In January 2014 the President of the World Bank, Dr. Jim Yong Kim, called for a “shared vision and strategy for global equity in essential surgical care,” stating “surgery is an indivisible, indispensable part of health care.”
In 2015, the World Alliance for Patient Safety chose safe surgery as the second Global Patient Safety Challenge.
For more than a century, surgery has been an essential component of universal health coverage. Given the increasing incidence of trauma, cancers and heart disease, the value of surgery in public health systems will also keep increasing
The WHO’s objectives are to improve the safety of surgery throughout the world by defining a set of safety norms that can be applied in all the member countries of the organization. To this end, various groups composed of international experts with an in-depth knowledge and understanding of this problem gathered together and identified four areas where a significant progress can be made towards safe surgical care: prevention of surgical site infection, anesthesia safety, surgical equipment safety and measurement of surgical care outcomes.
Surgery for the People
5 Billion people lack access to safe, affordable, and timely surgical and anesthesia care. The poorest one third of the world’s population only receives 3% of the surgical procedures performed. Based on this need, Operation Smile has united our efforts with the government of Nicaragua through a close collaboration with the Ministry of Health, embarking on a program called, Surgery for the People or Cirugía Para El Pueblo”. The pilot project’s primary focus is to increase the access and impact of surgical care in two rural primary hospitals in Nicaragua through equipment, education, and community outreach. Furthermore, the project is also focused on identifying the core components of successful primary hospital safe surgical care to enable replication and scale up, both nationally and internationally.
Surgery for the People unites Operation Smile’s 35-year track record of successfully implementing safe, high-quality cleft surgical programs in austere settings with the Nicaraguan Ministry of Health’s developed rural outreach programs and networks, and campaigns towards increasing access to safe surgery, as well as the World Health Organization’s patient-centered healthcare model.
The project builds on previous efforts to strengthen surgical care systems, such as: American Heart Association resuscitation and life support courses to all perioperative personnel in the country, improvements in patient care coordination, patient follow-up and outcomes measurement, targeted field innovations, and health system strenghtening. Surgery for the People has been designed to facilitate scalability and replicability to other departments of Nicaragua and other regions internationally.
“Las Minas” Region
The Bonanza municipality covers an area of 2,039 km. It is about 380 km Northeast of Managua and 32 km Northeast of Rosita in the remote North Caribbean Coast Autonomous Region of Nicaragua. Bonanza, due to its geographic location, is a multi-ethnic municipality. Due to the gold boom, people from diverse origins converged in this area along with their traditions and beliefs.
The majority of the population, or 63%, is mestizo, 30% mayagna, and 7% misquito. Among the economic activities of the population are mining, forest ecotourism, and hydropower.
Bonanza’s geography is composed of mountains, irregular terrain elevating up to 300 meters above sea level.
Hospital Primario Esteban Jaenz Serrano
Esteban Jaenz Serrano, the primary hospital is a small, 30-bed, district hospital located in Bonanza in the North Caribbean Coast Autonomous Region of Nicaragua. It was inaugurated in 2002 and has an emergency area, operating room and ward area.
The primary hospital sees patients referred from the municipalities of Rosita and Prinzapolka turning it into a local reference unit. Furthermore, the hospital refers patients to Puerto Cabezas and Siuna.
The hopsital has only one functional operating room, which makes increasing surgical throughput a constant challenge. The surgical agenda is frequently interrupted due to cesarean surgeries and other emergency surgery.
The Siuna municipality covers an area of 5,039.81 km2. It belongs to the group of 5 municipalities that forms SILAIS Las Minas health sector. Siuna is about 334 km from Managua and 240 km to Puerto Cabezas.
The total population in Siuna is 103,462, of which 85% is rural. The urban population is 15%, of which the majority is ethnically mestizo. Throughout the municipality, the largest ethnicity is mestizo (98.7%), followed by Misquito (0.6%), Mayagna (0.6%) and Creole (0.1%).
Siuna offers extensive forests of precious wood, namely mahogany and cedar. Due to its geographical position it also includes mountainous elevations, rivers and water sources.
The municipality has a tropical monsoon with temperatures averaging 26º C and a precipitation higher than 2,000 mm annually.
The urban sector of the municipality includes schools, recreational parks, baseball stadium, basketball courts, restaurants, hotels and bars, as well as a town hall, airstrip and police station.
Hospital Primario Carlos Centeno
Carlos Centeno is a primary hospital inaugurated in 2001. Patients are frequently referred from the municipalities of Rosita, Bonanza, Prinzapolka, Waslala and Mulukukú.
The hospital has 48 beds. It currently has one major functional operating room and a second operating room that was habilitated in 2016, although incompletely in order to help with the demand on scheduled and emergency surgery. The hospital currently offers services in the following specialized areas: maxillofacial surgery, pediatric surgery, orthopedic surgeon, radiology anestehsiology, urology, internal medicine, general surgery, obstretic and gynecology and pediatrics.
In order to reduce maternal mortality indices, 4 casas maternas (maternal house) were created, two of which are located in the urban zone and 2 in the Hormiguero and Las Quebradas. The maternal house model has been shown throughout the country to be an effective strategy in improving safe birth and pregnancy complications.