Surgery Resumes: Safety for Patients and Medical Staff Our Top Priority

While COVID-19 has put so much of life on hold, our patients can’t afford to wait. When their care is delayed, their conditions worsen and surgery becomes more complex. Yet operating in the pandemic also poses a greater risk to patients—especially if they have COVID at the time of the operation or contract the virus during their recovery—and to the medical personnel on the surgical team. In the midst of these new realities, our program partners only performed five emergency surgeries between March and August of this year, instead of the hundreds of operations we would provide in a normal year. 

As COVID-19 case levels plateau and Bolivian hospitals are able to open up beds in their surgical wards, our surgical programs are gradually resuming in some hospitals. New protocols are crucial to resuming this work in the safest way possible. As elsewhere, a negative COVID test is required of all patients prior to surgery. The population we serve has been plunged deeper into poverty with the loss of income related to quarantine, and the cost of this additional pre-op lab could become yet another barrier to care. In response, our local partner, Puente de Solidaridad, has negotiated with laboratories in Cochabamba and Santa Cruz to facilitate timely and low-cost COVID testing for our patients. Solidarity Bridge is contributing funds to cover this extraordinary expense as well as some other labs and images as needed. We are grateful to our generous donors who have made this support possible.

Each of our four surgical programs faces specific challenges particular to the specialty. Below we share an update on the current status of surgery provision in each program.

General Surgery 

General surgery is our most active specialty, accounting for more than half of our surgeries provided in 2019. Two emergency gallbladder surgeries were performed in June amid the peak of the pandemic, while other patients were medically treated to delay surgery as long as possible. Today we are slowly reopening the program to many such patients, including three who underwent surgery in the last two weeks of September. Mandatory pre-surgical screening is revealing that 90% of our general surgery patients have had COVID-19, confirmed through antibody tests. This illustrates the rapid spread of the virus through the low-income population we serve, and the importance of maintaining strong protective protocols while moving forward with surgery. The consequences of exposure are especially widespread in a country with so few surgical specialists; multiple surgeries are currently postponed in Santa Cruz while one of our partner physicians is in quarantine after exposure to a COVID-positive patient.   

Neurosurgery

In the city of Santa Cruz, our partners have resumed surgery and provided operations for four patients, including three children. But the need for specialized materials and equipment that are often hand-carried to Bolivia on our mission trips threatens to slow their progress. We continue to explore every avenue for donation of needed materials and have had much success in transitioning our supply delivery from suitcases to freight shipment. Surgeries have not resumed in the city of Cochabamba yet, but Puente de Solidaridad is hopeful to host a spinal surgery campaign there before the end of the year. This new initiative will provide life-changing surgery for five or more patients. 

Gynecologic Surgery 

It is obvious that perinatal care could not be put on pause for the pandemic; obstetricians and gynecologists continued to report to work as usual. As a consequence, it is one of the specialties in Bolivia that lost the highest number of doctors and nurses to COVID-19, including two young gynecologists who had recently completed their residencies at our partner hospital, the Cancer Institute in Santa Cruz. Special support will be needed in coming years to shore up this specialty amid such devastating losses. Throughout this period, our partner gynecologists have been most focused on the pregnant and new mothers in their care. As their practices stabilize, we will soon resume surgeries for the post-reproductive aged women who are the primary target of our program. Our social workers are currently screening and preparing several patients for surgeries programmed in the coming month.  

Heart Surgery

Our heart surgery program is comprised of two specialties: pacemaker implants and pediatric cardiology. 

Pacemaker Surgery
As we reported in August, pacemaker implants have restarted, and follow-up care has resumed in our clinics. Puente de Solidaridad was able to move forward with a number of implants, including an emergency case, thanks to pacemakers and leads received from Solidarity Bridge donors. Meanwhile, Bolivian distributors who sell pacemakers in both the public and private markets are reporting delays in importing implantable devices. That has made pacemakers even more scarce and expensive elsewhere in the country, reiterating the importance of the lifeline we provide for desperate patients.   

Children’s Heart Surgery
Multiple factors must coincide to make it safe to operate our tiniest patients—babies born with congenital heart malformations. They are incredibly prone to catching infections of all types, and have little reserve with which to fight them off. Their condition must be stabilized as well as possible, and their families must all be healthy too. In July, our partners at the Incor Heart Institute in Santa Cruz had to operate on a fragile newborn with multiple heart defects who would not survive without immediate intervention. We are delighted to report that the little girl is home with her mother and doing well. In Cochabamba, conditions aligned in September to allow one toddler to undergo surgery to patch the hole in his heart. That surgery was also a success. Many more children are now awaiting care in both cities.