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Medical Research Project
ILBS is supporting a project to find ways in which doctors in rural India can get access to affordable surgical equipment with emphasis on minimal invasive surgery.
Under the Auspices of the International Leadership and Business Society[1]
Dr. med. Elias Engelking[2]
Research Project: Development of Laparoscopy in Rural India
Since the early 1970′s pioneers in India have set mile stones in laparoscopy and later in laparoscopic surgery (LS)[3]. In time many of these hospitals became specialised high volume centres based in major cities. With two thirds of India’s population living in rural areas and one third of the population living below the poverty line, access to sophisticated surgery is limited. However these patients benefit most from the early return to work after minimal access surgery[4,5]. The scope of operations in the rural setting is considerable and often cost-cutting, ranging from diagnostic laparoscopy saving CT or MRI scanning or laparoscopic vagotomy saving a life long medication on proton pump inhibitors with cholecystectomy, appendectomy and sterilisation making up the most of operations[6,7,8,9,10]. There is concern whether LS is to be promoted in rural hospitals due to concerns of a greater consumption of resources[11]. Cost effectiveness is a key issue, thus forcing the rural surgeon to improvise[12,13,14]. One of the main cost factors is the investment in surgical instruments and equipment (camera, light, monitor, CO2-insufflator, etc.).
This study is to determine the availability of LS in rural India with present investments and the projected development of LS, the need for facilities and financial resources. Special emphasis is placed on the surgeon’s needs. For this a questionnaire [Appendix I] will be circulated to the Members of the Association of Surgeons of India (ASI), the Indian Association of Gastrointestinal Endosurgeons (IAGES) and the Association of Rural Surgeons of India (ARSI).
Approximately 12800 ASI[15], 1800 IAGES[16] and 400 ARSI[17] Members add up to a total of 15000 potential recipients of the questionnaire. A survey among ASI members in the year 1986[13] judging the activity in rural areas had a feedback of 1,7%. By adding a prepaid return envelope this rate can surely be improved to at least 5%, giving a projected return of 750 questionnaires thus providing adequate data to be able to determine significant results.
Relying purely on a printed questionnaire and postal services creates costs per recipient of approximately 50 INR adding up to a total of 7.5 lakhs (11000 Euro). This may be restricted due to limited financial resources available from industry sponsoring the research. So a two-staged procedure is advocated: Primarily there will be a telephone survey with known better return rates[18]. Lack of telephone connections in rural areas calls for a second step circulating the questionnaire via postal services reducing the number by step one.
Projected results are that there is a desire to facilitate LS in rural hospitals but that there is a need of sturdy reusable equipment at drastically reduced cost. The goal is to demonstrate to industry that the developing world has a huge potential for LS equipment which needs to meet specific demands different to the increasingly sophisticated equipment in Europe or the US.
References
1 The International Leadership and Business Society e.V., Johannesstrasse 14, 78609 Tuningen, Germany, at www.ilbs.org
2 Dr. med. Elias Engelking, Hugstetter Str. 19, 79106 Freiburg, eliasengelking@yahoo.com. Surgeon in training at Diakoniekranenhaus Freiburg (Teaching Hospital of the University of Freiburg).: . , ().
3 Udwadia TE: Diagnostic laparoscopy. Surg Endosc 2004, 18 (6-10).
4 Cadière GB: Laparoscopic surgery and the third world. Surg Endosc 1996, 10 (957-958).
5 Udwadia TH: Laparoscopy in India – A personal perspective. J Min Access Surg 2005, 1 (51-52).
6 De U : Laparoscopic versus open appendicectomy: An Indian perspective. J Min Access Surg 2005, 1 (15-20).
7 Jesudian G: Laparoscopic surgery in rural areas. ANZ Journal of Surgery 2007, 77 (799-800).
8 Manning RG, Aziz AQ: Should Laparoscopic Cholecystectomy be Practised in the Developing World? The Experience of First Training Program in Afganistan. Ann Surg 2009, 5 (794-798).
9 Mir IS et al.: Laparoscopic cholecystectomy in a small rural hospital in Kashmir Valley, India. Trop Doctor 2008, 38 (213-216).
10 Ramakrishna HK: Experiences at a M.A.S. unit in a rural area. Rural Surgery 2004, 4 (4-7).
11 Anita NH: ARSI, Its origin, Present status and Future. Rural Surgery 2006, 1 (2-3).
12 Jesudian G: Laparoscopic surgery in rural areas. ANZ Journal of Surgery 2007, 77(9) (799-800).
13 Banerjee JK: Caring for Developing Communities. Eur J Surg 1999, 165 (69-71).
14 Arun SK, Cost-efficient laparoscopy in India, 125th Congress of the German Association of Surgeons, Berlin 2008,
15 ASI Members Directory, July 2009 at www.asiindia.org
16 IAGES Members Directory, July 2009 at www.iages.org.in
17 ARSI Members Directory, July 2009 at www.arsi-india.org
18 Statistical Survey, 26.7.2009 at www.en.wikipedia.org/wiki/Statistical_survey
