Dr. Prasad, Pratap Narayan, Dr. Thakur, Rama Shanker, Dr. Aacharya, Ramesh Prasad
Background:
Nepal is one of the least developed country in the world. One-third of land
is covered by high mountains including the highest peak Mount Everest. Ninety
percent of the total population live in villages with varied geographical terrain.
The doctor population ratio is 1:21,000. Most of the doctors are concentrated
in the city. The existing 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 centres. GPs are effectively
providing surgical services at district hospitals.
Aim:
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 GP specialist as a surgeon at
district, zonal and regional hospitals in developing countries.
Significance of the work:
To establish the role of GP as an emergency surgeon in urban area of developing
countries.
Method:
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 GP. The surgical services provided by GP
specialist at the district hospital were analyzed.
Result:
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 number of surgical
cases were 1,205(51.8%). Out of this, 514(42.7%) cases were gone under surgery.
The general surgery cases comprise 447(87.0%), Obstetric and Orthopaedic cases
67(13.0%). All surgeries were performed in limited resources by GP.
Conclusion:
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).