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Original Research

Assessment of Surgical and Trauma Capacity in Potosí, Bolivia

Authors:

Kevin J. Blair ,

Northwestern University, Feinberg School of Medicine, Department of Surgery, Division of Trauma & Critical Care, Chicago, IL
About Kevin J.
BA
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Marissa A. Boeck,

Northwestern University, Feinberg School of Medicine, Department of Surgery, Division of Trauma & Critical Care, Chicago, IL; New York Presbyterian Hospital, Columbia University Medical Center, Department of Surgery, New York, NY; Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA
About Marissa A.
MD, MPH
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José Luis Gallardo Barrientos,

La Caja Nacional de Salud—Potosí, Departamento de Cirugía, Potosí, Bolivia
About José Luis
MD, FACS
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José Luis Hidalgo López,

Servicio Departamental de Salud—Potosí, Potosí, Bolivia
About José Luis
MD
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Irene B. Helenowski,

Northwestern University, Feinberg School of Medicine, Department of Preventative Medicine, Chicago, IL
About Irene B.
PhD
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Benedict C. Nwomeh,

Nationwide Children's Hospital, Department of Pediatric Surgery, Columbus, OH
About Benedict C.
MD, MPH
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Michael B. Shapiro,

Northwestern University, Feinberg School of Medicine, Department of Surgery, Division of Trauma & Critical Care, Chicago, IL
About Michael B.
MD
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Mamta Swaroop

Northwestern University, Feinberg School of Medicine, Department of Surgery, Division of Trauma & Critical Care, Chicago, IL
About Mamta
MD, FACS
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Abstract

Background

Scaling up surgical and trauma care in low- and middle-income countries could prevent nearly 2 million annual deaths. Various survey instruments exist to measure surgical and trauma capacity, including Personnel, Infrastructure, Procedures, Equipment, and Supplies (PIPES) and International Assessment of Capacity for Trauma (INTACT).

Objective

We sought to evaluate surgical and trauma capacity in the Bolivian department of Potosí using a combined PIPES and INTACT tool, with additional questions to further inform intervention targets.

Methods

In June and July 2014 a combined PIPES and INTACT survey was administered to 20 government facilities in Potosí with a minimum of 1 operating room: 2 third-level, 10 second-level, and 8 first-level facilities. A surgeon, head physician, director, or obstetrician-gynecologist completed the survey. Additional personnel responded to 4 short-answer questions. Survey items were divided into subsections, and PIPES and INTACT indices calculated. Medians were compared via Wilcoxon rank sum and Kruskal-Wallis tests.

Findings

Six of 20 facilities were located in the capital city and designated urban. Urban establishments had higher median PIPES (8.5 vs 6.7, P = .11) and INTACT (8.5 vs 6.9, P = .16) indices compared with rural. More than half of surgeons and anesthesiologists worked in urban hospitals. Urban facilities had higher median infrastructure and procedure scores compared with rural. Fifty-three individuals completed short-answer questions. Training was most desired in laparoscopic surgery and trauma management; less than half of establishments reported staff with trauma training.

Conclusions

Surgical and trauma capacity in Potosí was most limited in personnel, infrastructure, and procedures at rural facilities, with greater personnel deficiencies than previously reported. Interventions should focus on increasing the number of surgical and anesthesia personnel in rural areas, with a particular focus on the reported desire for trauma management training. Results have been made available to key stakeholders in Potosí to inform targeted quality improvement interventions.

How to Cite: Blair, K.J., Boeck, M.A., Gallardo Barrientos, J.L., Hidalgo López, J.L., Helenowski, I.B., Nwomeh, B.C., Shapiro, M.B. and Swaroop, M., 2017. Assessment of Surgical and Trauma Capacity in Potosí, Bolivia. Annals of Global Health, 83(2), pp.262–273. DOI: http://doi.org/10.1016/j.aogh.2017.04.002
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Published on 24 May 2017.
Peer Reviewed

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