This article reports a retrospective analysis of a 6-year experience of providing surgical care in remote areas of southern Sudan under extremely adverse conditions.
Teams of expatriate consultants (surgeon, anesthetist, scrub nurse) carried out 28 “surgical missions” with the aims of treating surgical cases previously selected and of training local personnel in basic surgery on the job.
A total of 1642 patients (71% males, 30% under the age of 16) have undergone an operation. Altogether, 1264 elective procedures (77%) and 378 emergency procedures (23%) were performed. Hernia surgery comprised the main workload, followed by proctologic and gynecologic operations. Most operations were performed under spinal anesthesia. Other cases required ketamine, and a small number of patients had local anesthesia. There were 14 fatal complications, most of them related to the delay in obtaining medical attention. Based on the training results, the Sudanese personnel of two of the five health centers involved in the program are already fully autonomous. Two doctors and two nurses are proficient in essential surgery; two not qualified nurses are proficient in “primary” anesthesia; and others are proficient in scrubbing and surgical nursing.
This report demonstrates that it is feasible to establish surgical services in rural areas of developing countries by utilizing simple facilities, providing them with basic equipment, and employing local personnel selected and trained on the job by teams composed of a consultant surgeon, anesthetist, and scrub nurse. This seems to be the only realistic possibility for providing surgical care to the rural populations of the least developed countries.
We are deeply grateful to Dr. Achol Marial Achol, Health Secretary of Sudan Relief Rehabilitation Commission, and to several other volunteer consultants (surgeons, gynecologists, anesthetists, and nurses) who have been providing their professional services in southern Sudan: Maria Teresa Boninchi, head nurse; Claudio Cardani, MD, sonologist and radiographer; Monica Chiari, anesthesia nurse; Loredana Delfino, anesthesia nurse; Andrea Pellegrino, anesthetist; Adriano Santospagnuolo, MD, gynecologist; Luigi Spagna, MD, gynecologist; Marco Vanni, MD, anesthetist; Giuseppe Vassallo, MD, surgeon. We owe also particular gratitude to all of the CCM Sudanese staff, who keep on working under extremely adverse conditions. Since July 2002, this surgical activity is being carried out in the framework of the 3-year program “Chirurgia Essenziale in Aree remote in Sud Sudan,” approved and co-funded by the Italian Cooperation, Ministry of Foreign Affaires.
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