If the patients can’t get to the operating theatre, the operating theatre goes to the patients. This is the idea that a dozen years ago led to a lorry being equipped to tour the remote areas of Ecuador, arriving in villages a long way from the cities and hospitals and operating on ten of thousands of people.

Better than small hospitals. The idea came to a group in the University of Cuenca, headed by Edgar Rodas, a surgeon who for many years had worked in hospitals in small towns and seen how they were often badly equipped and poorly staffed. The result was that patients in the rural areas of Ecuador aer forced to go to cities like the capital, Quito, even for small operations, travelling for many kilometres and leaving their families back in the villages for days on end. “Patients who come from rural areas don’t know the city and have lots of problems there”, explained Ana Vicuna, an anaesthetist and manager of Cinterandes, the foundation that launched the initiative. “Generally they have to wait 2 days for an appointment and then another 15 before the operation”. So when they have minor problems they live with it. “We’ve seen patients who’ve had hernias for twenty years”, Vicuna told us, but the white lorry offers a solution to this problem. “Everybody talks about how it’s necessary to do something”, Rodas added, referring to the necessity to improve healthcare in rural areas, “but they don’t say how. We think we’ve found a solution”.

Over five-thousand successes. The lorry has its own operating theatre, measuring five metres by three, and over the years has carried out tonsillectomies and hernia repairs and cut out small, superficial tumours for a total of around 5,200 operations that have cured patients’ problems without running important risks. There have been complications in less than one percent of the cases treated, and even they turned out alright in the end thanks  in part to the special attention from those who offer the service - before the lorry arrives, the doctors who work in the various communities select the cases with characteristics that are best suited to operations in these conditions. The patients are then visited by the medical staff from the mobile operating theatre, made up of three surgeons, one or two anaesthetists, a nurse and an assistant. The type of operations carried out varies from community to community, depending on the resources available for treating the patient after the operation. If there is access to Internet, the possibility of offering telemedicine for post-operation assessment and check ups makes it possible to increase the type of operations carried out in the white lorry, including cholecystectomies and hysterectomies.

The results of prevention. Apart from surgery, the lorry also offers general medicine. Cinterandes explained that a doctor in the most isolated areas is responsible for anything between 5,000-10,000 people, or even more, spread out over a vast area. The possibility of offering treatment is limited to the most urgent cases and there’s a lack of healthcare education and sickness prevention. With the Integral Family Health Programme, 22 doctors based in 10 communities are responsible for the healthcare needs of children, mothers and families in an attempt to prevent sickness, malnutrition and whatever else comes along. In four years, a programme of this type in the city of Santa Ana (in the south-east of the Cuenca region) has managed to vaccinate all the children (before only 3 out of every 10 were vaccinated)and to help malnutrition decrease from 63% to around 23% in children of between one and four.