Surgery in rural Nigeria--problems, challenges and recommendations

A review of 1,645 major and intermediate operations performed in a 20-bed rural hospital over a period of 4 years was undertaken to highlight the problems associated with rural surgical practice. Despite such problems as lack of essential facilities, poorly trained paramedical and support staff, a commendable measure of success was achieved in terms of low rates of mortality and morbidity. This was possible through hard work, meticulous surgical technique and sound judgement. Interestingly, all the cases comprising 271 major and 1,374 intermediate operations were performed using local, regional, light general anaesthesia or combinations thereof, without the help of an anaesthetist. Our surgical training programmes should include rotations through rural surgical units, because of the particular situations involved.