Research in a Conflict Zone: When High-needs Meet Extreme Uncertainty

Surgery room, Courtney, 2013, Unmodified.

Surgery room, Courtney, 2013, Unmodified

By David H. Rothstein, MD, MS

Published September 18, 2018

5 billion people worldwide lack access to timely, safe, and affordable surgical care. In many places, the challenges to provision of this care are daunting. Health systems lack basic human and material resources, rudimentary education regarding congenital anomalies and need for referral at the primary care/midwife/rural medical center level, and safety and transportation logistics. 

I previously worked in Goma, a city in the eastern part of the Democratic Republic of the Congo, and partnered with the humanitarian group Doctors Without Borders. Our team, which includes UB faculty as well as colleagues from Université Libre des Pays des Grand Lacs, aims to investigate the barriers that face children with surgically correctable congenital anomalies, acquired infection diseases with need for surgical intervention, and traumatic injuries in Goma. Our ultimate goal is to develop pediatric surgery infrastructure for the region near the Ugandan and Rwandan borders.

In order to improve provider education, we have teamed with Congolese medical students from the Université Libre des Pays des Grand Lacs and physicians from our UB team (including medical students) to create rudimentary pictorial diagrams that may help local practitioners identify surgically correctable congenital anomalies.

Most recently, we developed and conducted hospital-based surveys to quantify the hospital’s capacity to provide pediatric surgical care. We selected hospitals representing a wide geographic area and accessibility. Findings from these surveys are being analyzed and will inform future work.

Transportation in this region is challenging, and one of the primary reasons patients from rural areas fail to reach higher-level medical care. Safety concerns due to troop and rebel group movements, poor road infrastructure (particularly during rainy seasons), and financial constraints due to widespread extreme poverty have a direct effect on patient health. In order to better quantify the transportation challenges and potential solutions, our partner, Dr. Enki Yoo, associate professor of geography at UB, will create geomapping heat maps displaying average travel distances patients face to access various levels of surgical care.

Security concerns as well as a recent Ebola outbreak exemplify the uncertainties that exist in conflict zones. Although these challenges affect our research timeline, our work in Goma continues. We are most concerned with the health and wellbeing of our partners and the population.

Our Publications:

Kalisya LM, Bake JF, Bigabwa R, Rothstein DH, Cairo SB. Operations for Suspected Neoplasms in a Resource-Limited Setting: Experience and Challenges in the Eastern Democratic of Congo. World J Surg. 2017 Dec 31. doi:10.1007/s00268-017-4452-2. [Epub ahead of print] PubMed PMID: 29290072.

Cairo SB, Agyei J, Nyavandu K, Rothstein DH, Kalisya LM. Neurosurgical management of hydrocephalus by a general surgeon in an extremely low resource setting: initial experience in North Kivu province of Eastern Democratic Republic of Congo. Pediatr Surg Int. 2018 Feb 16. doi: 10.1007/s00383-018-4238-0. [Epub ahead of print] PubMed PMID: 29453580.

Cairo SB, Kalisya LM, Bigabwa R, Rothstein DH. Characterizing pediatric surgical capacity in the Eastern Democratic Republic of Congo: results of a pilot study. Pediatr Surg Int. 2017 Nov 20. doi: 10.1007/s00383-017-4215-z. [Epub ahead of print] PubMed PMID: 29159423.