Global Health Fellow Angela published a recent blog discussing the many, many aspects of planning a surgical camp. As anyone who has traveled, planned a large event, or works in the medical field can imagine, rural surgical camps rarely go exactly to plan. That’s why we’re so thankful to have Angela and our partners from Kab and KCH who are committed to patient care and flexible in the face of obstacles.
So what are some of the frequent obstacles the team comes up against when planning and conducting a surgical camp?
Equipment Failures
In 2019 we refurbished all the electrical sockets in theater to accommodate equipment that had been donated by another partner but was sitting in storage due to electrical incompatibility. That equipment is now gratefully in use at Kabudula and has served us well over the past three years as we expanded camps from annual visits with international teams to bi-monthly activities with Malawian surgeons from Lilongwe.
In 2020 we provided a new set of reusable cloth theater gowns, drapes, and patient gowns as well as refilling the oxygen cylinder, not only for camps but also in case of need for COVID patients.
In 2021 we provided spare parts to fix the sluice machine, drains, and other plumbing issues in theater.
In 2022, we are renovating the operating tables to make them safer for patients and fully functional for use during operations.
Space Limitations
Right now, Kab has two large operating theaters. The most frequent procedure done in these theaters is C-sections, which are performed with great regularity and frequency. In the future, we are interested in building a standard minor operating theater where Kab staff could conduct minor procedures independently, further reducing referrals to KCH in Lilongwe. The staff at Kab have identified a space that abuts the current theaters and only needs few construction additions to meet medical standards. Those construction changes include important upgrades such as further enclosing the space with its own doors in order to maintain sterility and separation from the main operating theater.
Serving Remote Patients
Prior to a surgical camp, we try to meet patients at their nearest health center for screening to be sure they qualify for surgery before they travel long distances to Kab. At these screenings, we also give them all of the information about the surgical program so that they only have to make one trip to Kab on operating day. Each patient gets a reminder phone call or text message the day before their operation, sometimes passed through a friend or neighbor if the patient does not have a cell phone. This reminder confirms the date the patients should travel to Kab and any pre-op instructions such as no food or drink for a set amount of time before the procedure. Patients who don’t have phones are told to list numbers of friends, relatives, chiefs, or anyone in their village with phone access, and that person can deliver the message by walking or biking to the patient’s home.
Procuring Pharmaceuticals
The long list of pharmaceuticals needed for a surgical camp can never be found all in one place, or even in the same place month to month. Rather, collecting all the necessary medications requires going around to many different wholesale pharmaceutical companies in Lilongwe in search of the various items. Exacerbated during COVID, many large pharmacies experience frequent shortages of basic necessities. Specialized items such as a steroid injection to prevent the recurrence of keloids, for example, can be even more difficult to find. When the search within pharmacies turns up nothing and orders from abroad do not reach Lilongwe in time, we reach out to private clinics who may or may not have the items on hand and might be willing to sell them to us. Local medical staff are highly skilled at improvising under resource constrictions, but in some cases, we must postpone procedures if certain materials are lacking. This is why international teams bring materials and equipment that is used not only during their visit but throughout the year. Right now, we’re in need of circular staplers for stoma reversals at KCH, mesh for hernia camps, and different kinds of sutures for general procedures at Kab.
Scheduling
Many factors go into scheduling screenings and procedures. First we consider any surgical specialty of the visiting experts, like ENT, gyn, or plastic surgery. We must consider length of procedure and which conditions can be managed in the minor vs. major theaters. On the part of anesthesia, we have two great anesthetists at Kab, but they are so good that they also get called to other facilities when help is needed! So we must make sure that both of them are committed to staying at Kab for surgical week. We must look at the ages of the patients – although our anesthetists can handle almost any case, Kab as a facility is not well-equipped for very young pediatric cases and does not have an ICU. We consider where patients are coming from and determine if and how we can assist with transportation. Finally, some patients can arrive and leave on the same day, but others must be admitted for an overnight stay either pre-operatively for testing, post-operatively for monitoring, or both.
Recruiting Patients
As awareness of our programming has expanded and thankful patients share their stories, recruiting patients has become much easier as many seek us out. When we were first starting surgical camps, we had to ride on motorcycles down dusty paths to distant health centers to introduce the program to new communities and identify potential patients needing care. We still make these visits every so often to maintain our relationships with rural health centers and follow up on patients. Word-of-mouth is the best form of communication in Malawi, and news of our surgical program has spread near and far. The surgical schedule fills up quickly with many patients seeking treatment after hearing about the program or witnessing neighbors who have been helped. When patients come between surgical camps, clinicians record their information and pass it along to us for scheduling. Once all the patients on Kab’s waiting list have been scheduled, we open the opportunity for patients from neighboring areas.
Nurse Christina calls patients to confirm their procedure dates in preparation for an upcoming surgical campm.
Planning a surgical camp takes time and resources, but serving patients is worth it. As our partnerships with Kab, KCH, the Ministry of Health, and rural health centers continue to deepen, we are able to tackle more issues at their root, working to achieve our mission to improve access to quality health services, education & resources through community-driven initiatives in Malawi.