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ORIGINAL ARTICLE
Year : 2020  |  Volume : 15  |  Issue : 3  |  Page : 627-633

Traumatic brain injury in Mumbai: A survey of providers along the care continuum


1 Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
2 Department of Surgery, King Edward Memorial Hospital, Mumbai, Maharashtra, India
3 Department of Cultural Anthropology, Duke Global Health Institute, Duke University, Durham, North Carolina, USA
4 Department of Surgery, Beth Israel Deaconess Medical Center; Program for Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
5 Program for Global Surgery and Social Change; Department of Otolaryngology, Massachusetts Eye and Ear Institute, Harvard Medical School, Boston, MA, USA
6 National Health System Resource Center, New Delhi, India
7 Program for Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
8 Department of Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India

Correspondence Address:
Dr. Saksham Gupta
Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02120
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ajns.AJNS_4_20

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Introduction: Traumatic brain injury (TBI) represents a significant burden of a global disease, especially in low- and middle-income countries (LMICs) such as India. Efforts to curb the impact of TBI require an appreciation of local factors related to this disease and its treatment. Methods: Semi-structured qualitative interviews were administered to paramedics, anesthesiologists, general surgeons, and neurosurgeons in locations throughout Mumbai from April to May 2018. A thematic analysis with an iterative coding was used to analyze the data. The primary objective was to identify provider-perceived themes related to TBI care in Mumbai. Results: A total of 50 participants were interviewed, including 17 paramedics, 15 anesthesiologists, 9 general surgeons, and 9 neurosurgeons who were involved in caring for TBI patients. The majority of physicians interviewed discussed their experiences in public sector hospitals (82%), while 12% discussed private sector hospitals and 6% discussed both. Four major themes emerged: Workforce, equipment, financing care, and the family and public role. These themes were often discussed in the context of their effects on increasing or decreasing complications and delays. Participants developed adaptations when managing shortcomings in these thematic areas. These adaptations included teamwork during workforce shortages and resource allocation when equipment was limited among others. Conclusions: Workforce, equipment, financing care, and the family and public role were identified as major themes in the care for TBI in Mumbai. These thematic elements provide a framework to evaluate and improve care along the care spectrum for TBI. Similar frameworks should be adapted to local contexts in urbanizing cities in LMICs.


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