Challenges of starting pediatric surgical services in a resource-limited location – experience at the Makunda Christian Hospital in Assam, India

Vijay Anand Ismavel , Ann Miriam*

Email: ivijayanand@yahoo.in

Phone: +91 9365727334

Missions Department (Directorate) Christian Medical College, Vellore India

Abstract

Introduction:

The greatest transformational impact achieved by starting a new service occurs in those locations where the service is most difficult to access and therefore service utilization is the lowest. However, these locations are also associated with the greatest challenges which include geographical factors, institutional factors andpatient factors besides issues related to the specialty. Our article explores these issues from the experience of the authors in starting pediatric surgical services in a remote rural part of northeast India. We also discuss possible solutions and ways forward for those considering similar initiatives in other parts of the developing world.

Background:

The Makunda Christian Leprosy and General Hospital was started in 1951 as a leprosy colony by American Baptist missionaries. The hospital was closed in the early 1980s when expatriate staff were asked to leave the country. In the following 10 years, the staff at the hospital sold its equipment to pay themselves salaries leading to loss of electricity, running water and other essentials. Two doctors joined the hospital in 1992 and restarted services in 1993. They went for their higher studies in Pediatric Surgery and Anesthesia and returned in 2000 to establish the only pediatric surgical service at that time in the southern half of northeast India, a part of India wedged between Bangladesh in the west and Myanmar in the east.

They continued to serve at the institution for the following 20 years. This article describes the challenges faced and draws learnings from their experience of starting the new service at this remote location to provide suggestions for similar initiatives in low-resource settings.

Problem statement:

Low-resource settings in the rural developing world present with a host of challenges which are general to the starting of any medical service with some that are specific to pediatric surgery. This article considers both the general and specific challenges encountered by the authors in their nearly 30 years of service at the Makunda Christian Hospital located in south Assam’s Karimganj District, close to the borders with Tripura and Mizoram states in India and to the international border with Bangladesh.

Each of the challenges are discussed and internal insights from interventions made are described. Since many of these challenges would be encountered in similar settings across the developing world, the authors hope that their experience would assist other teams with their plans to establish similar services.

Materials and methods:

A description of the setting, initial facilities, challenges and actions taken to manage them form the first part of this section. This is followed by a brief discussion on an external study on the business model of the hospital with specific focus on pediatric surgery.

Results:

The setting – Makunda Christian Leprosy and General Hospital was started in 1951 as a large leprosy colony. After a few years, an American missionary doctor, Dr. Gene Burrows, was appointed and he managed the colony as well as many non- leprosy patients who came to him for care for 25 years. In the early 1980s, all the expatriate staff were asked to leave the country and were not permitted to re-enter. With no medical staff and loss of patients and external support, the hospital closed.