title: Patient and Physician Perceptions of Changes in Surgical Care in Mongolia 9 Years After Roll-out of a National Training Program for Laparoscopy.
abstract: In 2005, the general population of Mongolia was not aware of laparoscopic surgery and was skeptical about the safety of surgical care. A 9-year initiative to expand laparoscopic surgery was initiated by Mongolian surgeons. This study examines the current barriers to and perceptions of surgical care following laparoscopic surgical expansion countrywide.
  
  
  
  In September 2013, interviews were conducted with 71 patients, and 39 physicians in Mongolia. Patients and physicians were interviewed using separate sets of interview questions. Questions were designed to gauge perceptions of surgical care in Mongolia evaluating for access, affordability, sustainability, barriers to care, quality, and knowledge of laparoscopy. Responses were fine coded for statistical analysis.
  
  
  
  79 % of patients felt surgical care was improving in Mongolia, and 76 % would choose laparoscopy if available. Physicians (100 %) felt laparoscopic surgery had improved surgical care in Mongolia. Barriers to care for patients were time to work up and diagnosis (37 %), and funding an operation (39 %). None of the 36 % of patients who stated funding an operation would be difficult identified government sources of funding (p < 0.001). Physicians identified insufficient equipment supply (69 %), insufficient training (41 %), and cost (38 %) as barriers for laparoscopy. 74 % of physicians felt that Mongolian physicians return or stay in Mongolia after training, defying the trend of migration in low-resource settings.
  
  
  
  Improved local patient and physician perception of laparoscopy is propelling the expansion of laparoscopy in Mongolia.
authors.affiliation: The University of Utah Center for Global Surgery, Salt Lake City, USA. katie.m.wells@gmail.com.|The Johns Hopkins Bloomberg School of Public Health, Baltimore, USA. katie.m.wells@gmail.com.
authors.forename: K M
authors.initials: KM
authors.lastname: Wells
authors.affiliation: University of Nottingham School of Medicine, Nottingham, UK.
authors.forename: H
authors.initials: H
authors.lastname: Shalabi
authors.affiliation: Mongolia Health Sciences University, Ulaanbaatar, Mongolia.|First Central Hospital Mongolia, Ulaanbaatar, Mongolia.
authors.forename: O
authors.initials: O
authors.lastname: Sergelen
authors.affiliation: Department of Anthropology, The University of Utah, Salt Lake City, USA.
authors.forename: P
authors.initials: P
authors.lastname: Wiessner
authors.affiliation: Department of Internal Medicine and Epidemiology, The University of Utah, Salt Lake City, USA.
authors.forename: C
authors.initials: C
authors.lastname: Zhang
authors.affiliation: The University of Utah Center for Global Surgery, Salt Lake City, USA.
authors.forename: C
authors.initials: C
authors.lastname: deVries
authors.affiliation: The University of Utah Center for Global Surgery, Salt Lake City, USA.|Intermountain Healthcare, Salt Lake City, USA.
authors.forename: R
authors.initials: R
authors.lastname: Price
mesh_terms: D001291:Attitude of Health Personnel; D004503:Education, Medical, Graduate / Q000458:organization & administration*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D010535:Laparoscopy / Q000193:education* / Q000523:psychology / Q000592:standards; D008297:Male; D008986:Mongolia; D010820:Physicians / Q000523:psychology; D016730:Program Development; D015397:Program Evaluation; D058996:Quality Improvement