Making Surgery Work in the Places that Need it Most

Making Surgery Work in the Places that Need it Most

A quarter of the world’s population resides in countries impacted by conflict, according to the United Nations –  the largest number of people living in harm’s way since World War II. While wars impact all aspects of health care, their disruption of services such as surgery, which are already rare in many low- and middle-income countries, can deepen the long-term suffering of communities scarred by conflict.

The new research focused on Mother of Mercy Hospital in part because it defies that trend. Launched in 2008 by Tom Catena, M.D., an alumnus of the Duke School of Medicine, the 425-bed facility consistently has offered a range of surgical services in an isolated region of southern Sudan that has been marked by cycles of conflict since 2011. The hospital serves a population of nearly 2 million people, many of whom have been displaced by the ongoing war.

Catena performs many of the surgeries, including obstetrical procedures, laparotomies and repairs of open fractures. Other providers at the hospital are trained to do cataract and dental surgeries. Patients pay some expenses if they are able, but the hospital’s budget, which comes mostly from philanthropic donations, fills in for those who can’t afford care.

The researchers determined the cost-benefit of the hospital’s surgeries by assessing the probability of a patient dying prematurely or being permanently disabled if surgery were not performed, a standard way to measure the value of medical interventions. Their calculation of a 14-to-1 return on investment exceeds what has been measured in studies of surgery in politically stable settings, Rice notes.

It’s a unique facility in that they are able to provide these services at a very low cost,” says Rice. “What we’re able to show is that the investment they have made in surgery is a very worthy investment, even despite the challenges.”

Although the study reflects the success of a single hospital, Rice says it offers a model for showing the tangible benefits of maintaining resilient health systems in places affected by conflict.  While there are strong moral and humanitarian arguments to support healthcare in conflict-affected areas, an economic analysis can document the kinds of bottom-line impacts that often drive resource decisions by donors or governments, he notes.

“The sad fact is that over half of the world’s children live in areas affected by armed conflict,” He says, “And so we’re going to have to get better at understanding how to deliver care in ways that are efficient and cost-effective in those settings.”

Catena and staff at Mother of Mercy Hospital collaborated on the research, along with public health scholars at Harvard University and African Mission Healthcare, a Kenyan foundation that supports mission hospitals across Africa. Emily Smith, Ph.D., an assistant professor of emergency medicine and global health at Duke, co-authored the study. 

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