World Journal of Surgery

, Volume 30, Issue 4, pp 495–504 | Cite as

Rural Surgery in Southern Sudan

  • Giuseppe Meo
  • Dario Andreone
  • Umberto De Bonis
  • Giorgio Cometto
  • Stefano Enrico
  • Guido Giustetto
  • Alberto Kiss
  • Marino Landra
  • Maria Palmas
  • Laura Sacchi
  • Peter Taliente
  • Guido Vergnano
Article

Abstract

Introduction

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.

Methods

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.

Results

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.

Conclusions

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.

Notes

Acknowledgments

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.

References

  1. 1.
    Meo G, Qasim S. Surgery under Adverse Conditions in South Sudan. German Society for Tropical Surgery, Second International Meeting, Munich 1997. Munich, GSTS, 1997Google Scholar
  2. 2.
    Makender E, Qasim S, Meo G. Surgery and community participation in a community-based programme in war situations. Trop Doc 2000;30:20–23Google Scholar
  3. 3.
    OlaOlorum DA, Meier DE, Tarpley L. Operative management of thyroid abnormalities in a general medical practice hospital in Sub-Saharan Africa. Trop Doc 2000;30:221–223Google Scholar
  4. 4.
    Tovey F. Thyroid surgery with limited facilities. Trop Doc 2000; 30:193Google Scholar
  5. 5.
    McConkey SJ. Case series of acute abdominal surgery in rural Sierra Leone. World J Surg 2002;26:509–513CrossRefPubMedGoogle Scholar
  6. 6.
    Diallo FB, Idi N, Vangeenderhuysen, et al. Uterine rupture at the Niamey Central Maternity Reference Center, Nigeria: epidemiologic features and prevention strategies. Dakar Med 1998;43:74–78PubMedGoogle Scholar
  7. 7.
    Ameh EA, Mbibu HN, Adams LM, et al. Role of a general surgeon in obstetrics and gynaecology in a rural setting. East Afr Med J 1998;75:27–29PubMedGoogle Scholar
  8. 8.
    Mulumba Nkata. Rupture of the uterus: review of 32 cases in a general hospital in Zambia. BMJ 1996;312:1204–1205Google Scholar
  9. 9.
    O’Leary DP, Hardwick RH, Cosford E, et al. Does hospital mortality rate reflect quality of care on a surgical unit? Ann R Coll Surg Engl 1997;79:46–48PubMedGoogle Scholar
  10. 10.
    Harouna Y, Yaya H, Abdou I, et al. Prognosis of strangulated inguinal hernia in the adult: influence of intestinal necrosis; a propos of 34 cases. Bull Soc Pathol Exot 2000;93:317–320PubMedGoogle Scholar
  11. 11.
    King M, Bewes P, Cairns J, et al. Primary Surgery, Vol 1: Non-trauma). Oxford, Oxford University Press, 1990Google Scholar
  12. 12.
    Bird K, Hulme D, Moore K, et al. Chronic Poverty and Remote Rural Areas. Chronic Poverty Research Centre (CPRC), Manchester, UK, 2002Google Scholar
  13. 13.
    Kees Waaldijk. Step-by-Step Surgery of Vesicovaginal Fistulas. Edinburgh, Campion Press, 1994Google Scholar
  14. 14.
    Bickler SW, Telfer ML, Sanno-Duanda B. Need for paediatric surgery care in an urban area of The Gambia. Trop Doc 2003;33:91–94Google Scholar
  15. 15.
    Bickler SW, Rode H. Surgical services for children in developing countries. Bull WHO 2002;80:829–835PubMedGoogle Scholar
  16. 16.
    Rennie JA. The poor cousin of medicine [editorial]. Trop Doc 1994;24:5–6Google Scholar
  17. 17.
    Bossert TJ, Larranaga O, Giedion U, et al. Decentralization and equity of resource allocation: evidence from Colombia and Chile. Bull WHO 2003;81:95–100PubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2006

Authors and Affiliations

  • Giuseppe Meo
    • 1
    • 11
  • Dario Andreone
    • 2
  • Umberto De Bonis
    • 3
  • Giorgio Cometto
    • 4
  • Stefano Enrico
    • 2
  • Guido Giustetto
    • 5
  • Alberto Kiss
    • 6
  • Marino Landra
    • 7
  • Maria Palmas
    • 8
  • Laura Sacchi
    • 9
  • Peter Taliente
    • 10
  • Guido Vergnano
    • 6
  1. 1.Comitato Collaborazione Medica (CCM) Consultant SurgeonMedical Coordinator of the program “Surgery in Remote Areas of Sudan”Italy
  2. 2.CCM Consultant Surgeon, General SurgeonS. Luigi Gonzaga HospitalOrbassanoItaly
  3. 3.CCM Consultant AnaesthetistAnaesthetist Ospedale Civile
  4. 4.CCM Regional Medical CoordinatorNairobi Office for SudanKenya
  5. 5.CCM Consultant PhysicianTutor in Family Medicine, Torino UniversityItaly
  6. 6.CCM Consultant Surgeon, General SurgeonOspedale Maggiore di ChieriItaly
  7. 7.CCM Consultant Plastic Surgeon, General SurgeonOspedale Civile Santa Croce di CuneoItaly
  8. 8.CCM Consultant Surgeon, General Surgeon (retired)Ospedale Civico di Ghilarza (Oristano)Italy
  9. 9.CCM Consultant Surgeon, General Surgeon (retired)Ospedale S. Croce di MoncalieriItaly
  10. 10.CCM Consultant Surgeon, General SurgeonOspedale Morelli di Sondalo (Sondrio)Italy
  11. 11.Comitato Collaborazione MedicaItaly

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