Mobile Surgery

Interplast’s Edgar Rodas is my professional brother. Dr. Rodas and I are non-identical twins. We both came onto the scene seventy-six years ago. We both are surgeons — Dr. Rodas trained in general surgery, and I trained in plastic reconstructive surgery. We both underwent our surgical residencies at American universities and were certified by the American board of our respective surgical specialties. We then entered academic life — my brother Dr. Rodas at the University of Cuenca, Ecuador, and I at Stanford University, U.S.A.

Rodas has thirty-five years of humanitarian service during which contributed to a “new era” of medicine by popularizing mobile surgery. In mobile surgery, instead of the patient going to the doctor, the doctor comes to the patient. Rodas’s magnificent record of safety and efficacy in bringing the miracle of high-tech laparoscopic cholecystectomy to jungle communities in Ecuador is worth our attention.

Rodas’s mobility consists of an operating room built into the interior of a recreational vehicle. He has a postoperative care unit, a preop facility, and a sterilization and central supply capability in addition to the fully capable operating room. His five publications regarding this work bear witness to the popularization of the method. His 0.016% mortality rate (one in 6,000 cases) compares favorably with a modern U.S. hospital (0.1% mortality rate[1])

Forty-three years ago I began taking a multidisciplinary team to developing countries to repair cleft lip and palate. Regarding safety, this organization’s mortality was three in fifty thousand cases (a rate of 0.006%).

Both of our methods involve scheduled and regularly repeated  visits by the team, postoperative monitoring by the local medical system, as well as advice from the team via telecommunication (telemedicine). Telemedicine can be done by phone, email, or fax. Dr. Rodas lends cell phones to patients and installs cell phone repeaters in tall palm trees nearby.

Both of our foundations have demonstrated five key tenets:

  1. Direct patient care.
  2. On-the-job training and education of the patients, volunteers, and doctors of both countries involved.
  3. Public interest without self-aggrandizement.
  4. Research of efficacy and outcomes.
  5. Community involvement.

Our organizations have common goals with our universities and our governments. There is emphasis on research, education, and public interest. As tax-exempt non-profit organizations, we had the support of the public. The ultimate function is to transfer wealth in society from those who have it to those who don’t.

We both have found a huge source of income in our work. In helping others, we gain psychic income: the impressive joy one experiences when doing something for the benefit of others. The benefits come as a result of the happiness generated when working toward the greater good.

And we both teach our practices and philosophies at our respective universities. Dr. Rodas teaches Community Medicine at Cuenca and Azuay, and I teach International Humanitarian Surgery at Stanford. These courses prepare students for succession in our foundations. In this way, we create the long-term professional relationships that sustain the foundations.

In all these ways, Dr. Rodas and I are professional brothers. Our practices of mobile surgery have produced the highest standards of medical care in rural areas. As you’ll see, Dr. Rodas’s work in jungles, mountaintops, and seashores, done using our set of standard operating procedures, show mortality rates better than that of most U.S. hospitals. Dr. Rodas details his thoughts and methods below.


[1] Naqesh-Bandi, Hasan, and M. A. Gok. “Cholecystectomy Mortality: a Single Centre Experience.” Society for Surgery of the Alimentary Tract. 2007. 27 Feb. 2009 <http://www.ssat.com/cgi-bin/abstracts/07ddw/SSAT-DDW07-Poster-57.cgi&gt;.

[vimeo http://vimeo.com/14868756]

The Concept

At the beginning of the 21st. Century, the world lives a tremendous contradiction. On one side we have great scientific and technological progress, designed for the well being of mankind, and on the other, the everyday widening gap between a few who have more than what they need and the vast majority of people who do not have enough.

This contradiction is also evident in surgery. We are able to replace and transplant damaged organs. We can model the human figure to restore beauty that time has taken away, or to give beauty that nature has denied. Tele-surgery allows us to operate in a remote geographical location. Yet, in spite of all of these advances, several mothers and children die, because they do not have access even to a simple Cesarean operation. Many people in the country or in the slums of the big cities die or are subjected to long periods of pain and incapacity due to a perforated appendix or a strangulated hernia, problems that could have been solved easily with a simple procedure performed in a timely manner.

Until now, we have not been able to apply our knowledge to benefit the mass of underserved people.  As surgeons and teachers, we have the duty to pursue excellence and strive for the progress and perfection of our science and art, but we believe that it is equally important, especially for surgeons in the developing countries, to search for new methods and systems to make that progress readily accessible to the common people.

With these principles in mind, the aim of our project was to take the operating room to the countryside and to the most disadvantaged neighborhoods of the cities. Progress in ambulatory surgery has made it possible to perform several types of operations and discharge the patient on the same day. The operating room is a limited space, relatively easy to equip and maintain. The areas required for patients preparation and postoperative recovery are also easy to arrange.

The Mobile Surgical Unit crossing Andean stream on its way to surgical mission

As it was said before, contact with international medical missions such us Project Hope and Interplast, inspired the idea of taking medical care to underprivileged areas of the country. If foreign doctors and nurses were offering their services to our Country, it is certainly a duty of Ecuadorian medical personnel to do the same for our own people.

There are mobile hospitals, some on water like the ship Hope; some on land, such as the Military Ambulatory Surgical Hospitals (MASH); and an ophthalmologic operating room has been installed on an airplane

With these premises and examples, the idea that an operating room could be set on a truck was born.  A mobile surgical unit was assembled and a new milestone in the history of mobile surgery began.

(Continued on Page 2)

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