SURGERY IN RURAL NEPAL

The curriculum of the post graduate program in General Practice in Nepal is designed to develop comprehensive and effective health care as well as timely life-saving surgical services in the District Hospital. District hospitals in rural Nepal encounter many surgical emergencies. Most of the times, the patient can not afford to go to higher centers. General Practitioners (GPs) are effectively providing surgical services at district hospitals. The aim of this study is to focus the types of surgical cases that were managed by GP and establish the role and utilization of General Practice (GP) specialist as a surgeon at district, zonal and regional hospitals in developing countries. This is retrospective study of all cases at district hospital, Surkhet, (25 beds) of western part of Nepal during the period of one year (March 2000 to February 2001), that were managed by GPs. The surgical services provided by GP specialist at the district hospital were analyzed. A total of 16,975 cases were attended in the hospital during above period. Out of this, a total of 2,327(13.7%) were hospitalized. The total numbers of surgical cases were 1,205(51.8%). Out of this, 514(42.7%) cases had undergone surgery. The general surgery cases comprise 447(87.0%), Gynae / Obstetric and Orthopedic cases 67(13.0%). All surgeries were performed in limited resources by GPs. GP specialist can effectively manage the surgical cases and perform surgery at the district hospital competently. In country like Nepal, where number of surgical specialist are less and not available in majority hospitals, GPs can substitute the surgical specialist and provide emergency surgical services in urban areas (zonal and regional hospitals). Key Words: Surgery, Rural, General Practice, Nepal