title: A quantitative analysis of surgical capacity in Santa Cruz, Bolivia.
abstract: OBJECTIVE
  This investigation aimed to document surgical capacity at public medical centers in a middle-income Latin American country using the Surgeons OverSeas (SOS) Personnel, Infrastructure, Procedures, Equipment, and Supplies (PIPES) survey tool.
  
  
  METHODS
  We applied the PIPES tool at six urban and 25 rural facilities in Santa Cruz, Bolivia. Outcome measures included the availability of items in five domains (Personnel, Infrastructure, Procedures, Equipment, and Supplies) and the PIPES index. PIPES indices were calculated by summing scores from each domain, dividing by the total number of survey items, and multiplying by 10.
  
  
  RESULTS
  Thirty-one of the 32 public facilities that provide surgical care in Santa Cruz were assessed. Santa Cruz had at least 7.8 surgeons and 2.8 anesthesiologists per 100,000 population. However, these providers were unequally distributed, such that nine rural sites had no anesthesiologist. Few rural facilities had blood banking (4/25), anesthesia machines (11/25), postoperative care (11/25), or intensive care units (1/25). PIPES indices ranged from 5.7-13.2, and were significantly higher in urban (median 12.6) than rural (median 7.8) areas (P < 0.01).
  
  
  CONCLUSIONS
  This investigation is novel in its application of a Spanish-language version of the PIPES tool in a middle-income Latin American country. These data document substantially greater surgical capacity in Santa Cruz than has been reported for Sierra Leone or Rwanda, consistent with Bolivia's development status. Unfortunately, surgeons are limited in rural areas by deficits in anesthesia and perioperative services. These results are currently being used to target local quality improvement initiatives.
authors.affiliation: Departments of Emergency Medicine and Internal Medicine, Henry Ford Hospital, Detroit, MI. Electronic address: abe.markin@gmail.com.
authors.forename: Abraham
authors.initials: A
authors.lastname: Markin
authors.forename: Roxana
authors.initials: R
authors.lastname: Barbero
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Leow
authors.forename: Reinou S
authors.initials: RS
authors.lastname: Groen
authors.forename: Evan J
authors.initials: EJ
authors.lastname: Skow
authors.forename: Keith N
authors.initials: KN
authors.lastname: Apelgren
authors.forename: Adam L
authors.initials: AL
authors.lastname: Kushner
authors.forename: Benedict C
authors.initials: BC
authors.lastname: Nwomeh
mesh_terms: D000776:Anesthesiology; D001838:Bolivia / Q000453:epidemiology; D003906:Developing Countries; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D004865:Equipment and Supplies, Hospital / Q000706:statistics & numerical data; D013502:General Surgery / Q000706:statistics & numerical data; D006779:Hospitals, Public / Q000706:statistics & numerical data; D006780:Hospitals, Rural / Q000706:statistics & numerical data; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D010820:Physicians / Q000600:supply & distribution*; D013503:Surgery Department, Hospital / Q000706:statistics & numerical data; D000078329:Workforce
keywords: Bolivia; Emergency surgery; Essential surgery; Global surgery; Latin America