Emergency Surgical Care
A neglected public health issue at primary level
Many a time, surgery is the only option to save lives and prevent disabilities, especially in case of emergencies. Often surgery cannot be safely postponed to allow their transfer to a secondary or tertiary-level hospital. But the emergency surgical services is the commonly missing component of primary healthcare in Bangladesh. Most of the rural areas, patients have no access to even simpler procedure and trauma care at primary level (Upazilla health complex and union sub-centres). Experts urged to step up basic surgical care facilities to handle a large number of emergency conditions like road traffic injuries, inter-personal violence, abdominal emergencies, pregnancy complications, congenital abnormalities, fractures, burns or the consequences of acute infections at primary level to prevent unnecessary deaths and disabilities. World Health Organisation (WHO) estimates that 11 percent of the global disease burden is treatable by surgery. Improving surgical care at initial level can significantly reduce the huge death toll caused by various conditions corrected by simple but valuable surgery. Expert identified lack of basic surgical training of healthcare professionals working at upazilla health complexes, shortage of manpower especially anesthetist, inadequate supply of operating instrument and medication needed for surgery are the central barriers that constrain people to access basic surgical services. Moreover, people assume that surgery is an expensive tertiary care intervention that requires sophisticated equipment and expertise. However, a number of isolated, simple and inexpensive local initiatives have shown that even with only basic training and technologies, many lives could be saved or improved. Experts from WHO suggest that surgery should be an integral part of primary health care and a cost-effective way of dealing with many health challenges specific to resource poor settings like Bangladesh. For instance, clubfoot (a congenital deformity of the foot, marked by a twisted position of the ankle, heel and toes) is a common cause of physical disability in children. In most of the cases, clubfoot can be successfully treated by using a minimally invasive technique called the Ponseti method. Proper implementation of the Ponseti method results in a dramatic decrease in the number of clubfoot cases that require surgery. Like this, a traumatic dislocation can often be corrected by manual maneuver with adequate sedation by a trained physician. There are several simple techniques that can be readily performed by health professionals at primary level if they have been adequately trained. Again, most of the surgeons serve in urban areas and adequate surgical services are found only in tertiary centres placed in urban areas. Although there is post for consultant at Upazilla level, they most often concentrate to cities creating vacuum in proper service and care. Even though, at secondary level, some district hospitals have no specialist surgical teams, anesthetist and are staffed by medical, nursing and paramedical personnel only who perform a wide range of surgical procedures, often with inadequate training. "As a medical officer at Upazilla health complex, we have to deal with various surgical conditions those mostly arise from road traffic accidents, trauma, acute infections, gynaecological and orthopaedic emergencies. But there is no initiatives to train us to perform basic surgery that is safe and effective. Many of us have been specially trained to handle TB, HIV/AIDS and emerging diseases, but emergency surgical training is totally overlooked. This training is particularly important to perform surgical interventions in emergency situations rather than medical care that focus on prescribing medicine", said Dr M Abdullah (name disguised to protect identity) working at a Upazilla health complex. In many cases, a simple surgery can make a big difference. We need to shift the way we think about surgery as a neglected public health issue. We should step up our efforts to establish emergency and essential surgical services at primary level. It is the backbone of primary healthcare and a cost-effective way to save thousands of deaths and prevent disabilities. .......................................................... E-mail: rajibssmc@gmail.com
For all latest news, follow The Daily Star's Google News channel.
Comments