Skip to main content

Advertisement

SpringerLink
Log in

Mobile gastrointestinal and endoscopic surgery in rural Ecuador: 20 years’ experience of Cinterandes

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Introduction

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.

Methods

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.

Results

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.

Conclusion

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  1. Meara JG, Leather AJ, Hagander L et al (2015) Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet 386(9993):569–624

    Article  PubMed  Google Scholar 

  2. Weiser TG, Regenbogen SE, Thompson KD et al (2008) An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet 372(9633):139–144

    Article  PubMed  Google Scholar 

  3. Grimes CE, Bowman KG, Dodgion CM et al (2011) Systematic review of barriers to surgical care in low-income and middle-income countries. World J Surg 35:941–950

    Article  PubMed  Google Scholar 

  4. Grimes CE, Law RSL, Borgstein ES et al (2012) Systematic review of met and unmet need of surgical disease in rural sub-Saharan Africa. World J Surg 36:8–23

    Article  PubMed  Google Scholar 

  5. Rodas E, Vicuña AL, Rodas EB (2014) President, Founder, and Lead Surgeon. Cinterandes Foundation. 25 interviews with the author between 01/05/2014 and 01/07/2014. Personal communication

  6. Cinterandes Foundation (1980–2014). Internal documents, reports, and databases. Cinterandes Central Office, Cuenca, Ecuador. Unpublished

  7. Fontana M, Lucha P, Snyder M et al (1999) Surgery aboard ship: is it safe? Mil Med 164(9):613–615

    CAS  PubMed  Google Scholar 

  8. Cheng LHH, McColl L, Parker G (2012) Thyroid surgery in the UK and on board the Mercy Ships. Br J Oral Maxillofac Surg 50(7):592–596

    Article  PubMed  Google Scholar 

  9. Sechriest VF, Lhowe DW (2008) Orthopaedic care aboard the USNS Mercy during operation unified assistance after the 2004 Asian Tsunami. J Bone Joint Surg Am 90(4):849–861

    Article  PubMed  Google Scholar 

  10. Price MD, Shalabi HT, Shalabi ST et al (2015) Is mobile surgery successful in overcoming patient barriers to surgery? Poster session presented at: Extreme Affordability Global Health Conference 2015, Centre for Global Surgery, University of Utah. 3rd Annual Conference. 10–11 April 2015; Salt Lake City, Utah, USA

  11. Mora F, Cone S, Rodas E et al (2006) Telemedicine and electronic health information for clinical continuity in a mobile surgery program. World J Surg 30:1128–1134

    Article  PubMed  Google Scholar 

  12. Central Intelligence Agency (2015) Ecuador. In The World Factbook. www.cia.gov/library/publications/the-world-factbook/geos/ec.html. Last Accessed 17/04/2015

  13. Shalabi HT, Price MD, Shalabi ST et al (2015) Cost-effectiveness of mobile surgery in low- and middle-income countries: an Ecuadorian case study. Oral presentation at: 46th World Congress of Surgery. International Society of Surgery. 23–27 August 2015; Bangkok, Thailand

  14. Chao TE, Sharma K, Mandigo M et al (2014) Cost-effectiveness of surgery and its policy implications for global health: a systematic review and analysis. Lancet Glob Health 2:e334–e345

    Article  PubMed  Google Scholar 

  15. De Vries C, Price R (2010) Global surgery and public health: a new paradigm. Jones and Bartlett, Sudbury

    Google Scholar 

  16. Doorslaer V, O’Donnell O, Rannan-Eliya RP et al (2006) Effect of payments for health care on poverty estimates in 11 countries in Asia: an analysis of household survey data. Lancet 368(9544):1357–1364

    Article  PubMed  Google Scholar 

  17. Bickler SW, Weiser TG, Kassenbaum N et al (2014) Chapter 2: Global burden of surgical conditions. In: Disease control priorities, 3rd edn: Economic Evaluation for Health. World Bank, Washington

Download references

Acknowledgments

Dr. Edgar Rodas, founder and leader of Cinterandes since inception in 1980, sadly passed away on 2 March 2015. It is because of his visions and fortitude that Cinterandes has remained one of the most successful mobile surgical units in the developing world, dedicated to treating the poor and remote population. The methodology, concepts, and principles of Cinterandes examined in this paper were his visions and ideologies. This paper is dedicated in his memory. Further acknowledgements and thanks are made to Freddy Peralta (operating-room technician), Gonzalo Matute (driver and assistant), Carolina Donoso (general coordinator), Janeth Matute Mendoza (administration manager), and Dolores Rodas (visionary) for their substantial aid and initiatives in acquiring archived and current data and documents.

Author information

Authors and Affiliations

  1. University of Nottingham, Nottingham, UK

    H. T. Shalabi

  2. Cinterandes Foundation, Cuenca, Ecuador

    H. T. Shalabi, M. D. Price, S. T. Shalabi, E. B. Rodas, A. L. Vicuña, B. Guzhñay, R. R. Price & E. Rodas

  3. Gold Coast University Hospital, Gold Coast, Australia

    H. T. Shalabi & S. T. Shalabi

  4. Brigham Young University, Provo, UT, USA

    M. D. Price

  5. Queen’s Medical Centre, Nottingham, UK

    S. T. Shalabi

  6. Universidad de Cuenca, Cuenca, Ecuador

    E. B. Rodas, A. L. Vicuña & E. Rodas

  7. Centre for Global Surgery, University of Utah, Salt Lake City, UT, USA

    R. R. Price

Authors
  1. H. T. Shalabi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. D. Price
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. T. Shalabi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. E. B. Rodas
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. L. Vicuña
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. B. Guzhñay
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. R. R. Price
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. E. Rodas
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to H. T. Shalabi.

Ethics declarations

Conflict of interest

HT Shalabi, MD Price, ST Shalabi, EB Rodas, AL Vicuña, B Guzhñay, RR Price, and E Rodas have no conflicts of interest or financial ties to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shalabi, H.T., Price, M.D., Shalabi, S.T. et al. Mobile gastrointestinal and endoscopic surgery in rural Ecuador: 20 years’ experience of Cinterandes. Surg Endosc 31, 4964–4972 (2017). https://doi.org/10.1007/s00464-016-4992-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-016-4992-9

Keywords

Search

Navigation