Hernia Repair for the Underserved
By Matthew N. Skoufalos
There are three chief limitations to achieving better-quality medical care in the developing world, says Dr. David Chen, Associate Professor of Surgery at the University of California Los Angeles: mentorship, education, and resources.
Many doctors who perform medical missions have the ability and the interest to provide the first two, but thanks to partnerships with technology companies like Google, GoPro, and Cisco Systems, they are gaining access to the third as well.
“There’s always been asymmetry in the world between developing countries and the first world because of resources,” Chen said.
“Companies like Google and Apple and GoPro, their whole business model is to connect people,” he said. “We can close that gap with some of the infrastructure that someone else built. The quality of care can really get better because you’re connected.”
Chen participates in a charity called Hernia Repair for the Underserved, the goal of which is to provide free surgery to patients in America’s poorest hemispheric neighbors; countries like Haiti, Paraguay, and Brazil.
In the course of a week, surgeons will perform 60 to 80 cases, Chen said. Added to that mission work, however, is a bit of infrastructure-building that involves identifying surgeons from the local main teaching hospitals “and putting them through a training program so they won’t need us anymore,” he said.
“The hernia operation is something that we can do and we can leave,” Chen said. “The outcomes are pretty reproducible, and we can train [doctors for] it in a short period of time.”
“We really want to make them able to take care of their local populations,” he said.
In as few as five supervised procedures, Chen said, training physicians can know that their charges are capable of replicating the results of the surgeries successfully in the absence of supervision. But when the doctors return to the United States, they are still available for consultation at more and deeper levels than before, thanks to technology.
“We’ve been able to build everything really on very little of a budget because we just use what’s there,” Chen said. “We use GoogleDocs, and every surgeon we train, we track them. We have a rating scale that we use for U.S. residents that determines competency. I can give them a report card at the end of their training. Right after a case, everyone sits down with a smartphone, tablet, and data, and decides if you’re competent or not based on metrics.”
Chen will return to Brazil in September 2014, and to Haiti a month later. When he departs from the facilities, however, he and his fellow volunteer surgeons will leave behind tele-networking equipment that will enable them to continue mentoring the native surgeons in those places as well.
“We’re leveraging all this technology because the world is connected,” Chen said. “In Haiti, I can do grand rounds while sitting in a conference room in Santa Monica.
“Their greatest need is education,” he said. “When the earthquake hit [Haiti], people died and people left. That’s what they’re missing.”
The post-mission support began with the very sophisticated teleconferencing equipment—a couple of pairs of Google Glass enable supervising surgeons to effectively be in the room with their trainees during the procedure —and has been distilled to the simpler interactions of a closed Facebook group of some 700-plus international surgeons and medical industry professionals.
“GoPro and Google Glass help identify if you have problems with a case,” Chen said. “They can log every patient they operate on; they just don’t have the resources to do it. When you can do it off your smartphone – it’s amazing. They all have smartphones – they can do these things.
“We can help them look at their outcomes, look at their quality, publish their outcomes, and become leaders in the field,” he said.
What the Facebook group offers, Chen said, is an opportunity for medicine by immediate consensus, which is almost entirely antithetical to the tradition of medical publishing. The “room” in this case comprises 600-plus surgeons and medical industry professionals of varying levels of ability, all of whom can weigh in on a question, whether procedural, technological, or philosophical. That freedom of discussion creates an experience that leverages “power in numbers” and an attitude of collaboration, Chen said.
“It used to be that people would protect what they learned and did because the culture of academia is that you’re only given credit for what you publish,” he said, “but it’s a new world where people are so connected and so excited about things, they put it right out there.
“The turnaround time to ask a question on Facebook and Twitter, you have your answer in one day, as opposed to in the scientific community where we ask a question and do a study and get results five years later,” he added.
As inspirational and empowering a message as the collective spirit of such a movement can engender, putting that collective knowledge to use for charitable ends is the true focus of the efforts of Chen and his cohorts. The doctors who operate on patients in the areas of need are fully vetted by the organization to have achieved a certain level of competence. The treatment they provide is reserved as a preferential option for the poor; Chen notes that “concierge” patients of means are often turned away, and entire trips have been cancelled “where the situations aren’t ideal.” And regardless of the clinical setting, which can be meager in certain circumstances, “we treat everyone there as we would treat our own family members,” he said.
“We’re really trying to build something sustainable, and partnering at the very top level with the best universities or directly with the ministry of health and trying to identify the best surgeons,” Chen said.
“The way that we see it is we’re training people in countries that are developing, and by subsequent generations being trained, the poor and the wealthy in these countries get treated,” he said. “We make sure that the patients are vetted and vested and the staff and the patients get first-rate care.
“I’m busy to the hilt, but I believe in it.”