Online Program

Modern surgical ecosystems: Models for surgical care in limited-resource settings

Tuesday, November 5, 2013 : 4:30 p.m. - 4:50 p.m.

Yao Yang, BS, MPH Candidate, School of Public Health, Yale University, New Haven, CT
Catherine deVries, MD, Center for Global Surgery, University of Utah, Salt Lake City, UT
Background: Surgery is an irreplaceable health intervention that can be thought of as an ecosystem, with distinct infrastructure, personnel, and supply chain needs. Challenges inherent to providing surgical care include the need for skilled professionals and specialized sterilization equipment and processes. Surgical centers in the developed world possess a wealth of knowledge that can benefit those seeking to establish or improve surgical care in the developing world, though the cost of sophisticated systems can be prohibitive in low resource settings. Methods: Interviews were conducted with key surgical services personnel at 7 hospitals in Salt Lake City, Utah. Participants were asked to discuss their professional roles, the daily tasks associated with their roles, and perspectives of how their roles fit into the overall system of surgical services as well as the wider context of health care. Participants included surgeons, anesthesiologists, nurses, clinical engineers, administrators, and sterile processing technicians. Results: Participants illuminated the myriad processes that must function in synchrony to provide advanced surgical care. They described an intricate, dynamic environment driven by dedication to quality and patient safety. They also highlighted the essential role of effective communication, education, and participation in professional communities. Recurrent themes emerged that underscored common features of well-functioning surgical centers. Conclusions: In developed settings, surgical care benefits from abundant resources, advanced technology and human expertise. While such luxuries cannot be guaranteed in global developing settings, lessons learned from analysis of more privileged surgical systems can be applied to raise the standard of surgical care for all.

Learning Areas:

Clinical medicine applied in public health
Conduct evaluation related to programs, research, and other areas of practice
Program planning
Provision of health care to the public
Public health or related organizational policy, standards, or other guidelines
Public health or related research

Learning Objectives:
Identify the essential human and infrastructural components of a surgical care facility. Differentiate between luxuries and necessities in surgical care Discuss the inputs necessary to implement a basic surgery program in a low-resource setting. Define the professional roles and responsibilities of key players in surgical care provision. Debate the public health importance of building surgical care capacity.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a public health masters student specializing in chronic disease epidemiology. I have global health volunteering and consulting experience. My interest lies in the area of global surgery infrastructure and capacity building. I have travelled to developing areas abroad where I have observed various surgical care contexts, and I have also conducted research on surgical care in developed settings.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.