 |
| About Bioline | All Journals | Testimonials | Membership | News |
|
||||||
|
||||||
Indian Journal of Surgery, Vol. 65, No. 1, Jan.-Feb. 2003, pp. 22-23 Editorial Rural Surgery R. D. Prabhu Shree Dutta Hospital, Tilaknagar, Shimoga-577 201, Email: rdprabhu@sarcharnet.in Code Number: is03003 Misconceptions about the surgeons in rural India, generally called rural surgeons, are many. An ASI governing council member once asked me where my bullock cart was! A delegate in the ARSICON-2001 at Patna, reportedly a professor of surgery, is supposed to have expressed that the rural surgeons must restrict themselves to performing hernia and hydrocele surgeries. These are just two examples of the misconceptions that prevail in the minds of our teachers and professional leaders. Rural surgeons do own cars and there are rural surgeons who perform oesophageal operations and the abdominal part of A.P.resection with a laparoscope. It is said that "so long as the lions do not have their own historians, so long will the hunter emerge as heroic, mighty and right". 1 There are extremely capable rural surgeons as well. This issue of IJS may help to dispel some misconceptions about rural surgeons. The IJS needs to be praised for its special issue on rural surgery because it gives recognition, long overdue, to the surgeons in rural India. Another misconception is that rural surgery is second grade surgery. Surgery must ultimately be judged by the quality of the surgical skills and the circumstances in which the skills are used. Here it would be a mistake to use western standards as a tool of judgement and it would be more appropriate that we develop our own standards. The surgery that is appropriate for our people is the best surgery for us. A surgeon repeatedly performing a particular procedure is likely to be far more adept in it than one who performs the same procedure occasionally. The difference may only be that between a good and a better surgery and it may not be significant when compared to the advantages of low-cost treatment offered close to the patient's home. All surgeons in India come from the same stock. William Jones, a philosopher had once said, "there is very little difference between men, but the little difference there is makes all the difference." Whatever small differences there are between rural surgeons and others therefore make all the important difference. A common argument concerns the definition of rural surgery. Our concept of rural surgery may be defined as a multi-speciality surgery (true general surgery) performed under (severe) constraints. This conveys the spirit of rural surgery even if it does not define the precise meaning. With primary care, rural surgery involves secondary surgical care too. It is said that for every 1000 primary care patients, 50-100 need secondary care, about 5-10 tertiary care and 1 quaternary care2. So a rural place cannot sustain a rural surgeon; he has to be in communities with larger populations. Dr. T.E.Udwadia, in his presidential address during the golden jubilee conference of ASI in 1988, in Delhi had expressed that " …the committee on rural surgery..… will soon be detailing what Indian surgeons need to be taught….the education of surgeons should not be left to the whims, fancies and foibles of politicians or bureaucrats, be they in the Senate of Universities, in the Medical Councils or in the Government, so that ultimately the training of surgeons will be dictated by those who truly practise the art of surgery". His prediction appears to be so correct. Indira Gandhi National Open University (IGNOU) has launched a certificate course for practising and aspiring rural surgeons. The course is developed by rural surgeons with the help of open-minded professors of different branches of surgery. Dr. Jena has discussed more about this in his article-"Distant education, a training tool for rural surgeons". This training is aimed to fill the gap between the current training of a surgeon and what is required of a surgeon in rural India. The state governments, I am told, are reducing the number of admissions in government nursing schools; their arguments are that government hospitals do not need any more nurses. If private hospitals need nurses they must train them themselves! The private nursing schools are like private medical colleges; students pay hefty donations and high tuition fee. Nurses that pass out from these take lucrative positions at hospitals abroad. Rural surgeons' needs therefore, remain unfulfilled and they in turn have to train their own nurses and technicians. Dr. Shipra Banerjee has given some extremely nice tips on this in her article- "Human resource development in rural surgery-developing the paramedic training programme". There is always a controversy whether state-of-the-art technology is suitable for rural surgeons. Each new technology attracts a surgeon (practitioner) because it is: A-a truly better method of treatment, Each user himself knows which of these reasons lead him to choose a particular technology in his practice. Dr. Ramakrishna makes a case for taking high-tech surgery to rural patients. An ailment may be amenable to many different forms of treatment. The costliest mode of treatment may not always be the appropriate treatment for a particular patient; Rolls Royce, the best car, is not a car for the common man. Similarly, the economics of treatment plays an important role in India while selecting the form of treatment. One urologist used to say a decade ago, that a well-to-do patient chooses shock-wave-lithotripsy, a middle-class patient the per-cutaneous nephro-lithotomy and the poor go for formal nephrolithotomy. If evidence-based medicine is the correct way to practise, the older forms of treatment are still relevant and make treatments affordable. Dr. Sitanath De discusses this point very well in his article on Chole-docho-duodenostomy. Similarly, Dr. Dakshinamoorthy presents how he manages patients with Necrotising Enteritis in his rural practice. Dr.Tongaonkar and others show how an ordinary mosquito net can be used for hernia repairs. Many people innovate procedures and equipment to simplify and reduce the cost. Most of them remain unknown to others. Dr. K.C. Sharma lists some of the innovations. They are meant to stimulate the readers so that they can apply themselves to put on the 'thinking cap' and to question, if a particular procedure or equipment could be improved, simplified or even made more economical. Obstetrics had no place in the IJS. But a large number of surgeons in rural India manage obstetric emergencies like obstructed labour, ruptured ectopic pregnancy, bleeding, septic abortion with its complications, in the absence of an obstetrician in their area. Every attempt has to be made to see that whatever they do as general surgeons is done, as far as possible, in a manner acceptable to modern scientific practices. Therefore, we have included an instructional article "Rural Surgeons and Obstetric Emergencies" by Dr S.K. Basu. There must be many more surgeons in rural India who could have contributed papers on their experiences and innovations for this issue of IJS. But I do not know who they are or where they practise. Many of them may not even be members of ASI. I hope that this issue of IJS on rural surgery may motivate them all to apply for membership; so that hopefully we may get to learn more of and from them. REFERENCES
Copyright 2003 - Indian Journal of Surgery. Also available online at http://www.indianjsurg.com |
| |||||||||
