Surgery and Healing in the Developing World - Dartmouth-Hitchcock

Mobile Surgery
Figure 1.
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of technology and ingenuity, to custom build an operating room in a van, making
possible to transplant our selves and our medical capabilities from the fixed medical
centers to the underserved suburban neighborhoods and country side communities.
Over the past five years The CINTERANDES Foundation in cooperation with
the Medical School of the University of Cuenca (Ecuador) has introduced into the
Andean mountains, Coastal region and Amazon jungle of Ecuador a different and
innovative method of surgical care, Mobile Surgery (MS).
Rather than taking selected patients who require surgery to a hospital, we bring
a fully equipped operating room to the communities where the operations, recovery
and postoperative follow-up take place.
Overcoming The Roadblocks
Despite facing many hurdles and disadvantages the project has been successful
in providing specialized medical treatment to people that otherwise have had no
option for attending their surgical needs. In many aspects we believe that we not
only met our expectations but that we have well surpassed them by integrating components
that were not thought of when the program first spun its wheels.
On a 24 foot Isuzu van, an operating room and a preparation room were installed
(Fig. 1). We could have used more space, but a bigger vehicle is difficult to
drive in the winding and narrow Andean roads. The operating room is equipped
with an operating table and light, anesthesia machine and monitoring equipment,
suction, electro surgical unit, a Mayo and side table. Compartments for medicines
and surgical supplies were built in the walls of the room. And lately with continuing
support and help of our friends in the USA we have been able to equip our Mobile
Surgical Unit (MSU) with laparoscopic equipment and low bandwidth telemedicine
capabilities. The unit contains also a preparation room with a scrubbing sink, an
autoclave and cabinets for supplies. A bathroom is also used as a changing room.
We have simplified the trays to contain only the indispensable instruments. There
are three types of basic sets: one for major surgery, such as cholecystectomy and
hysterectomy. (To these sets we add the specific instruments according to the type of
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