Access to surgical care is a major public health crisis for many living in low and middle-income countries. Patients must often overcome barriers to care in order to access needed interventions. Using the Three Delays Model we aim to describe factors contributing to delayed surgical treatment for patients presenting to a tertiary hospital in Kigali, Rwanda. A cross-sectional interview-based pilot study was performed in which all patients undergoing surgery were asked questions to understand their pre-surgical interactions with the healthcare system. Over a three-week period, there were 24 (33%) general and 49 (67%) orthopedic surgery patients. The median number of days from first symptom to the decision to seek care was 1 day while the median number of days from the decision to seek care to arrival at the tertiary hospital was 9.5 days. There was a median of 2.25 days from the arrival at the hospital to surgery and the total time from first symptom to surgery was a median of 12.25 days. Patients experiencing barriers to care had significantly longer times from first symptom to the decision to seek care, as well as from arrival at the hospital to surgery (p < .01). The most significant barriers in terms of impact on time from first symptom to surgery were encountered during the care seeking time period. The most common barriers encountered related to not knowing care was needed, issues with transportation, and surgeon or operating room availability. Initiatives are needed in order to address these barriers. Educational programs designed to help patients identify key danger signs would encourage earlier presentation to providers. Systems based projects to improve road conditions could enhance transport to facilities. Furthermore, training providers at District Hospitals to perform essential surgeries would reduce delays, as well as improve access to both surgeons and operating rooms.
Dworkin, Myles; Frasso, PhD, MSc, CPH, Rosemary; and Rickard, Jennifer, "Barriers to Surgical Care at a Tertiary Referral Hospital in Kigali, Rwanda" (2019). Master of Public Health Capstone Presentations. Presentation 297.