Resetting outcome targets of community surgery camps: The case of the Chhattisgarh tragedy

State-driven community surgery camps have been organised in India for nearly five decades. Despite their being extremely beneficial to people not having ready access to surgical healthcare (SHC), they continue to be mired in controversies because of negative consequences following free surgery, eg blindness following cataract surgery; infection/death following tubectomy/vasectomy. While the onus of complications during and following surgery camps is commonly ascribed to deficient camp infrastructure/facilities; the contribution of the tendency to achieve high-frequency targets, ie to-do-more-surgery-in-less-time to the problem; continues to escape public scrutiny. Ironically, even the significant and multiple morbid events during surgery camps only evoke a transient public outcry, reflective professional criticism, hyper-media whimpers, and legal turbulence; before fading completely from public memory. This viewpoint piece, by taking into consideration the various ethical burdens that assail community surgery camps (13 deaths in the Chhattisgarh tragedy of 2014, as a case in point); aims to deconstruct inadequate SHC systems and conflicted surgery targets seeking promotion and fame. It also suggests remedial measures to address the problems, especially in terms of identifying a valid end-point for successful surgery, ie surgery completion or surgery outcome; and how the media, polity, professional fraternity, and executives could reorient themselves to respond more sensitively to problems, for the benefit of the patients and community at large.

Molecular adsorbent and re-circulating system.

The molecular adsorbent recirculating system (MARS) is a non-biological artificial liver support system. Used for almost a decade, there are only two randomized controlled trials on the efficacy of MARS till date. A number of uncontrolled studies have documented a marked improvement in the biochemical parameters of patients after MARS. Although MARS seems to be an effective and promising tool in the management of liver failure, its cost needs to be reduced to enable it use in a member of indications.