Since starting services at the Sanfe Clinic, Nyaya Health has been planning for the ultimate day when we would start surgical services. Now, nearly two years into services at Bayalpata Hospital, we are making preparations to take that next step. Concurrently, Nyaya Health has been developing the basic infrastructure necessary to conduct “implementation research” to help rigorously develop and disseminate our model. Implementation research is the scientific study of the real-world deployment of healthcare services, and is necessary in bringing key public health interventions to scale. We have decided to study the implementation process of surgical services at Bayalpata Hospital as our first major research endeavor. We are doing this because there is an acute need: two billion people live in places like Achham, where there is less than one operating room for 100,000 people. Yet never before has anyone undertaken to prospectively study the deployment of surgical services in a place such as ours. So, we are endeavoring to study the process of scaling-up surgical services in Achham. To do this, we are collaborating with our colleagues at the Center for Surgery and Public Health. Trauma surgeon Selwyn Rogers and myself will be leading a team of researchers. We recently have submitted an NIH grant for this purpose.
In this noon-conference at my residency program, I grapple with my colleagues about the challenges of research in a setting such as ours. We discussed issues of unreliable electricity supplies, of staff familiarity with research protocols, and of not obstructing our service mission with the logistics of research. We also discussed challenges particular to the NIH grant process and of identifying mentors for this kind of work. I provide our readers with the slideset to give a sense of the talk:
Duncan Maru, MD, PhD is a co-founder and President of Nyaya Health. He is currently a resident in the Internal Medicine – Pediatrics program and fellow in Global Health Equity at Brigham and Women’s Hospital and Children’s Hospital of Boston. This post is part of a series on the logistical challenges of achieving transparent operations.