Thursday, November 1, 2012

Surgical Infrastructure and Operative Capacity in Liberia

Tiffany Chao, MD, MPH  General Surgery Resident
  Massachusetts General Hospital
  Paul Farmer Global Surgery Research Fellow
  Program in Global Surgery and Social Change  Harvard Medical School / Children's Hospital Boston
JFK Medical Center
Monrovia, Liberia
Ever since I visited Liberia in 2008 on a surgical trip with my medical school, I have wanted to return to this country.  Liberia, a small West African nation approximately the size of the US state of Virginia with a population of 3.5 million, at once demonstrates real health care capacity needs and the potential for considerable progress. A post-conflict nation recovering from a devastating 14-year civil war (1989–2003), Liberia is in the midst of critical period of stabilization.  Studies have begun to address the longstanding dearth of data regarding Liberian surgical capacity, and  the burden of specific disease entities and evaluation of particular interventions through outcomes monitoring are also of particular interest.

This year, I had the opportunity to work with Harvard Medical School's Program in Global Surgery and Social Change (PGSSC) as a research fellow, and I was extremely lucky that our program works in Liberia in addition to Partners in Health sites in Haiti and Rwanda.  Because of this, I have been able to come to Liberia for five weeks in October and November in order to teach medical students, contribute to clinical care, and develop research projects in conjunction with the local surgeons at JFK Medical Center, which is the country's only tertiary care hospital.
Here is a photo of me teaching medical students before rounds. My iPad has proven to be quite handy for this!

The current research project that I am working on with the entire surgical department involves developing a fundamental knowledge base about surgical demographics and operative capacity through a comprehensive operative log review and analysis at JFK Medical Center during 2009-2012. This data will guide the development of surgical capacity at the primary medical institution in the country in an epidemiologically-based and patient-centered way that can hopefully be replicated throughout the country. Once established, this knowledgebase can be used to focus direction of limited resources to provide high-quality care, improve efficiency and guide development of residency programs in the most crucial clinical areas.  

I have already been in this country for two weeks, and it is remarkable how much the infrastructure has advanced since 2008.  Back then, we had blackouts nearly every day and were often forced to operate in the dark with headlights.  Today, that would be unlikely, and the only time we ever lost power was in our dorms, at night, during a particularly bad storm.  That is progress!  
Of course, there are still significant resource limitations here, as in all developing countries.  

Here is a picture of a "wheelchair."

In particular, surgical capacity in Liberia is limited by human resources--in addition to the extremely limited numbers of physicians in this country, there are only four fully-trained surgeons working in this entire country, and only two of them operate full-time.  The good news is that there are plenty of medical students in the pipeline.  As you can imagine, I have been trying to encourage the medical students to go into the field of surgery!

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