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Tiny Human Spaces: Mobile Solutions For Surgery
Christopher D. Hughes, MD, MPH1, Amy Hughes, MD1, Craig McClain, MD, MPH2, Swagoto Mukhopadhyay, MD, MPH3, Heather A. Harmon, MPH4, Allison Denisky4, Bernard T. Lee, MD, MBA5, David Walton, MD, MPH6, Jim Ansara4.
1CT Children's, Hartford, CT, USA, 2Boston Children's Hospital, Boston, MA, USA, 3University of Connecticut, Farmington, CT, USA, 4Build Health International, Beverly, MA, USA, 5Beth Israel Deaconess Medical Center, Boston, MA, USA, 6Brigham and Women's Hospital, Boston, MA, USA.

PURPOSE:
Surgical care in low- and middle-income countries (LMICs) often exists as a privilege for those who can afford it. Over 40 million people risk poverty each year accessing surgical services. In addition to medical costs, indirect costs substantially impact a patient's ability to get treatment. One of the most consistently cited barriers to care is transportation, i.e: getting to the hospital or clinic. When that travel burden is lessened or eliminated, access to surgery improves.
METHODS:
We conducted an iterative design process with multilayered input from surgeons, anesthesiologists, OR support staff, architects, designers, and lay personnel to create an innovative mobile surgical prototype to address problems of surgical access related to transportation in LMICs.
RESULTS:
"tinyOR" is a mobile, scalable, cost-efficient concept that allows patients to access surgical care closer to home. It is a modified, trailer-based platform designed to house a preoperative triage area, a fully-functional operating room with the ability to provide a wide range of anesthetics, and a substerile instrument room. The unit can function adjacent to clinics or health centers to both utilize existing infrastructure for postoperative recovery and to partner with local healthcare personnel for perioperative care. tinyOR is lightweight enough to be pulled by a commercially available truck, and once in place it can run independent of its towing vehicle. Because of its scalability and cost-effectiveness, tinyOR can be incorporated into existing regional healthcare infrastructure as a way to strengthen local health systems.
CONCLUSIONS:
tinyOR is about (tiny) space making. It allows surgical patients to be treated close to where they live, without fear of impoverishment. It makes space for dignity, respect, and individual freedom in settings where those very ideals are often challenged on a daily basis.



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