Where there is no specialist: surgical care in a secondary health facility in a developing country

Abstract

Background A major deterrent to providing qualitative surgical care in developing countries is the lack of adequate facilities and severe shortage of human resources. Therefore, most of the surgical workforce in rural areas and urban slums predominantly includes general practitioners with little formal training in providing surgical care. There is a need for constant review of patients' care in this setting with the aim of improving service delivery and conforming to the internationally acceptable standard of practice. Materials and methods A 5-year descriptive retrospective study, from January 2007 to December 2011, of general surgery cases at State Specialist Hospital Ikere-Ekiti (Nigeria) was carried out. Results A total of 80 patients underwent 85 surgical operations. Most of them (86.2%) had ward admission for a mean duration of 4.6±1.4 days. The most frequent elective operation was hernia repair [66 (77.7%)]; whereas that of emergency was appendectomy [seven (8.2%)]. Other operations included lumpectomy [three (3.5%)], hydrocelectomy [two (2.4%)] and orchidectomy and laparotomy [three (3.5%) each]. All patients received postoperative antibiotics, with 71.3% receiving two or more antibiotics. Fifteen (18.8%) patients had surgically excised specimens with no histopathological evaluation. Only four (5%) patients were followed up beyond 4 weeks. No mortality was recorded. Conclusion Surgical volume was grossly low and there is a need for the government to equip secondary healthcare centres with basic facilities and strengthen surgical capacity for maximum utilization and improved quality of care. Periodic training programmes for general practitioners to ensure strict adherence to the international best practices will be helpful. In addition, health education should be available for everyone to reduce sociocultural-related problems.