University of Nottingham, Nottingham, UK.
Cinterandes Foundation, Cuenca, Ecuador.
Surg Endosc. 2017 Dec;31(12):4964-4972. doi: 10.1007/s00464-016-4992-9. Epub 2017 Jun 21.
Five billion people worldwide do not have timely access to surgical care. Cinterandes is one of the only mobile surgical units in low- and middle-income countries. This paper examines the methodology that Cinterandes uses to deliver mobile surgery.
Founding and core staff were interviewed, four missions were participated in, and internal documents and records were analysed between 1 May and 1 July 2014.
Cinterandes performed 7641 operations over the last 20 years (60% gastrointestinal/laparoscopic), travelling 300,000 km to remote areas of Ecuador. The mobile surgery programme was initiated by a local Ecuadorian surgeon in 1980. Funding was acquired from businesses, private hospitals, and individuals, to fund a low-cost surgical truck, simple equipment, and running costs. The mobile surgical unit is a 24-foot modified Isuzu truck containing a preparation room with general equipment storage and running water, together with an operating room including the operating table, anaesthetic and surgical equipment. Mission structure includes: patient identification by a network of local medical personnel in remote regions; pre-operative assessment at 1 week by core team via teleconsultations; four-day surgical missions; post-operative recovery in tents or a local clinic; post-operative follow-up care by local personnel and remote teleconsultations. The permanent core team includes seven members; lead surgeon, lead anaesthetist, operating-room technician, medical coordinator, driver, general coordinator, and receptionist. Additional support members include seven regular surgeons, residents, medical students, and volunteers.
Surgery is a very effective way to gain the trust of the community, due to immediate results. Trust opens doors to other programmes (e.g. family medicine). Surgery can be incorporated with all other aspects of health care, which can in turn be incorporated with all other aspects of human development, education, food production and nutrition, housing, work and productivity, communication, and recreation.
全球有 50 亿人无法及时获得外科护理。Cinterandes 是中低收入国家唯一的移动外科手术单位之一。本文探讨了 Cinterandes 提供移动手术的方法。
对创始人和核心工作人员进行了访谈，参加了四次任务，并于 2014 年 5 月 1 日至 7 月 1 日分析了内部文件和记录。
Cinterandes 在过去 20 年中进行了 7641 例手术（60%为胃肠/腹腔镜手术），行驶了 30 万公里到达厄瓜多尔偏远地区。该移动手术项目由当地厄瓜多尔外科医生于 1980 年发起。资金来自企业、私立医院和个人，用于资助低成本的手术卡车、简单的设备和运营成本。这辆移动手术车是一辆 24 英尺长的改装五十铃卡车，包含一个准备室，配有普通设备存储和自来水，以及一个手术室，包括手术台、麻醉和手术设备。任务结构包括：由远程地区的当地医务人员网络识别患者；核心团队通过远程咨询在一周内进行术前评估；为期四天的手术任务；在帐篷或当地诊所进行术后康复；由当地人员和远程远程咨询进行术后随访。固定核心团队包括七名成员；主刀医生、主麻醉师、手术室技术员、医疗协调员、司机、总协调员和接待员。其他支持成员包括七名普通外科医生、住院医师、医学生和志愿者。
由于手术效果立竿见影，因此它是赢得社区信任的非常有效的方法。信任为其他计划（例如家庭医学）打开了大门。手术可以与所有其他医疗保健方面结合，进而与人类发展、教育、食品生产和营养、住房、工作和生产力、通信和娱乐的所有其他方面结合。
