M. M. Esquivel1, J. Chen1, N. Siegler1, T. Uribe-Leitz1, D. Siegler2, T. G. Weiser1, G. Yang1,3 1Stanford University,General Surgery,Palo Alto, CA, USA 2Santa Clara Valley Medical Center,Obstetrics And Gynecology,Santa Clara, CA, USA 3Palo Alto VA Health Care System,General Surgery,Palo Alto, CALIFORNIA, USA
Introduction: Essential surgical conditions account for 18% of the Global Burden of Disease. Short-term surgical missions help address these needs, but there are concerns about appropriate resource allocation. The costs of visiting teams can be significant, and some have questioned whether that money would be better spent expanding local resources. We examined the costs of a short-term surgical mission in rural Guatemala as an approach to conducting a cost comparison of different monetary allocation strategies.
Methods: We gathered diagnostic and therapeutic information on patients presenting to general, pediatric, plastic, ophthalmologic, and obstetric and gynecologic (Ob/Gyn) clinics from July 27 to August 6, 2015 at a free-standing clinic and surgery center in rural Guatemala. We also obtained information on patient costs and local provider salaries. Separately, we obtained data on the costs of running a 2-week surgical mission, including administrative fees, local staff salaries, travel, and supplies.
Results: The total cost for delivering the 2-week surgical mission was $105,050. Administrative costs, consumables, and salaries for local hospital staff (including the 3 Guatemalan primary care providers) were $26,940. Travel costs for the visiting surgical team (which included surgeons, operating room scrubs, techs, and nursing staff) were $48,110. The majority of surgical supplies and medications were donated, although some were purchased; the total value was estimated at $30,000. Total fees of $27,310 were collected from patients, of which $4,950 was for 1067 clinic visits and $22,360 was for operations performed on 258 patients. Had local Guatemalan surgical providers for those specialties (specifically 2 obstetricians and gynecologists, 1 general surgeon, 1 pediatric surgeon, 1 plastic surgeons, 3 ophthalmologists, and 4 anesthesiologists) performed these procedures in place of the visiting team, their costs would have been an estimated $26,670.
Conclusion: Local fees covered all the local costs generated by the provision of care, but only 26% of the total costs of surgical care provided. If local surgical providers were substituted in place of the visiting team, it would cost over half of the equivalent to what was spent on travel. The visiting team expanded service coverage, provided nearly equivalent resources in purchased and donated supplies and medications, and supported an extended range of specialty care. Recruiting and retaining similar capacity is difficult given the lack of local human resources and does not include the numerous scrub techs, nursing and support staff required during the surgical mission. Until such resources are available locally, combining surgical missions with local capacity-building extends access to primary and specialty surgical care.