# Community Perceptions of Accessing Surgical and Anesthetic Care in Rural Guatemala: A Cross-Sectional Survey

## TL;DR

This study explores how people in rural Guatemala perceive access to surgical and anesthesia care, finding significant barriers like cost and distance.

## Contribution

The study provides new insights into community perceptions and barriers to surgical care in rural Southwest Guatemala.

## Key findings

- Most households reported prior surgical experiences, with Cesarean sections and appendectomies being the most common.
- Financial costs were the primary barrier to accessing surgical care, with out-of-pocket expenses ranging from $384.60 to $1282.05.
- Over 90% of respondents reported inadequate access to surgical and anesthesia care in their communities.

## Abstract

Access to essential surgical and anesthesia care is limited in rural areas in low- and middle-income countries. Knowledge of the perceptions of access and utilization of surgical care among rural populations in Guatemala is lacking. This cross-sectional study examines self-reported trends and barriers to accessing surgical and anesthesia care in rural Southwest Guatemala. Semi-structured interviews were conducted with individuals who presented to the Trifinio Center for Human Development (TCHD) in Southwestern Guatemala and consented to participate. Information regarding household experience, community trends, and perceptions of access was recorded and analyzed for themes. Individuals from 50 different households were interviewed. There were 29 (58%) respondents who reported a prior surgical history in the household. The most commonly perceived procedures in this region were Cesarean section and appendectomy, reported by 35 (70%) and 38 (56%) households, respectively. Forty (80%) households described an overall preference within their communities for birth in a hospital setting, as well as concerns about increasing rates of Cesarean sections. The median distance, in time traveled, required to travel to the nearest surgical hospital was 60 minutes (interquartile range 11.25 minutes), with a maximum time of five hours (n=1). The nearest urban centers for specialized surgical care reported were Quetzaltenango in 47 (94%) respondents (approximately two hours travel time) and Guatemala City in 14 (28%) respondents (approximately five hours travel time). Among respondents, 46 (92%) report inadequate access to surgical and anesthesia care in their communities. The primary perceived barriers to care were financial costs in 35 (70%) households, with reported out-of-pocket costs ranging from US$384.60 to US$1282.05, followed by geographic distance in 22 (44%) households and lack of quality of care in 12 (24%) households. In this study, we highlight a significant demand for essential surgeries in rural areas and identify perceived barriers to surgical and anesthesia care in Southwestern Guatemala. Future efforts should integrate community perspectives to ensure patient-centered approaches to improve access to essential care in marginalized populations.