In Guatemala, where individuals have little access to surgical care, and high morbidity and disability associated with unmet needs, a multidisciplinary team from Duke is helping make life-saving surgery accessible to children.
With support from Duke Medicine and US-based NGOs, Duke surgeon Henry Rice has led a team of surgeons, anesthesiologists, nurses, technicians and trainees to Guatemala City over the past three years to provide pediatric surgical care, training and education, and research to areas with great need. His team has included DGHI faculty members David Boyd and Eric Finkelstein, Duke Medicine faculty Sherry Ross and Brad Taicher, and trainees including Duke Master of Science in Global Health student Ben Silverberg.
“Unmet surgical care contributes to at least 11% of the global burden of disease,” said Rice. “For children, surgical care can decrease mortality, improve overall health, and decrease costs for care of disabilities. So, our work with partners in Guatemala is particularly important for families and communities in this low-income setting.”
Providing Care and Educating
The Duke team not only provides care, they also perform surgeries and train Guatemalan health workers on safe surgical practices. On the most recent visit, the team worked with Guatemalan providers to perform 51 general surgery and urology procedures on children without access to surgical care. They treated various common surgical and urological conditions like undescended testis, inguinal hernias and breast tumors, and they also trained both US- and Guatemalan nurses and technicians in safe surgical practices like endotracheal intubation.
“In addition to helping Guatemalan children,” said Rice, “our Duke staff gains enormously value from the chance to work with Guatemalan staff in such an environment. Our staff learns not only of what challenges are faced in these settings, but also better ways to approach their own jobs here.”
Through private grants and the Duke REMEDY program, Rice and his team have provided Guatemalan health workers with surgical equipment that enables them to provide the highest quality care. As a result, the Duke team was able to perform the first advanced laparoscopy, and plans to lead a training course next year in advanced adult and pediatric laparoscopy.
Conducting Research That Matters
The Duke team has also led research projects in the areas of surgery, urology, anesthesia, operating room systems and patient safety. In one study, Duke researchers found that high costs, perceived low quality of care and long delays in accessing care are preventing Guatemalan families from seeking surgical care for their children. The research team also learned that, despite not having access to pain medications, regional anesthetics can be an effective alternative in Guatemala. In the future, the team plans to study the factors that most often influence families to seek surgical care.
“Guatemala is a challenging environment to support the care of children due to tremendous economic, political, and cultural stressors on its health system,” said Rice. “We are fortunate to have a chance to work closely with Guatemalan providers, supported by a great team of NGOs to study ways to understand this health system.”
It’s the type of project that has the potential to make a long-lasting impact in global health.
