Implementation of The Lancet Commission on Global Surgery in India

Raykar, Nakul; Mukhopadhyay, Swagoto; Saluja, Saurabh; Amte, Sheetal; David, Siddharth; Gnanaraj, J; Kataria, Raman; Jadhav, B.T.; Johnson, Walt; Meara, John G.; Menon, Nandakumar; Prabhu, Radhakrishna D; Shetty, Devi Prasad; Singh, Ravikant; Tongaonkar, Ravindranath; Vora, Ravindra; Roy, Nobhojit

doi:10.1016/j.hjdsi.2018.11.001

Cited by 11 publications

(12 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Delivering safe and quality bellwether surgical care, in rural India is challenging. Recently trained orthopedic surgeons with limited experience, functioning as a single-doctor unit to provide care without an anesthesiologist is a routine narrative not just in India, but in many LMIC healthcare systems [ 6 , 18 , 21 , 22 ]. Considering the projected shortfall and estimated time necessary to achieve the minimum goal of ensuring 20 Surgeons, Anesthesiologists and Obstetricians (SAOs)/100,000 population, rural areas will continue to have a shortage of physician anesthesiologists and will have to choose between declining care or providing emergency essential surgical care without an anesthesiologist or training a physician to give safe anesthesia without reaching full specialist status as they do in Australia and Canada [ 21 , 23 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

Delivering Essential Surgical Care for Lower‐limb Musculoskeletal disorders in the Low‐Resource Setting

et al. 2021

Self Cite

View full text Add to dashboard Cite

Background Mismatched surgeon-anesthesiologist ratios often exist in low-resource settings making safe emergency essential surgical care challenging. This study is an audit of emergency essential procedures performed for lower-limb (LL) musculoskeletal disorders (MSD) when an anesthesiologist was unavailable. It aims to identify strategies for safe anesthesia. Methods A 5-year retrospective audit of emergency essential LL orthopedic procedures performed at remote mission hospital in Central India was performed. Out of necessity, a regional anesthesia (RA) protocol was developed in collaboration with anesthesiologists familiar with the setting. The incidence of intraoperative surgical and perioperative anesthesia complications when RA was administered by a surgeon was evaluated. Results During this period, 766 emergency essential LL MSDs procedures were performed. An anesthesiologist was available for only 6/766. RA was administered by a surgeon for 283/766. This included spinal anesthesia (SA) for 267/283 patients, peripheral nerve blocks for 16/283. Local infiltration and/or sedation was administered to 477/766. There were 17 intraoperative surgical complications. Anesthesia-related complications included 37/267 patients who required multiple attempts to localize subarachnoid space and SA failure in 9/267 patients all of whom had successful re-administration. Additional sedation and infiltration of local anesthetic was required in 5/267 patients. Conclusion Remote pre-anesthesia consultation for high-risk patients, local surgeon-anesthesiologist networking, protocol-guided management, and dedicated short duration of training in anesthesia may be considered as an alternative for delivering RA for emergency essential surgery for LL MSDs due to unavailability of anesthesiologists.

show abstract

Section: Discussionmentioning

confidence: 99%

Delivering Essential Surgical Care for Lower‐limb Musculoskeletal disorders in the Low‐Resource Setting

et al. 2021

Self Cite

View full text Add to dashboard Cite

show abstract

“…[ 19 ] Multi-institutional partnerships between the Indian hospitals, including trauma centers in Mumbai, and outside institutions have allowed for progress in understanding trends and gaps in trauma care within the city. [ 19 20 21 22 ] Further collaborative efforts between Mumbai health institutions and their local and international partners to address the barriers to care we identify will be crucial to preventing and managing TBI.…”

Section: Discussionmentioning

confidence: 99%

Traumatic brain injury in Mumbai: A survey of providers along the care continuum

et al. 2020

Self Cite

View full text Add to dashboard Cite

Introduction: Traumatic brain injury (TBI) represents a significant burden of a global disease, especially in low- and middle-income countries (LMICs) such as India. Efforts to curb the impact of TBI require an appreciation of local factors related to this disease and its treatment. Methods: Semi-structured qualitative interviews were administered to paramedics, anesthesiologists, general surgeons, and neurosurgeons in locations throughout Mumbai from April to May 2018. A thematic analysis with an iterative coding was used to analyze the data. The primary objective was to identify provider-perceived themes related to TBI care in Mumbai. Results: A total of 50 participants were interviewed, including 17 paramedics, 15 anesthesiologists, 9 general surgeons, and 9 neurosurgeons who were involved in caring for TBI patients. The majority of physicians interviewed discussed their experiences in public sector hospitals (82%), while 12% discussed private sector hospitals and 6% discussed both. Four major themes emerged: Workforce, equipment, financing care, and the family and public role. These themes were often discussed in the context of their effects on increasing or decreasing complications and delays. Participants developed adaptations when managing shortcomings in these thematic areas. These adaptations included teamwork during workforce shortages and resource allocation when equipment was limited among others. Conclusions: Workforce, equipment, financing care, and the family and public role were identified as major themes in the care for TBI in Mumbai. These thematic elements provide a framework to evaluate and improve care along the care spectrum for TBI. Similar frameworks should be adapted to local contexts in urbanizing cities in LMICs.

show abstract

“…While our results' recount of these challenges is not entirely new, the potential solutions identified by our study participantsthose on the front lines of obstetric and surgical care deliveryare innovative and meaningful. Since the 2015 publication of the LCoGS Report, global surgery efforts have focused on integrating surgical care into national public health planning through data collection and policy enumeration, with an emphasis on local stakeholder involvement and locally derived solutions [22][23][24][25]. However, in the arena of blood, this local data are lacking.…”

Section: Discussionmentioning

confidence: 99%

The global surgery blood drought: frontline provider data on barriers and solutions in Bihar, India

Sood

Yorlets

Raykar

et al. 2019

Global Health Action

Self Cite

View full text Add to dashboard Cite

Background: Limited access to safe, timely banked blood is a critical barrier to providing basic surgical care in resource-limited settings globally. Contextual, locally driven data are required to elucidate country needs, develop effective interventions, and guide policy decisions. Objective: We employ qualitative methodology to describe barriers faced and solutions proposed by front-line obstetric providers in Bihara poor, populous Indian state where maternal mortality exceeds the national average. We aim to make locally driven recommendations for ongoing policy work in India to strengthen the country's blood transfusion system. Methods: From February to May 2016, two researchers conducted semi-structured interviews with 19 obstetric providers across Bihar. Snowball sampling was employed until thematic saturation was reached. Following immersion into de-identified texts and dual codebook development, a primary analyst completed topical coding, and a secondary analyst confirmed reproducibility. Results: Providers report that pervasive banked blood shortages force hospitals to require replacement donation, but patients' families often cannot or will not donate. Providers wait one to six hours for blood, depending on availability of staff and supplies, blood bank proximity, and the ability of the patient being treated to navigate the system. Providers feel forced to refer their patients, often to distant, poorly equipped centers. Providers identify donor education, improved infrastructure, and improved local coordination as focus areas for intervention. Conclusions: A multi-stakeholder approach that aims to increase blood donation through community education, mitigate limited infrastructure through short-term workarounds, and improve local-level coordination through state support and policy change is required in Bihar. This study generates data to guide policy and future research aimed at generating affordable, contextually appropriate interventions to the blood drought.

show abstract

Implementation of The Lancet Commission on Global Surgery in India

Cited by 11 publications

References 4 publications

Delivering Essential Surgical Care for Lower‐limb Musculoskeletal disorders in the Low‐Resource Setting

Delivering Essential Surgical Care for Lower‐limb Musculoskeletal disorders in the Low‐Resource Setting

Traumatic brain injury in Mumbai: A survey of providers along the care continuum

The global surgery blood drought: frontline provider data on barriers and solutions in Bihar, India

Contact Info

Product

Resources

About