Performing successful surgery in developing countries can be difficult, especially without all of the proper supplies. University of Virginia undergraduate Mary Lansden Brewbaker aims to remedy this, but is discovering that the problem is more complex than she imagined.
Brewbaker, a fourth-year economics and religious studies double major, traveled to Rwanda last summer to determine the priorities of surgical supply spending there. Her research is underwritten by a Harrison Undergraduate Research Grant.
Harrison Undergraduate Research Awards fund undergraduate research projects for one year. First-, second- and third-year undergraduate students compete for approximately 40 awards of up to $3,000 each. Recipients then work closely with a faculty mentor to carry out their research.
Brewbaker, 21, of Tuscaloosa, Ala., started her project after members of the U.Va. Global Surgery Initiative, in which she participated, and the Clinton Healthcare Access Initiative in Rwanda reported a lack of surgical supplies in that country. The U.Va. Global Surgery Initiative is a joint effort between the U.Va. Department of Surgery and the U.Va. Center for Global Health that strives to forge education, research and relationship development across disciplines and borders in the area of global surgery.
“A more informed, efficient health care spending prioritization system was the first step in meeting this need,” Brewbaker said. “I am an economics major, had been to Rwanda before and was interested in learning more about the health care system there.”
Brewbaker said while more surgical supplies of all kinds are needed in Rwanda, there is a lack of quality supplies and little agreement on what supplies are needed.
“This research was to determine which surgical supplies were most needed in referral hospitals in Rwanda,” she said. “The immediate goal was to create a list of supplies in order of most needed to least needed so that Rwandan procurement officers and supply chain managers could make more knowledgeable decisions when procuring supplies. The greater, long-term goal was to create a medical supply ranking system suitable for use in many low-income country health care settings.”
Brewbaker emailed hospital directors before arriving in Rwanda and received permission to directly approach the surgeons at each hospital. She and her research partner, Rachel Jordan, who attends the University of North Carolina at Chapel Hill, personally interviewed each surgeon.
But she found that this was not as simple as she thought.
“I learned that comparing one supply to another is a very difficult task, for which many doctors have different answers and logic,” she said. “I learned, too, that the approach of Western surgeons to medical supplies is very different to that of East African surgeons, which resulted in a wide variety of answers to the survey.”
Brewbaker found that Western doctors, who were used to working with high-quality materials, focused on supplies.
“American doctors often indicated that they needed every type of suture, while East African doctors said they needed only a few types as long as the supply was plentiful,” Brewbaker said. “East African doctors focused on the need for more doctors and large equipment rather than consumables, which is what our project focused on, while Western doctors focused on consumables,” such as sutures.
Brewbaker’s data is being analyzed by a research assistant who works with Dr. James F. Calland, assistant professor in the Department of Surgery, who was the U.Va. medical faculty adviser on the project. The details, which will be spelled out in a final paper, can be used by procurement officials to more knowledgeably purchase medical supplies in Rwanda.
“When completed, this study will serve as an important building block to understanding the bottlenecks in creating surgical capacity in Rwanda and other similar Sub-Saharan African countries,” Calland said. “I worked with Mary Lansden for almost a year in preparing for getting the project under way and see her as a delightful young woman with a bright and affable demeanor, a caring heart and a drive to improve the world she lives in.”
While Brewbaker is still working on the project, she thinks the scope of her original project may have been too wide.
“Because of the great need for every consumable mentioned by the doctors and because of the few number of surgeons working in Rwanda, we have not been able to reach a satisfactory conclusion concerning which specific supply is most needed,” she said. “We do, however, have a list of basic supplies that are lacking and a few ways to rank them.”
She thinks that future surveys of this subject should be done by people with more knowledge of surgery.
“I still believe that the project we began needs to be done and is incredibly useful, but I think it would be best for medical professionals to be more involved in it,” she said. “When working in developing countries in the future, I want to be sure to have knowledgeable people closely involved in the practicalities of the project itself rather than just advising it.”
Brewbaker said doing this research has allowed her to more fully realize the limits of her skills and experience. But it does not deter her. She is planning to move to Kigali, Rwanda, in August and work for a small management consulting firm.
“I have learned that I work best in groups and with clear directions and goals,” she said. “I learned that I love challenges and problem-solving, but that I also greatly benefit from other people who challenge me and have a different skill set than my own.”