Easy Appointments

More general surgical operations (including trauma, acute abdomen, and other surgical emergencies) are performed in hospitals that have specialists available, but estimates indicate that in all region

More general surgical operations (including trauma, acute abdomen, and other surgical emergencies) are performed in hospitals that have specialists available, but estimates indicate that in all regions, the met need for these emergencies is even lower than the met need for obstetrical care (chapters 5 and 6). The list of operations actually performed in one year in eight first-level hospitals in Sub-Saharan Africa (table 12.4) shows that many of the problems in table 12.5 that could be addressed in these facilities were not treated at all. Wide variations exist among hospitals; in some cases, there was complete omission of operations that are urgently needed, not complicated, and within the competence of general practitioners with brief surgical training (for example, open reduction of compound fractures). Such omissions can lead to a major loss of cost-effectiveness in these hospitals.

Closed fracture treatment and some uterine evacuations may not have been recorded in the operating room logbooks (the source of data for this study) because they are not always carried out in the main operating rooms. Trauma is not listed separately, but the very small number of open fracture reductions (with the exception of Kiryandongo) indicates that major trauma either is not being seen or is being referred elsewhere.

If general anesthesia and a qualified surgeon are available in a first-level hospital, all of the procedures in table 12.5 can be done at this level, which would be ideal, since referral often is not possible or practical. If all of the procedures in the first-level hospitals column could be mastered by the staff available at this level, few patients would need to be referred. The ideal will be to put fully qualified surgeons and obstetricians in all hospitals, but better training of the general practitioners and NPCs now serving as the only surgeons in many first-level hospitals could bring these facilities closer to the ideal.