The Key Components of Accessible Surgery

Written by Kelsey Christensen

Surgery is an indivisible, indispensable part of healthcare, and a basic human right to which all people throughout the world deserve access.

In our previous blogs, we’ve outlined the tremendous need for surgery around the world. Millions of people suffer and die each year from surgically treatable diseases, and we believe that surgery should be prioritized globally as an essential health service. But, what is needed to make surgery truly accessible?

Surgery is a complex service. It requires investments in infrastructure at all levels of the health system as well as multi-disciplinary teams of care providers trained in a wide variety of specialties. Only through timeliness, system capacity, safety, and affordability can surgery truly be considered accessible to patients at every rung of the social ladder. This chart details the four most critical components of surgical care.

Each of the components above are interconnected and necessary to ensure that surgery is accessible. In many low income countries there are frequently obstacles to some or all of these key components. For example, in remote or rural areas, patients may find that their local hospital is not equipped to provide surgery, especially more complex procedures. Traveling long distances to reach a surgical center in a major city, the patient may still face an under-resourced health system. Patients are likely to find that the surgical center has months or year-long wait times before they can be served, during which time their condition may worsen or become more complex and difficult to treat. In addition, many hospitals lack adequate resources, equipment, and personnel to provide needed care. Each of these obstacles can challenge the ability of a patient to receive timely, safe surgery.

At Solidarity Bridge we are proud of our work, in partnership with Puente de Solidaridad, to increase access to surgery in Bolivia. While we focus our efforts on serving some of the most vulnerable in the population, our efforts to train, equip and build relationships of solidarity make a sustainable impact that reverberates throughout the health system and increases access to surgery for all.

Here are some recent highlights of our work and how they impact each of the four key components of surgical access:

Timeliness: Laparoscopic surgery is minimally invasive and offers many advantages over traditional, open surgery, including shorter hospital stays. Patients treated laparoscopically can return home more quickly, which opens up hospital beds and allows the hospital to increase the number of surgeries it can provide each month. This shortens the wait time for patients in need of this care. To increase access to these types of surgery, Solidarity Bridge facilitated the donation of a new laparoscopic tower to the Viedma Hospital in Cochabamba, made possible by generous donors of Rotary. Additionally, our partners at Puente de Solidaridad use a mobile laparoscopic tower and equipment donated by Solidarity Bridge to bring this technology and treatment to smaller and rural hospitals that otherwise could not offer this care.

Capacity: Each year, Solidarity Bridge missioners carry with them a surplus of supplies on each mission trip that are used to equip and resource our Bolivian partner hospitals. In addition to the supplies hand delivered by our missioners, this past May we were able to send a shipping container filled with high-value medical supplies to our partners at Puente de Solidaridad. So far in 2018, we have made possible 15 bulk donations to our partner hospitals in Bolivia, better equipping them to provide the surgeries their patients need.

Safety: Close working relationships between US and Bolivian physicians, mentorship, and training have been a key part of our mission from the beginning. In this way, we can share our resources, skills, and knowledge to improve the safety of surgery provided. In the past year, Board Member Dr. Daniel Lum traveled to Bolivia to take part in discussions with our partner surgeons on quality improvement and best practices for post-operative care, and two Bolivia partner surgeons were welcomed here in the US for a Solidarity Visit.

Affordability: Solidarity Bridge continually faces the challenge of the impact of high surgical costs in our efforts to serve those who can least access surgery. We, and our partners at Puente de Solidaridad, respond to this economic reality on both systemic and personal levels. For example, on the system level, Puente de Solidaridad negotiates accessible service rates with public and private hospitals and individual doctors in Bolivia. On the personal level, each patient who undergoes surgery through one of our programs is paired with a social worker who evaluates their economic means, and works to ensure needed surgical services while preventing undue economic hardship. Additionally, medical supply donations from individuals and corporations in the United States are distributed to individual patients - those served by our surgical programs or referred by Bolivian partners - and to public hospitals throughout the country. These supplies directly impact the cost of surgery to patients in need. All of this is made possible thanks to the generous gifts of donors to Puente de Solidaridad and Solidarity Bridge.

Surgery is an indivisible, indispensable part of healthcare, and a basic human right to which all people throughout the world deserve access. Yet we have a long way to go to make this a reality. The global community must continue to speak on this, and we must continue to lend our voice and example as well. Investing in surgical care facilitates overall health system strengthening and improves the quality of life for patients, their families, and their communities. It is a good investment. Thank you for supporting our efforts in this area. Your involvement makes a tangible difference in the lives of our patients, and a sustainable impact on our partners in Bolivia. Together we strive toward a world where all can be healed.

The Catholic Church, the World Health Organization and the United Nations have all named health care as a human right, and national governments and humanitarian groups have responded with improvements in basic care and prevention and treatment of communicable disease. But surgically treatable conditions are responsible for more deaths globally than HIV/AIDS, tuberculosis, and malaria combined. Yet surgery has long been overlooked in the global health community as a luxury too expensive and too complex to prioritize.

This fall, we have shared a three-part blog series exploring the need for surgery globally. In our first blog we looked at the global burden of surgically treatable diseases, next we explored the case for surgery as part of essential health services. Our final blog will focus on key components needed for access to safe and timely surgical care.

Kelsey Christensen, MS is a healthcare professional in the Chicago area with 5 years of experience working in the field of pediatric transplant surgery. She is a recent graduate of Northwestern University’s Master of Science in Global Health program and is currently interning with Solidarity Bridge to learn more about the organization and nonprofit sector work.