OBJECTIVES: This 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 METHODS: We 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. RESULTS: Thirty-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). CONCLUSIONS: This 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.
OBJECTIVES: This 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 METHODS: We 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. RESULTS: Thirty-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). CONCLUSIONS: This 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.
Authors: Lucas C Carlson; Joseph A Lin; Emmanuel A Ameh; Wakisa Mulwafu; Peter Donkor; Miliard Derbew; Edgar Rodas; Nyengo C Mkandawire; Mitra Dhanaraj; Herve Yangni-Angate; Rachid Sani; Mohamed Labib; Roxana Barbero; Damian Clarke; Martin D Smith; Lawrence Sherman; Frederick A Mutyaba; Philip Alexander; Larry G P Hadley; Michael J VanRooyen; Adam L Kushner Journal: World J Surg Date: 2015-04 Impact factor: 3.352
Authors: Abraham Markin; Roxana Barbero; Jeffrey J Leow; Reinou S Groen; Greg Perlman; Elizabeth B Habermann; Keith N Apelgren; Adam L Kushner; Benedict C Nwomeh Journal: World J Surg Date: 2014-09 Impact factor: 3.352
Authors: Barclay T Stewart; Adam Gyedu; Cameron Gaskill; Godfred Boakye; Robert Quansah; Peter Donkor; Jimmy Volmink; Charles Mock Journal: World J Surg Date: 2018-10 Impact factor: 3.352
Authors: Evan G Wong; Thaim B Kamara; Reinou S Groen; Cheryl K Zogg; Michael E Zenilman; Adam L Kushner Journal: World J Surg Date: 2015-01 Impact factor: 3.352
Authors: Barclay T Stewart; Adam Gyedu; Francis Abantanga; Abdul Rashid Abdulai; Godfred Boakye; Adam Kushner Journal: World J Surg Date: 2015-11 Impact factor: 3.352
Authors: Kathleen M O'Neill; Sarah L M Greenberg; Meena Cherian; Rowan D Gillies; Kimberly M Daniels; Nobhojit Roy; Nakul P Raykar; Johanna N Riesel; David Spiegel; David A Watters; Russell L Gruen Journal: World J Surg Date: 2016-11 Impact factor: 3.352