Costly Surgery

I was surprised by the judicious use of disposable materials in the OR here in Kenya, so I made a list of the staff and the disposable materials used during the first operation that I saw in the OR, an inguinal hernia repair:

Medical staff:
1 Physician (non-surgeon) – equivalent to a resident in the American system
1 Scrub nurse
1 Anesthesia tech
1 Circulating nurse

Anesthesia:
2 spinal needles
1 IV catheter
3x 500 ml IV saline
Lidocaine
Ketamine
2 syringes

Surgery:
1 2/0 chromic suture
1 0 nylon suture
1 4/0 nylon suture
1 scalpel blade
12 gauze sponges
10 mL iodine
2 feet of cloth tape
3 pairs of sterile gloves

Very rough materials cost: $20

Now, here’s a list of the staff and disposable items used for the same surgery in the states. This is from memory, so I’m likely going to miss quite a number of things, but you’ll get the point.

Staff:
1 Attending surgeon
1 Resident surgeon
1 Medical student
1 Scrub nurse
1 Circulating nurse
1 Anaesthesia attending
1 Anaesthesia nurse

Anesthesia:
1 IV catheter
Benzodiazepine to calm patient
3x 500 mL IV saline
Paralytic agent
Propafol
1 endotrachial tube
6 syringes
4 EKG pads
6 pairs of exam gloves
2 feet cloth tape
6 sterile gauze pads
1 Bair Hugger (inflatable warming blanket)

Surgery:
3-4 disposable gowns
10 pairs sterile gloves
6 head covers
6 face masks
3x prefilled chlorhexidine prep sponges
1 Ioban antibiotic skin cover
2 SCDs (inflatable leg compression wraps)
2 foam heel pad booties
~5 impermeable paper drapes
2 light handle covers
1 Bovie skin pad
1 Bovie
1 Bovie tip
1 scalpel blade
6 feet of plastic suction tubing
1 Yankaur sucker
1 suction canister
1 sheet Ethicon Prolene hernia mesh
1 0 nylon suture
2 2/0 Vicryl
1 3/0 Monocryl
1 tube Dermabond
1 island dressing

Very rough cost: $2,000

This is just material costs and does not include surgical fees or any supplies used in the recovery room. Nor does it include the cost for the surgeons, anesthesiologists, nurses, and assistants, which are similar orders of magnitude more expensive in the US.

Now, I’m not going to claim that the outcomes of these procedures are the same. I would much rather have my hernia repaired at a hospital in the States than at the one where I’m currently working, but it was still amazing to see that 100x difference in material costs.

One thing that is the same when you compare Kenya and the US is that people have trouble paying their medical bills. The difference is that in Kenya, you know the price upfront since it's posted on the front wall of the hospital. [Click on the picture below to see a bigger version]



Don’t you wish things were this clear in the US? For reference, 80 KSH
= 1 USD and these prices are still a hardship for many families.