Surgery and Healing in the Developing World - Dartmouth-Hitchcock

CHAPTER 1
CHAPTER 36
Surgical Training of Nurses for Rural
Areas: Necessity or Aberration?
Ahuka Ona Longombe
In Northeast Zaire (the Haut-Zaire Region) 7.6 million of the 10 million population
live in the 44 rural districts where only 5 of the 44 specialist physicians practice.
At the Centre Medical Evangelique in Nyankunde selected nurses have
undergone an 18-month course of training in surgery. They are then capable of
performing all the commonly encountered and some of the less frequently seen
urgent surgical operations and some routine surgery. An account of their work in
remote areas is given.
Introduction
Surgery is a discipline which requires a high level of academic study and practical
training. It should not be left in the hands of charlatans or the unskilled. This requirement
has meant that in developed countries surgery is reserved for qualified
career surgeons with junior doctors gaining limited experience only under strict
supervision. The situation is quite different in developing countries, however, where
there is an acute lack of appropriately trained medical personnel. In the deep interior
of these countries, there are glaring inequalities between the towns and rural
areas. Such inequalities have been denounced clearly in the Declaration of Alma
Ata. 1
In developing countries there is an uneven distribution of qualified medical personnel;
80% physicians work in towns while the remaining 20% serve the rural
areas where most people live.
How do we manage the resulting situation in the African bush? In this chapter
we give our point of view and our reflections on the surgical training of nurses at the
Centre Medical Evangelique (CME) at Nyankunde in Zaire and illustrate our discussions
with the results of surgery by three nurses trained at CME.
Centre Medical Evangelique (CME), Nyankunde
CME, Nyankunde is a disctrict hospital with 250 beds which is situated in the
North East of Zaire (Haut-Zaire Region). The hospital acts as a referral hospital
with specialist services. The catchment area covers a large part of Eastern Zaire,
particularly Haut-Zaire and North KIVU Regions which have a population of more
than 10 million.
CME Nyankunde is organised under four clinical services (surgery;
gynaecology-obstetrics, internal medicine and paediatrics). In addition there are departments
of community health, ophthalmology, dentistry-stomatology, a labora-
Surgery and Healing in the Developing World, edited by Glenn Geelhoed.