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Bringing Surgery to Rural Children: Chittagong, Bangladesh Experience

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Abstract

There is unequal access to surgical health care in underdeveloped countries such as Bangladesh. Bangladesh has a large young population, with 70 % of the population living in rural areas. All of the pediatric surgical services of the country are situated in major cities. We therefore organized an outreach service with the aim of providing surgical services to these rural children by utilizing the existing facilities of primary and secondary care centers. The program originated at the Department of Pediatric Surgery, Chittagong Medical College and Hospital in Sept 2008. The data presented here are from its 2008 beginning to Nov 2011. A yearly plan is sent to the Divisional Director of Health Services for Chittagong Division, who notifies all of the concerned district hospitals (DHs) and Upazila Health Complexes (UHCs). A member of the outreach team contacts each center via telephone 1 month prior to the visit to help organize it. Doctors at each participating hospital in which day surgery is possible are informed as to which commonly performed day surgeries are available, and they then select the appropriate patients to be examined at that visit. The local doctors are also advised to choose other pediatric surgical patients as outpatients. The local doctors perform the follow-up. If necessary, patients are referred to our department for further management. During the study period, we made 32 visits to 5 DHs and 10 UHCs. In all, 674 children were seen as outpatients, and 407 underwent surgery, of which inguinal hernia repair was the most common. There were no deaths. Outreach service is a good way to extend curative care to the grass-roots population.

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Authors and Affiliations

  1. Department of Pediatric Surgery, Chittagong Medical College and Hospital, 1 KB Fazlul Kader Road, Chittagong, 4000, Bangladesh

    Tahmina Banu, Tanvir K. Chowdhury, Mahfuzul Kabir & Rupam Talukder

  2. Department of Paediatric Surgery, Oxford Children’s Hospital and University of Oxford, Oxford, UK

    Kokila Lakhoo

Authors
  1. Tahmina Banu
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  2. Tanvir K. Chowdhury
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  3. Mahfuzul Kabir
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  4. Rupam Talukder
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  5. Kokila Lakhoo
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Corresponding author

Correspondence to Tahmina Banu.

Appendix 1

Appendix 1

Guidelines for selecting patients for outreach service

  1. 1.

    Patients in whom day surgery can be done (e.g., inguinal hernia, undescended testis, distal hypospadias, angular dermoid, lipoma, tongue-tied)

  2. 2.

    Patients who do not require preoperative investigations (e.g., no complaints of respiratory distress, convulsion, bleeding manifestations)

  3. 3.

    Patients who are clinically fit for anesthesia (e.g., no anemia, normal chest examination, no urinary complaints)

  4. 4.

    Patients who do not require extensive postoperative monitoring

  5. 5.

    Patients whose guardians have provided informed consent for an operation

  6. 6.

    Patients who seek pediatric surgical consultations

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Banu, T., Chowdhury, T.K., Kabir, M. et al. Bringing Surgery to Rural Children: Chittagong, Bangladesh Experience. World J Surg 37, 730–736 (2013). https://doi.org/10.1007/s00268-013-1916-x

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  • DOI: https://doi.org/10.1007/s00268-013-1916-x

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