen Evan J. Skow Keith N. Apelgren Adam L. Kushner Benedict C. Nwomeh |
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Affiliation: | 1. Departments of Emergency Medicine and Internal Medicine, Henry Ford Hospital, Detroit, MI;2. Programa de Enfermedades no Transmisibles, Servicio Departamental de Salud, Santa Cruz, Bolivia;3. Centro Medico Galene, Santa Cruz, Bolivia;4. Surgeons OverSeas (SOS), New York, New York;5. Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, Maryland;6. Department of Psychiatry, Dartmouth Hitchcock Medical Center, Lebanon, NH;g Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;h Department of Surgery, Columbia University, New York, New York;i Department of Surgery, Ohio State University, Columbus, Ohio |
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Abstract: | ObjectivesThis investigation aimed to document surgical capacity at public medical centers in a middle-income Latin American country using the Surgeons OverSeas (SOS) Personnel, Infrastructure, Procedures, Equipment, and Supplies (PIPES) survey tool.Materials and methodsWe applied the PIPES tool at six urban and 25 rural facilities in Santa Cruz, Bolivia. Outcome measures included the availability of items in five domains (Personnel, Infrastructure, Procedures, Equipment, and Supplies) and the PIPES index. PIPES indices were calculated by summing scores from each domain, dividing by the total number of survey items, and multiplying by 10.ResultsThirty-one of the 32 public facilities that provide surgical care in Santa Cruz were assessed. Santa Cruz had at least 7.8 surgeons and 2.8 anesthesiologists per 100,000 population. However, these providers were unequally distributed, such that nine rural sites had no anesthesiologist. Few rural facilities had blood banking (4/25), anesthesia machines (11/25), postoperative care (11/25), or intensive care units (1/25). PIPES indices ranged from 5.7–13.2, and were significantly higher in urban (median 12.6) than rural (median 7.8) areas (P < 0.01).ConclusionsThis investigation is novel in its application of a Spanish-language version of the PIPES tool in a middle-income Latin American country. These data document substantially greater surgical capacity in Santa Cruz than has been reported for Sierra Leone or Rwanda, consistent with Bolivia’s development status. Unfortunately, surgeons are limited in rural areas by deficits in anesthesia and perioperative services. These results are currently being used to target local quality improvement initiatives. |
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Keywords: | Global surgery Bolivia Emergency surgery Essential surgery Latin America |
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