When Edgar Rodas, the former Ecuadorian minister of health, was a young surgeon, he traveled by horseback all night to reach a very ill woman in a far-off village. But the journey took too long, and he didn't make it in time - so he resolved to change things.
"I decided I would bring surgery to the poorest people of Ecuador, no matter where they live," he told David Cohen, who wrote about Rodas in New Scientist.
Cohen details what happened next:
[Rodas] bought an old goods delivery truck in California, converted it to a fully functioning operating theatre and shipped it to Ecuador. Since then, more than 7000 operations have taken place in the truck, performed in far-flung corners of the country, from deep in the Amazon jungle, to high in the mountains under the shadow of Ecuador's volcanoes.
Rodas went on to found the Cinterandes Foundation, which has been sending the surgery truck to remote villages and urban slums throughout Ecuador since 1994. "Instead of bringing the patient to the operating room," the organization's site explains, "the operating room is taken to the patient."
Here's the delivery truck, making one of its regular trips. A larger vehicle may have made surgery more comfortable for the doctors, but it would have been too difficult to drive on some of Ecuador's winding mountain roads:
The truck is equipped with a lift, to safely bring patients into and out of the operating room:
Here's the mobile operating room inside the truck:
And here are two images of the surgical team at work in the back of the truck:
Rodas wanted to address what he saw as a yawning gap between the high-tech surgical advances made at major medical centers and the lack of access to basic surgical services among the poor.
"Two-thirds of doctors and hospitals are concentrated in Ecuador's two largest cities, Quito and Guayaquil, where only a quarter of the country's population lives," The Lancet reported in 1998, in an article on the Foundation's early work. Rural health services "are frequently understaffed, badly equipped, and [unable to] respond adequately to the needs of the population."
The truck, meanwhile, can bring quality medical care and experienced surgeons to remote corners of the country. To make the best use of their limited resources, the mobile operating team focuses primarily on straightforward procedures on patients who are at a low risk for complications. As of 2006, their complication rate was under 1 percent.
"Many people in the country or in the slums of the big cities die or are subjected to long periods of pain and incapacity due to a perforated appendix or a strangulated hernia, problems that could have been solved easily with a simple procedure performed in a timely manner," Cinterandes explains.
Outfitting the truck for mobile surgery cost about $75,000 and was covered largely by General Motors. The surgeries average a cost of less than $100, Rodas reported in the World Journal of Surgery in 2005. Those same surgeries would cost about $10,000 each in the U.S., The Lancet estimated.
The Cinterandes Foundation has expanded to provide health and development programs beyond just the surgical services on the truck, but it is still best known for its highly effective - and very busy - mobile operating room.
Rodas helped implement a mobile operating service in Honduras and is now working to bring a similar program to South Sudan.
Mobile surgical units that are unaffiliated with Cinterandes also exist in New Zealand, Ghana, Saudi Arabia, and elsewhere - but the delivery truck operating room in Ecuador may be one of the most compact.