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| MISSION HOSPITAL SECTION |
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| Year : 2014 | Volume
: 1
| Issue : 3 | Page : 194-197 |
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Surgical services initiative: Taking modern surgery to the poor
J Gnanaraj, Sungtiakum Jamir
Department of Medical Services, Samiti for Education, Environment, Health and Social Action, Surgical Services Initiative, Coimbatore, Tamil Nadu, India
| Date of Web Publication | 17-Aug-2014 |
Correspondence Address:
J Gnanaraj
Director of Medical Services, Samiti for Education, Environment, Health and Social Action, Surgical Services Initiative, Alpha 5, Karunya University Quarters, Karunyanagar, Coimbatore - 641 114, Tamil Nadu
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/2348-3334.138900
Mobile surgical services have the inherent advantage that surgical conditions can be diagnosed and treated in a cost effective way in rural as well as remote areas. The Surgical Services Initiative comprises a group of doctors who have joined hands to help the poor and marginalized sections of the population by making modern surgical treatment available to them. The experience and details of one such surgical camp held over one month is presented in this article. The diagnostic and surgical camp model is also described here. Keywords: Diagnostic camps, minimally invasive surgeries, surgical camps
How to cite this article:
Gnanaraj J, Jamir S. Surgical services initiative: Taking modern surgery to the poor. CHRISMED J Health Res 2014;1:194-7 |
| Introduction | |  |
The World Health Organization has estimated that 11% of the global disease burden can be treated with surgical procedures, but there are still 2 billion people who have no access to basic surgical care. Out of the 234 million surgeries carried out each year, only 3.5% are carried out on the world's poorest population.
The Surgical Services Initiative is a non-profit organization formed by a group of doctors with the aim of providing quality, multispecialty, and cost effective surgical services to rural Christian hospitals and other charitable hospitals in India. The idea is to reach out and benefit patients with low cost surgical services. The local doctors are also involved and receive training in these fields.
| The Concept | | |
Diagnostic camps are held to diagnose surgically treatable conditions among populations in remote and rural areas. The diagnostic camps take all of the diagnostic facilities that are usually available at hospitals to remote rural areas. The entire laboratory with all routine and other investigations including gastroscopy, cystoscopy, ultrasound examinations, as well as the pharmacy is made available for the camp. However, X-rays are logistically difficult to provide at the site. The local churches, social service organizations or the villages themselves organize these diagnostic camps. They use the consultation fee to cover their expenses, and patients are happy to pay for the investigations, medicines and procedures.
Once diagnosed, the surgical patients get their treatment at the surgical camps. The surgical camps are located near hospitals or health care facilities. Advanced surgical procedures, endoscopic and laparoscopic surgical procedures are possible with the set of mobile equipment earmarked for these camps. Qualified and trained personnel are available at these hospitals for the surgical camp. One half of the nominal fee that the patients pay goes towards organizing the surgical camps while the other half is donated to the local hospital.
| The Experience | | |
We have carried out these diagnostic and surgical camps for over three decades in remote areas in Gujarat and northeast India. The first publication regarding these camps received the Barker Memorial Prize given by Tropical Doctor in 1997. [1] The study at Burrows Memorial Christian Hospital published in the Indian Journal of Surgery showed that the model is financially viable. [2] Donations were necessary only for the capital items. Many patients in rural areas benefited from the minimally-invasive surgical procedures. Another study published in the Australia and New Zealand Journal of Surgery, [3] showed that more than half of the patients who required surgical intervention for prostate disease did get the necessary treatment with this model.
Surgical camps are not unique. There are many organizations offering such service. [4] Operation hernia, [5] smile train, [6] do conduct such camps for specific purposes and have been very successful. However, they are expensive and need lot of grants and donations for sustainability.
[Figure 1], [Figure 2], [Figure 3] and [Figure 4] show some of the interesting aspects of the surgical camp and sharing these especially the Lift Laparoscopic surgeries. | Figure 3: Sometimes even the backup generator fails and torch light comes to the aid
Click here to view |
 | Figure 4: Lift laparoscopic surgery [gasless laparoscopy] workshop at Midnapore Medical College
Click here to view |
| The Advantages | | |
The advantages of the surgical camp model are
- It is cost-effective and has existed for over three decades. Funds are necessary only for the capital needs
- About three-fourths of the patients requiring surgical intervention were diagnosed for the first time during these camps. The ultrasound examinations and scopies were instrumental in the diagnosis of surgical conditions
- The surgical camps offered a great way for training the local surgeons and trainee surgeons as the number of surgical patients was higher during the camps
- Thousands of patients were able to have modern minimally-invasive surgeries at a very nominal cost
- Various innovations were possible during these surgical camps. Many articles were published in national and international journals from the findings and innovations made during these surgical camps
- Unlike the medical conditions diagnosed during the diagnostic camps, surgical treatment often provides a permanent cure
- Others have successfully replicated the model.
This model provides the necessary care at most reasonable costs to patients in rural areas, and the fast recovery time of minimally-invasive surgery allows them to return to their daily lives quickly.
Activities of surgical services initiative
- Diagnostic camps
- Surgical camps
- Surgical camp exposure for medical students, interns and volunteers
- Training programs
- Working holidays
- Medical tourism
- Resource sharing between hospitals
- Upgrading of local operation theatres
- Research work related to low cost equipment.
In addition to the diagnostic and surgical camps the Surgical services initiative offers training programs for medical students, interns and junior doctors. Working holidays and resource sharing is also possible along with offering medical tourism for patients from abroad.
The opportunities
- For learning
- For teaching
- For upgrading facilities
- For serving.
The following are the ways to get involved
- Volunteering for the surgical and diagnostic camps in remote and rural areas
- Helping with the research program
- Donating to the program
- Joining as full time staff
- Carrying donated medical supplies to the surgical camps
- Funding research projects.
A typical month at the SSI surgical camp
In March 2014, surgical camps were held at a few places in Mizoram, Manipur and a workshop was held in West Bengal. [Table 1] lists the surgical procedures carried out at the camp. The following were the benefits from the surgical camp:
- 98 patients benefitted from surgical procedures which they would not have been able to afford otherwise
- Two surgeons were able to assist and learn new procedures which they were able to perform independently towards the end of the surgical camp.
The team carried the urology and laparoscopic surgical equipment while the television monitors are from the local places where surgical camps were held. The team carried out ultrasound examinations while anesthesiologists available at the surgical camps did the complete pre-anesthetic checkups and investigations that are necessary for anesthesia. Most of the procedures were carried out under regional anesthesia while some needed general anesthesia.
The local surgeons or doctors follow up the patients and all the patients of the above camp were discharged and had an uneventful post-operative period. However one of the patient who had transurethral vaporization of prostate had difficulty in passing urine and was sent on catheter.
The surgical camps over the last three decades did have complications including serious sepsis leading to death and a patient with partial nephrectomy bleeding to death and a fair amount of minor complications. However, considering the average of over 500 surgeries every year for more than two decades, the incidence of complications is not higher compared to the statistics at hospitals.
The ethics committee of Emmanuel Hospital Association had earlier approved the surgical camps although specific approval was not sought for the particular camp mentioned above.
| Summary | | |
Surgical Services Initiative (SSI) is a cost effective way of offering surgical treatment to the poor and the marginalized sections of society. It provided opportunities for seniors like Dr. Michael Rhodes (Past president of Association of Laparoscopic surgeons of Great Briton and Ireland) to teach and at the same time helped junior surgeons like Dr. Sungtiakum Jamir and Dr. Nandamani to learn new procedures. It has helped hospitals located in remote, rural areas to provide advanced surgeries and the poor people greatly benefit from the initiative.
| Contact information | | |
Those interested can contact Dr. Sungti, the Executive Director of SSI [[email protected]] for further details.
| References | | |
| 1. | Gnanaraj J, Gnanaraj L, Shah VK. How to bring surgery to remote tribal areas. Trop Doct 1997;27:163-5. 
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| 2. | Gnanaraj J, Jason LY, Khiangte H. High quality surgical care at low cost: The Diagnostic camp model of Burrows Memorial Christian Hospital (BMCH). Indian J Surg 2007;69:243-7.
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| 3. | Gnanaraj J, Gnanaraj L. Transurethral electrovaporisation of prostate: A boon to the rural surgeon. Aust N Z J Surg 2007;77:708.
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| 4. | Kakalande I, Obote WW, Sebaale K. Surgical Camps: the Ugandan experience. http://www.bioline.org.br/pdf?js01010 [Last accessed on 2014 Jun 27]
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| 5. | Available from: http://www.operationhernia.org.uk/. [Last accessed on 2014 Mar 25].
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| 6. | Available from: http://www.smiletrainindia.org/. [Last accessed on 2014 Mar 25].
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1]
| This article has been cited by | | 1 |
Evaluation and usability study of low-cost laparoscopic box trainer “Lap-Pack”: a 2-stage multicenter cohort study |
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