Laura F Goodman1, Erdenetsetseg Chuluun2, Burmaa Sanjaa2, Sanchin Urjin2, Sarnai Erdene2, Narantuya Khad3, Adiyasuren Jamiyanjav4, Jacob Stephenson5,6, Diana L Farmer7. 1. Department of Surgery, University of California Davis Health, 2315 Stockton Boulevard OP512, Sacramento, CA, 95817, USA. laurafgoodman@gmail.com. 2. Mongolian National University of Medical Sciences, S. Zorig Street-3, Sukhbaatar District, P.O. Box 48/111, Ulaanbaatar, 14210, Mongolia. 3. Department for Statistics and Information Technology, Center for Health Development, Enkhtaivan Street - 13b, Sukhbaatar District, Ulaanbaatar, Mongolia. 4. Department of Pediatric Surgery, National Center for Maternal and Child Health, Khuvsgalch Road, Bayangol District, Ulaanbaatar, 16060, Mongolia. 5. Uniformed Services University of the Health Sciences, Bethesda, MD, USA. 6. Division of Pediatric Surgery, Department of Surgery, University of California Davis Health, 2221 Stockton Boulevard, Sacramento, CA, 95817, USA. 7. Department of Surgery, University of California Davis Health, 2221 Stockton Boulevard, Sacramento, CA, 95817, USA.
Abstract
BACKGROUND: Mongolia is a country characterized by its vast distances and extreme climate. An underdeveloped medical transport infrastructure makes patient transfer from outlying regions dangerous. Providing pediatric surgical care locally is crucial to improve the lives of children in the countryside. This is the first structured assessment of nationwide pediatric surgical capacity. METHODS: Operation rates were calculated using data from the Mongolian Center for Health Development and population data from the Mongolian Statistical Information Service. The Pediatric Personnel, Infrastructure, Procedures, Equipment, and Supplies (PediPIPES) survey tool was used to collect data at all survey sites. Descriptive data analyses were completed using Excel. Studies of association were completed using Stata. All reported percentages are of the hospitals outside of the capital (n = 21). RESULTS: All provincial hospitals have general surgeons; seven (33.3%) of them have pediatric surgeon(s). One facility has no anesthesiologist. All facilities perform basic procedures and provide anesthesia. Four (19%) can treat common congenital anomalies. All facilities have basic operating room equipment. Nine hospitals do not have pulse oximetry available. Twelve hospitals do not have pediatric surgical instruments always available. Pediatric supplies are lacking. CONCLUSIONS: Provincial hospitals in Mongolia can perform basic procedures. However, essential pediatric supplies are lacking. Consequently, certain life-saving procedures are not available to children outside of the capital. Only a few improvements would be amendable to low-cost process improvement adjustment, and the majority of needs require resource additions. Procedure, equipment, and supply availability should be further explored to develop a comprehensive nationwide pediatric surgical program.
BACKGROUND: Mongolia is a country characterized by its vast distances and extreme climate. An underdeveloped medical transport infrastructure makes patient transfer from outlying regions dangerous. Providing pediatric surgical care locally is crucial to improve the lives of children in the countryside. This is the first structured assessment of nationwide pediatric surgical capacity. METHODS: Operation rates were calculated using data from the Mongolian Center for Health Development and population data from the Mongolian Statistical Information Service. The Pediatric Personnel, Infrastructure, Procedures, Equipment, and Supplies (PediPIPES) survey tool was used to collect data at all survey sites. Descriptive data analyses were completed using Excel. Studies of association were completed using Stata. All reported percentages are of the hospitals outside of the capital (n = 21). RESULTS: All provincial hospitals have general surgeons; seven (33.3%) of them have pediatric surgeon(s). One facility has no anesthesiologist. All facilities perform basic procedures and provide anesthesia. Four (19%) can treat common congenital anomalies. All facilities have basic operating room equipment. Nine hospitals do not have pulse oximetry available. Twelve hospitals do not have pediatric surgical instruments always available. Pediatric supplies are lacking. CONCLUSIONS: Provincial hospitals in Mongolia can perform basic procedures. However, essential pediatric supplies are lacking. Consequently, certain life-saving procedures are not available to children outside of the capital. Only a few improvements would be amendable to low-cost process improvement adjustment, and the majority of needs require resource additions. Procedure, equipment, and supply availability should be further explored to develop a comprehensive nationwide pediatric surgical program.
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