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A qualitative review of hospital-based trauma care in Lima, Peru: Navigating resource gaps and resilient responses
Allison D Dentice1, Jaclyn A VanDerWal2, Gabriela Zavala-Wong3
1Froedtert & Medical College of Wisconsin, Division of Trauma, Critical Care and Acute Care Surgery/ Department of Surgery/Medical College of Wisconsin, Milwaukee, WI.
Background:
Health systems in low- and middle-income countries face significant challenges in providing timely and efficient trauma care. While Peru, a middle-income country, has developed basic trauma care infrastructure, challenges persist. This study aims to identify opportunities for improvement in trauma care through qualitative analysis of provider perspectives in the urban capital of Lima, Peru.
Methods:
As part of a broader study, semistructured interviews were conducted with trauma providers from 4 hospitals in Lima. Physicians, residents, and nurses across specialties were selected through purposive and snowball sampling. Interviews were conducted in Spanish, recorded, transcribed, and translated into English. Thematic analysis was used to identify key themes.
Results:
Thirty-four interviews were conducted, revealing 5 key themes. (1) Resource scarcity-Limited diagnostic capabilities, blood bank accessibility, and equipment shortages were common causes of delayed care. (2) Prehospital-hospital interface-Systemic communication gaps between prehospital services and hospitals hindered preparedness and patient transfer. (3) Capacity and infrastructure constraints-Overcrowding and suboptimal facility layouts were identified as barriers to efficient care. (4) System-level organizational challenges-Inconsistencies in trauma protocol implementation and workforce distribution were noted. (5) Adaptive strengths in trauma management-Despite resource limitations, effective teamwork and triage capabilities emerged as strengths.
Conclusion:
Lima's trauma care system faces persistent challenges with resources, workforce, and infrastructure. This exploratory analysis underscores the need for standardized, in-depth assessments of hospital-based barriers to trauma care. Combined with existing literature on prehospital barriers, these findings can inform targeted interventions to optimize trauma care in Lima and similar middle-income urban centers.
