Surgery and Healing in the Developing World - Dartmouth-Hitchcock

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Surgical Training of Nurses for Rural Areas 385 References 1. Santé du Monde. Declaration of Alma Ata. Aout- 1988; 16-17. 2. Wilson JN. Iatrogenic gangrene in the third world. Trop Doc 1991; 21:137-138. 3. Loutfi A, Pickering J, MacLean APH. Training general practitioners in surgical and obstetrical emergencies in ethiopia. Trop Doc 1995; 25(suppl 1):22-26. 4. Blair E. The malawi orthopedic project. Proc Assoc Surg East Afr 1992; 15:63-66. 5. Basic Surgical Facilities in Africa, Meeting organised by WHO/Brazzaville held in Blantyre, 1994. 36
CHAPTER 37 Training of Medical Assitants in Mozambique for Surgery in a Rural Setting Ivo Paulo Garrido It is a great honor and pleasure to address this crucial meeting on the future of surgery in Africa, on the subject of the training of medical practitioners and other health workers for surgery in a rural setting in Mozambique. To understand the solutions that we have been seeking in Mozambique one has first to understand the harsh realities of the health situation in my country. Mozambique is an underdeveloped country where more than 70% of the population (of about 16 million) live in rural areas. The Mozambique health services cover less than 30% of the population and are particularly scarce in the rural setting. The doctor/population ratio is 1:40 000 and the surgeon/population ratio is 1:400 000. At present there are fewer than 300 medical doctors in Mozambique and they include: 7 surgeons, 1 neurosurgeon, 4 orthopedic surgeons, and 12 specialists in obstetrics and gynaecology. None of these specialists works in the rural areas. The number of doctors in postgraduate training in surgery is 4 and in orthopedic surgery 1. These numbers are not likely to increase in any substantive way in the near future. The scarcity of doctors in general and the extreme scarcity of trained surgeons and other professionals with sufficient surgical training poses the problem of coping with the unmet needs of surgical care of the population living in the rural areas. To address these concerns in an expeditious way the Ministry of Health of Mozambique was obliged to start a 3-year training course in surgery for assistant medical officers (tecnicos de cirugia). 1 The first group started their training in 1984. Three groups (totalling 50 trainees) have now concluded their training programmes. The main aim of the course is to train assistant medical officers to deal with surgical emergencies and to perform lifesaving operations such as reduction of strangulated hernia and salpingectomy for ectopic pregnancy. Diagnosis and management of cold surgical conditions for elective repair are not a priority. Candidates are selected from among the best assistant medical officers available who have at least 5 years of experience. The first 2 years of training take place in Maputo (the capital city) and are concentrated on didactic and practical teaching. The students have daily lectures and rotate on patient wards in surgery, orthopedics and obstetrics and gynaecology. Around 40% of their learning time is spent in casualty to acquaint them with all kinds of surgical emergencies, in particular trauma and surgical infections. The last year is spent in a 250-bed provincial hospital, and the teaching is essentially practical. The students work under close supervision of a general surgeon. Surgery and Healing in the Developing World, edited by Glenn Geelhoed.
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Surgery and Healing in the Developi
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Contents Foreword .................
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25. Dentistry .....................
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Editor Contributors Harold P. Adolp
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Foreword Surgery and Healing in the
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“poor, but modern”, as for exam
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There may be at least one considera
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It is that higher accountability th
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1 2 Surgery and Healing in the Deve
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CHAPTER 2 Surgery in Developing Cou
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2 10 Surgery and Healing in the Dev
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CHAPTER 4 International Surgical Ed
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CHAPTER 9 Lab-in-a-Suitcase: Saving
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10 72 Surgery and Healing in the De
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CHAPTER 12 Communication in the Thi
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CHAPTER 13 Anesthesia in the Third
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13 100 Surgery and Healing in the D
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CHAPTER 15 Basic Obstetrics and Obs
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CHAPTER 16 Pointers for American Su
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CHAPTER 20 Chronic Pyogenic Osteomy
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CHAPTER 23 Cleft Lip and Palate Sur
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CHAPTER 24 Outreach Dentistry: A Wo
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CHAPTER 1 CHAPTER 26 Reconstructive
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Reconstructive Surgery in the Tropi
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CHAPTER 1 CHAPTER 27 Factors Influe
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Distribution and Incidence of Tropi
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CHAPTER 1 CHAPTER 28 Population Dyn
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Population Dynamics Of Surgical Tro
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Metabolic Maladaptation 289 Introdu
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Metabolic Maladaptation 291 some of
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Metabolic Maladaptation 293 In this
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Metabolic Maladaptation Table 1. Si
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Metabolic Maladaptation Table 4. Go
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Metabolic Maladaptation 299 the rev
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Metabolic Maladaptation Table 5. As
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Metabolic Maladaptation Table 6. Co
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Metabolic Maladaptation 305 the ris
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Metabolic Maladaptation Table 8. Go
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Metabolic Maladaptation Table 10. G
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Metabolic Maladaptation Table 12. C
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Metabolic Maladaptation 313 cell an
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Metabolic Maladaptation 315 Biologi
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Metabolic Maladaptation 317 from io
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Metabolic Maladaptation 319 25. Lon
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CHAPTER 1 CHAPTER 30 Nutrition and
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Nutrition and Development in Africa
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CHAPTER 1 CHAPTER 31 Uterine Ruptur
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Uterine Ruptures in Rural Zaire Tab
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Uterine Ruptures in Rural Zaire 329
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CHAPTER 1 CHAPTER 32 Vesicovaginal
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Vesicovaginal Fistula in Democratic
Page 350 and 351: CHAPTER 1 CHAPTER 33 Ophthalmology
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Page 420 and 421: Mobile Surgery Figure 1. 405 of tec
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Wanted 435 most pathologic presenta
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Wanted 437 “outliers” in the he
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World Health 439 challenge: name fo
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CHAPTER 1 CHAPTER 44 Treating Other
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Treating Others: Human Sciences in
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Treating Others: Human Sciences in
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CHAPTER 1 CHAPTER 45 The Impact of
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The Impact of a Volunteer Medical M
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CHAPTER 1 CHAPTER 46 Field Notes on
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Field Notes on a Typical Day in a H
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Surgery and Healing in the Developing World - Dartmouth-Hitchcock

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