Surgery and Healing in the Developing World - Dartmouth-Hitchcock

CHAPTER 1
CHAPTER 38
Training Surgeons in the Developing
World
David C. Thompson
Introduction
For the purposes of our discussion, we will define a surgeon as a physician who
has received special and extensive training to enable him to correctly diagnose surgical
disease, skillfully and safely perform the right operation for a wide variety of
surgical problems, and recognize and treat the complications that his operations
may sometimes produce.
According to this definition a surgeon is not simply a doctor who operates. If he
were, or if a physician could become a surgeon simply by performing a large number
of operations badly, there would be little need today for any physician to receive
formal surgical training.
Family practice physicians are not surgeons, but because in many countries there
are not enough surgeons for all of the operations that need to be done, for practical
reasons they can and should learn to perform some operations safely and well. Like
surgeons, they should have a clear understanding of both their capabilities and limitations.
Because surgeons literally hold the lives or well-being of their patients in their
hands, and because they also hold the keys to maintaining high surgical standards in
their communities, surgeons should be trained to do at least seven things well:
1. maintain a high level of interest and concern for the welfare of their patients;
2. correctly diagnose surgical disease;
3. adequately prepare patients for surgery;
4. plan for appropriate anesthesia;
5. perform the right operation safely and skillfully;
6. assure the patient’s postoperative recovery;
7. pass on surgical knowledge and skills to others who are qualified.
Western Models of Surgical Education
There is a belief in much of the developing world that the training of surgeons
should be left to academic surgeons working in technologically advanced hospitals,
preferably in advanced countries. This policy has produced a significant number of
surgeons who now practice not in the developing countries that desperately need
their skills, but in the wealthy countries in which they were trained. Those few who
out of a sense of duty or loyalty return home after completing their training usually
find themselves in a radically different medical setting. To practice the surgical skills
Surgery and Healing in the Developing World, edited by Glenn Geelhoed.