Quality surgical care for rural dwellers: the visiting option

Although the majority of Africans live in rural areas, the existing surgical infrastructure and expertise are concentrated in urban centres. Many rural dwellers dislike visiting urban hospitals due to poverty, ignorance, fear, distance or unpleasant city experience. Trained personnel are unwilling to work in rural areas because of poor infrastructure and lack of incentive. The best means of bringing surgical care to rural dwellers is yet to be determined. We explored the visiting surgeon option. For three days every 4-6 weeks, a general surgeon visited a rural health centre in the Maiyama Local Government area of Kebbi State, Nigeria, and operated on selected surgical cases. In total, 111 patients had 125 surgical procedures during 18 visits (January 2001-May 2003). These represented 66.7% of all surgical cases seen during the visits. There were 22 (17.6%) paediatric surgical, 90 (72%) general surgical and 13 (10.4%) obstetric and gynaecological (O&G) cases. Fourteen (11.2%) procedures were performed as emergencies. The most common operation was inguinal herniorraphy, which constituted 36% of cases. The morbidity rate was 1.6% with no operative mortality. Easily treatable but potentially fatal surgical conditions are common among poor, rural dwellers. A visiting service can offer this population sustainable, cheap, good-quality care in a friendly environment.