Aug 9th-11th, 2014:
Expecting to only take a tour around the institution on our first day, Kimber and I were quite spontaneously shuffled into the women changing room to get ready for our first surgical experience in Sevagram. We were able to observed a hysteroscopy, an ex lap diagnostics, and an emergency C-section.
It was almost as if they had a 10-minute rule here in the Sevegram's OT.
Having observed 5 different surgeries by different surgeons so far, we noticed that efficiency is the key in surgeries here at MGIMS. Many of the common practices, not only in the OT but also in the institution as a whole, are motivated by time and cost-efficiency.
First, surgeons here are forced to be as time efficient as possible in order to accommodate the volume of patients who arrive to seek care. We learned later from several OB/GYN physicians that 60% of the surgeries in the OB/GYN department are emergency cases; rarely do patients arrive with scheduled appointments. A GYNAE OT may have to handle 10-13 C-sections per day in addition to other gynecological operations.
Second, surgeries must be kept as cost-effective as possible in a setting where patients have to pay for every single stitch being applied to them out of pocket. Here at the MGIMS, disposable supplies are reused 30 times before getting disposed. This is one of the key factor that enables this institution to accommodate a wide range of surgeries from C-section to laparoscopic surgeries and microsurgeries. The harmonic scalpel is only affordable because the tip is reused 30 times before a new one has to be opened. In fact, a laparoscopic surgeon pinpointed cost-effectiveness as the biggest challenge in practicing MIS in resource-limited settings. Although basic equipments are provided by the institutions, surgeons bring their own specialized equipments to make their surgeries faster and safer.
An important point for us to always keep in mind is that physicians here are well aware of what they are not doing that is being done in places like the Johns Hopkins Hospital. MGMIS has developed its own best surgical practice guidelines by taking into consideration the context it is in and making appropriate adjustments to other published guidelines in developed countries.
Kimber and I will continue to observe more surgeries and speak to more stakeholders who are connected to the OT practices in the coming week. At this point, it seems as though MGIMS is the JHH of the resource-limited world. We look forward to learning a lot more from these highly motivated and hard-working faculty members, residents, and medical students here in Sevagram.
Expecting to only take a tour around the institution on our first day, Kimber and I were quite spontaneously shuffled into the women changing room to get ready for our first surgical experience in Sevagram. We were able to observed a hysteroscopy, an ex lap diagnostics, and an emergency C-section.
It was almost as if they had a 10-minute rule here in the Sevegram's OT.
C-section
1:58PM - 1st incision ... 2:00PM - Gained access to uterus ... 2:03PM - Baby cried
Hysteroscopy
12:33PM - Inserted hysteroscope ... 12:41PM - Removed hysteroscope, procedure completed
Ex Lap
12:47PM - Inserted trocar and laparoscope ... 12:56PM - Removed laparoscope and trocar, procedure completed
Having observed 5 different surgeries by different surgeons so far, we noticed that efficiency is the key in surgeries here at MGIMS. Many of the common practices, not only in the OT but also in the institution as a whole, are motivated by time and cost-efficiency.
First, surgeons here are forced to be as time efficient as possible in order to accommodate the volume of patients who arrive to seek care. We learned later from several OB/GYN physicians that 60% of the surgeries in the OB/GYN department are emergency cases; rarely do patients arrive with scheduled appointments. A GYNAE OT may have to handle 10-13 C-sections per day in addition to other gynecological operations.
Second, surgeries must be kept as cost-effective as possible in a setting where patients have to pay for every single stitch being applied to them out of pocket. Here at the MGIMS, disposable supplies are reused 30 times before getting disposed. This is one of the key factor that enables this institution to accommodate a wide range of surgeries from C-section to laparoscopic surgeries and microsurgeries. The harmonic scalpel is only affordable because the tip is reused 30 times before a new one has to be opened. In fact, a laparoscopic surgeon pinpointed cost-effectiveness as the biggest challenge in practicing MIS in resource-limited settings. Although basic equipments are provided by the institutions, surgeons bring their own specialized equipments to make their surgeries faster and safer.
An important point for us to always keep in mind is that physicians here are well aware of what they are not doing that is being done in places like the Johns Hopkins Hospital. MGMIS has developed its own best surgical practice guidelines by taking into consideration the context it is in and making appropriate adjustments to other published guidelines in developed countries.
Kimber and I will continue to observe more surgeries and speak to more stakeholders who are connected to the OT practices in the coming week. At this point, it seems as though MGIMS is the JHH of the resource-limited world. We look forward to learning a lot more from these highly motivated and hard-working faculty members, residents, and medical students here in Sevagram.
Wow, fascinating !
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