TY - JOUR
T1 - Barriers to Surgical Care at a Tertiary Hospital in Kigali, Rwanda
AU - Dworkin, Myles
AU - Cyuzuzo, Thierry
AU - Hategekimana, Jean de Dieu
AU - Katabogama, Jean
AU - Ntirenganya, Faustin
AU - Rickard, Jennifer
N1 - Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2020/6
Y1 - 2020/6
N2 - Background: The disproportionate distribution of surgical resources across the globe has left many in low- and middle-income countries without proper care. Patients often have complex surgical problems that are worsened by delayed presentation. We aim to describe barriers to surgical care at a tertiary hospital in Kigali, Rwanda. Materials and methods: A prospective review of all patients undergoing general and orthopedic surgery was performed at a tertiary hospital in Rwanda. Patients completed a questionnaire regarding their presurgical interactions with the health-care system. Results: Over a 3-wk period, there were 24 (33%) general and 49 (67%) orthopedic surgery patients. Patients reported delays seeking care (n = 21, 29%), reaching care (n = 28, 38.5%), and receiving care (n = 44, 60%). The median number of days from first symptom to surgery was 7.3 d and was significantly longer for patients reporting at least 1 barrier to care (P < 0.001). Barriers reported during the care-seeking time period had the largest impact on time to surgery (51.5 d versus 5.7 d, P = 0.01). Meanwhile, the most frequently reported barriers included not knowing care was needed (n = 17, 23%), transportation issues (n = 25, 34%), and surgical staff availability (n = 23, 32.5%). Conclusions: Initiatives are needed to address common barriers to surgical care in Rwanda. Educational programs designed to help patients identify key symptoms could encourage earlier presentation to health-care providers. System-based projects to improve transportation could facilitate patient transfers within the health-care system. Finally, increasing surgical staff at hospitals throughout the country would reduce delays and improve access.
AB - Background: The disproportionate distribution of surgical resources across the globe has left many in low- and middle-income countries without proper care. Patients often have complex surgical problems that are worsened by delayed presentation. We aim to describe barriers to surgical care at a tertiary hospital in Kigali, Rwanda. Materials and methods: A prospective review of all patients undergoing general and orthopedic surgery was performed at a tertiary hospital in Rwanda. Patients completed a questionnaire regarding their presurgical interactions with the health-care system. Results: Over a 3-wk period, there were 24 (33%) general and 49 (67%) orthopedic surgery patients. Patients reported delays seeking care (n = 21, 29%), reaching care (n = 28, 38.5%), and receiving care (n = 44, 60%). The median number of days from first symptom to surgery was 7.3 d and was significantly longer for patients reporting at least 1 barrier to care (P < 0.001). Barriers reported during the care-seeking time period had the largest impact on time to surgery (51.5 d versus 5.7 d, P = 0.01). Meanwhile, the most frequently reported barriers included not knowing care was needed (n = 17, 23%), transportation issues (n = 25, 34%), and surgical staff availability (n = 23, 32.5%). Conclusions: Initiatives are needed to address common barriers to surgical care in Rwanda. Educational programs designed to help patients identify key symptoms could encourage earlier presentation to health-care providers. System-based projects to improve transportation could facilitate patient transfers within the health-care system. Finally, increasing surgical staff at hospitals throughout the country would reduce delays and improve access.
KW - Delivery of health care
KW - Global surgery
KW - Referral and consultation
KW - Rwanda
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U2 - 10.1016/j.jss.2019.12.045
DO - 10.1016/j.jss.2019.12.045
M3 - Article
C2 - 32062430
AN - SCOPUS:85079199312
SN - 0022-4804
VL - 250
SP - 148
EP - 155
JO - Journal of Surgical Research
JF - Journal of Surgical Research
ER -