Our Work

Global Access to Surgical Health Care in Rural India

Project Objectives

To establish a symbiotic relationship at Duke University, a reputable urban hospital and an established rural health-related NGO will help in the dissemination of advanced medical knowledge and technology in the urban areas, while advocating and implementing means to make quality surgical care available to the urban poor and rural populations. We hope this will promote internal (urban to rural) technology transfer. More importantly, through sharing of cutting edge technology with them, we hope to provide incentives to urban surgeons to work in rural areas. Some of the low-cost health care models established by NGOs in the rural setting can be reverse-engineered to fit the urban environment. We hope this will encourage and foster clinical and outcomes research in both rural and urban settings.

Project Outcomes

1. Comparison of scope, safety, and impact of surgery in rural and urban settings in Maharashtra, India.
Janeil M. Belle, Rani A. Bang, Dhananjay Kelkar, Truls Østbye, Sandhya A. Lagoo-Deenadayalan. 2014.

Submitted to World Journal of Surgery, 2014

Background: In medically underserved regions worldwide, non-permanent surgery programs or camps have been conducted to expand access to surgical services. Surgery camp programs have been reported in rural India, primarily in ophthalmic and obstetric fields; however, provision of general surgical services in these settings is largely unknown.
Methods: A 12-month retrospective review of non-ambulatory procedures performed at a rural hospital surgery camp program and at an urban hospital in Maharashtra, India, was completed to characterize relative differences in procedural activity, frequency and severity of perioperative complications, and to evaluate the efficacy of care.
Results: 449 cases were performed in rural hospital surgery camps and compared with 344 cases performed in the urban hospital in the study period. Majority of rural surgical cases were elective and intermediate complexity. Approximately 4% of rural cases were complex-major compared to 17% of urban cases. Intraoperative complications occurred in 0.2% rural cases compared to 5.5% of urban cases, p= 0.01. Postoperative complications were predominantly low grade in both groups. The postoperative complication rate was higher among rural surgical patients (43.4%; 23.5%, p<0.01), though the Surgical Risk Score was significantly lower in this group (p<0. 01). Rural surgery camp activity over 12 months achieved diagnostic and/or therapeutic goals in 92.2% of procedures and rendered 1.74-2.69 DALYs-averted-per-patient.
Conclusion: Rural general surgery camps can safely and effectively provide a wide range of surgical services under appropriate collaborative and clinical conditions. They may be a safe, temporizing solution to observed needs until substantial gains in rural healthcare are realized.

2. Levels of Surgical Disease and Predictors of Barriers to Care in Rural India.
Jessica Lynn Hudson, Sandhya Lagoo%u2010Deenadayalan, Truls Østbye, Christopher Woods.
Thesis Submission (2012) for Master of Science in the Duke Global Health Institute
in the Graduate School of Duke University

Manuscript in preparation

An estimated 234.2 million major surgical procedures are performed annually
worldwide, yet the wealthiest third of the world's population receives 73.6% while the
world's poorest third receives only 3.5%. Approximately one%u2010third of the global
population has no access to basic surgical care. Knowing that large unmet surgical need
in a community can lead to high morbidity and mortality in the population, the purpose
of this novel study was to assess the level of surgical conditions in rural Gadchiroli,
India as well as to conduct a quantitative assessment of the barriers to surgical care. In
this retrospective, cross%u2010sectional needs assessment, a study%u2010specific survey was
administered in a clinic%u2010based setting. Of the 500 participants, 141 (28.2%) reported
surgical conditions, for a total of 175 surgical cases, in the preceding two years. The
conditions with the highest prevalence were hydrocele, anorectal processes,
dysfunctional uterine bleeding, cataracts, appendicitis, and spondylosis with neurologic
claudication. Assessment of the conditions by a healthcare provider occurred in 133
(76.6%) of the cases of which only 32 (24.1%) reported having undergone surgery during
the two year period. Overall, in this population, the burden of surgical disease is higher
than previously expected and while willingness to undergo surgery is high, the
completion rate is quite low. Certain factors appear to predict difficulty in seeking or
receiving surgical care, including lost wages (p=0.027), the amount of time that family
members need to stay in the hospital to h

Project Policy Impact Description

Both studies described above will help shape policy regarding work force decisions for surgical care in rural Maharashtra and also help decision making regarding split funding for urban surgeons willing to help with surgical care via surgical camps in rural settings.

Department & School

School of Medicine



  • Duke-Department of Surgery Duke Global Health Institute


  • Dinanath Mangeshkar Hospital

Project Status


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