Tuesday, February 17, 2015

A mobile surgical unit in Ecuador

Latest 3 Quarks Daily column is about my healthcare-themed trip to Cuenca, Ecuador last October. Full essay is here. This is how it begins: 
Since 1994, a small team of clinicians has been bringing elective surgeries to Ecuador's remotest towns or villages, places that have do not have hospitals in close proximity. From the city of Cuenca – Ecuador's third largest town, where they are based – the team drives a surgical truck to a distant village or town. Though a small country by area, the barrier of the Andes slices Ecuador into three distinct geographic regions: the Pacific coast in the west; the mountainous spine that runs through the middle; and the tremendously bio-diverse but also oil rich jungle expanse to the east, El Oriente, home to many indigenous tribes. Apart from a few major cities – Quito, Guayaquil, Cuenca – towns and villages tend to be small and remote.   
Isuzu Truck 2

Each year the team goes on 12 surgical missions, roughly one per month. A trip lasts around 4 days: a day's drive to get to the place; 2 days to conduct 20-30 surgeries (sometimes more sometimes less); and then a day to return. Patients pay a nominal/reduced fee if they can: the surgeries are done irrespective of the patient's ability to pay. The clinicians belong to a foundation called Cinterandes (Centro Interandino de Desarollo – Center for Inter-Andean Development).   
Amazingly, the very same Isuzu truck (see above) has been in use for more than 850 missions and has seen 7458 surgeries from 1994-2014! The truck itself is not very large; in fact, it cannot be, because it has to reach places that do not have good roads. The mobile surgery program has the lowest rates of infection in the country. Not a single patient has been lost. The cases to be operated on have to be carefully chosen. Because of the lack of major facilities nearby, only surgeries with a low risk of complication can be done. Hernias and removal of superficial tumors are the most common. Hernias can be debilitating, yet patients may simply choose to live with them for many years rather than visit a far-off urban hospital. For many, leaving work for a few days and traveling to get a health problem fixed is not an option.

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