The poor cousin of medicine

Rural Surgery in Southern Sudan

INTRODUCTION

This article reports a retrospective analysis of a 6-year experience of providing surgical care in remote areas of southern Sudan under extremely adverse conditions.

METHODS

Teams of expatriate consultants (surgeon, anesthetist, scrub nurse) carried out 28 "surgical missions" with the aims of treating surgical cases previously selected and of training local personnel in basic surgery on the job.

RESULTS

A total of 1642 patients (71% males, 30% under the age of 16) have undergone an operation. Altogether, 1264 elective procedures (77%) and 378 emergency procedures (23%) were performed. Hernia surgery comprised the main workload, followed by proctologic and gynecologic operations. Most operations were performed under spinal anesthesia. Other cases required ketamine, and a small number of patients had local anesthesia. There were 14 fatal complications, most of them related to the delay in obtaining medical attention. Based on the training results, the Sudanese personnel of two of the five health centers involved in the program are already fully autonomous. Two doctors and two nurses are proficient in essential surgery; two not qualified nurses are proficient in "primary" anesthesia; and others are proficient in scrubbing and surgical nursing.

CONCLUSIONS

This report demonstrates that it is feasible to establish surgical services in rural areas of developing countries by utilizing simple facilities, providing them with basic equipment, and employing local personnel selected and trained on the job by teams composed of a consultant surgeon, anesthetist, and scrub nurse. This seems to be the only realistic possibility for providing surgical care to the rural populations of the least developed countries.

Utilization of district health services by injured persons in a rural area of Ghana

INTRODUCTION

Injury is a significant health problem in many less developed countries. However, strategies for dealing with it have been only minimally addressed.

GOALS

We ought to assess the pattern of health care utilization by injured persons in rural Ghana. We thus hoped to provide data that would assist in strengthening injury treatment in this setting.

METHODS

Using household interviews, we surveyed 9442 person. We sought information on any injury during the previous year that resulted in one or more days of disability. Injured persons were interviewed regarding the mechanism of injury, treatment obtained and length of disability.

RESULTS

During the previous year, 923 nonfatal injuries were reported. Half the injured persons (49%) received no formal medical care. When treatment was received, it was primarily delivered by a non-doctor staffed primary health care (PHC) clinic. Such clinics provided treatment for 30% of all injured persons (58% of those receiving formal medical care). Twenty percent of the injured received hospital-based care (39% of those receiving formal medical care). Among those using hospitals, the majority (92%) used district hospitals.

CONCLUSIONS

In this setting, efforts to improve injury treatment should include district hospitals and PHC clinics. At both there is a need to advance the concept of 'essential' injury treatment services, addressing equipment, supplies and training.