Global Health and the Surgeon 2013 Runner-Up Abstract - Challenges and Training Opportunities in Voluntary Surgery - Perspectives from an Operation Hernia Mission in Rural Ecuador

Abstract

We report the procedural results of an Operation Hernia mission in La Concordia, Ecuador, learning points as well as the difficulties we faced whilst delivering high-quality, low-cost surgery to the local population. During the 6-day mission, we performed 74 hernia repair operations on 72 patients. 41% of the 74 hernia repairs were umbilical, 39% inguinal (either unilateral or bilateral), 12% incisional, 5% epigastric, 3% femoral, and 1% lumbar. 53% of all hernias were reducible, and 88% were primary repairs. At 2 weeks follow-up, there were no mortalities, and a 3.9% complication rate (3 patients). The mission was an excellent training opportunity for all involved; surgical decision-making skills, as well as theatre-management were key in the mission's success. We faced challenges on various levels during the mission, and these can be divided into problems with preliminary mission groundwork, as well as operating and anaesthetic facilities. While there are no simple remedies for some of the issues we identified, we believe that many of these problems can be overcome with adequate preparation and organisation. Hence, we would like to contribute our findings to the growing evidence base on delivering voluntary medical or surgical services to developing countries. We hope our insights can be used to inform future missions or projects and be used to improve the quality of care delivered to patients worldwide.