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After a 15-year-quest to obtain the necessary resources, equipment and team, Cinterandes was established in 1994, and has now been successfully delivering surgery in remote areas for over 20 years, completing over 7,500 operations.
The village-based approach to delivering surgery may work better in certain environments than others and should be considered along with other strategies for further research.
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The operating model depends upon delivering surgeries at high volume – the surgeons there are ten times more productive than surgeons elsewhere in the country.
Dr Edgar Rodas, Ecuador's general surgeon and previous minister of health, had a vision to deliver surgery through a truck converted into a mobile operating theatre.
There is an established body of linguistic knowledge about such things as eliciting patients' concerns, framing discussions about whether to have surgery, delivering bad news, perceiving a patient's indirect expression about reluctance to take medication and many other medical subjects.
Pattern of surgical provision: we do not yet know the most effective way of delivering trichiasis surgery: is it through a high-volume surgical camp, or through a single surgeon working long-term in a specific district?
And so he created a eye hospital that was a combination of both, recognizing the power of storytelling, efficiencies and just-in-time approaches to delivering eye surgery.
Results Among the 585 women who had undergone bariatric surgery and had a delivery, 269 delivered before surgery and 316 delivered after surgery.
Compared with women who delivered before surgery, women who delivered after surgery had substantially lower rates of pre-eclampsia and eclampsia (odds ratio 0.20, confidence interval 0.09 to 0.44), chronic hypertension complicating pregnancy (0.39, 0.20 to 0.74), and gestational hypertension (0.16, 0.07 to 0.37) (fig 2).
This yielded a final sample of 585 women, 269 who delivered before surgery and 316 who delivered after surgery.
Most women in each group underwent gastric bypass surgery (73.6% (198) in those who delivered before surgery and 88.3% (279) in those who delivered after; total 81.5% (477)).
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com