Table 4: Challenges reported, solutions, and future plans.

DomainChallengesSolutions

Water and electricity Lack of running water at some sites
Prolonged power outages at two sites
Patients and/or their attendants to provide 20 litres of water each
Using a generator (consider standby generators in future surgical camps)
Inadequate number of anesthetists
No anesthetic machine
Predetermining personnel needs and secure personnel (anesthetists) beforehand

Sterilization and suppliesLimited capacity to sterilize (due to inadequate number of autoclaves), power outages, and inadequate linen supplies
Drugs and surgical sundries were in short supply
Better projections and resource mobilization for future camps
Considering hiring autoclaves
Contact nearby hospitals to participate and share

Equipment and instruments Equipment and instruments were limited (surgical sets, anesthesia equipment)
There was a concurrent ophthalmology camp going on
We had only one oxygen source
Doing better projections, hiring equipment and instruments
Considering portable oxygen supply

Human resourceSeveral patients with gynecological conditions came yet we had no gynecologists
Operating theater condition: some were very old, dilapidated
Few staff in the theater to help in coordination and patient flow
Inadequate postoperative nursing manpower
One of the team members fell sick
Including gynecologists in future camps
Instituting quality assurance and safety guidelines and agreeing on the minimum standards
Getting required personnel to commit before the camp begins

Demand for serviceOverwhelming number of cases
Some pediatric cases could not be worked on
Planning triage days before the camp begins and generating manageable operating lists

Technical operative difficulties Giant hydroceles and hernias that had stayed for over 10 years were a challenge, with no intensive care unit (ICU) facilitiesTriage and referral to better facilitated centers
Allocating “difficulty” cases to the experienced surgeons
Priority was given to children, the elderly, and those whose conditions greatly affecting the quality of life
Mainly cases which need minimal postoperative nursing care were done

Others Only a handful presented for preoperative screening
Due to limited working space, privacy could not be observed all the time
Inadequate linen
Encouraging preoperative screening in future camps
Procuring tents as a way of availing more working space
Getting more linen