Surgery and Healing in the Developing World - Dartmouth-Hitchcock

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380 Surgery and Healing in the Developing World
Table 1. Distribution of health zones
Area Health Zones %
Rural 44 93.6
Urban 3 6.4
TOTAL 47
Table 2. Distribution of specialist physicians
Area Specialists %
Rural 5 12.5
Urban 35 87.5
TOTAL 40
tory for medical analyses and histopathology and a large central pharmacy. The
referral services are used by more than 15 hospitals and many health centres.
In principal CME has always preferred to have specialists at the head of each
service. In reality, however, the lack of specialized surgical personnel (a
gynaecologist-obstetrician in particular) means that all the surgical disciplines (general
surgery, orthopedics-traumatology, gynaecology and obstetrics, urology…) are
shouldered by one general surgeon.
CME, Nyankunde plays a very important role in the training of newly arrived
missionary physicians, young Zairian physicians and of paramedical personnel working
in the Northeast (NE) of Zaire. For some years practical training in surgery for
nurses has been given. These nurses are then sent to isolated health centres where, in
general, medical help is nonexistent.
The Haut-Zaire Area
Zaire is a very large country, situated in the centre of Africa. It has an area of
2,345,000 square kilometres and is administratively divided into 11 regions, of which
Haut-Zaire is one of the largest, with an area of 529,000 square kilometres (a little
smaller than France and four times the size of Malawi). Haut-Zaire is divided into
four rural subregions (Bas-Uélé, Haut-Uélé, Tshopo, Ituri) and one urban subregion
(Kisangani). Of the 306 health Zones (districts) in Zaire, 47 lie within the
Region of Haut-Zaire.
Haut-Zaire has a population of approximately 8 million inhabitants, of whom
only 400,000 live in Kisangani City, the Region’s capital, giving a rural/urban population
ratio of 20:1.
The distribution of human resources for health services in Haut-Zaire (Tables 1,
2 and 3) shows clearly that rural areas are overloaded and at a disadvantage in relation
to surgical care as compared with urban areas.
The surgical workload becomes impossible with inevitable negative consequences
for those living and working in the most isolated area. For this reason we have
developed a programme of practical surgical training for nurses working in rural
areas. The programme began in 1990.