Our study shows that PAACS general surgery training program has a high retention rate of African surgeons in rural settings compared to all programs reported to date, highlighting a multifaceted, rural-focused approach that could be emulated by surgical training programs worldwide.

keywords HINARI, medical informatics, health information technologyIn 2004, The Lancet asked: 'Can we achieve health information for all by 2015? ' (Godlee et al. 2004). Nearly 10 years later, we continue to see a lack of reliable relevant information hinder the provision of health care in resource-poor countries. The healthcare information gap often feels more like a chasm than a gap, and thus, many individuals in resource-poor countries die because healthcare professionals lack access to quality information. However, we must also celebrate the great achievements that have been made in reducing the information gap since 2004. Godlee et al. (2004) acknowledged that 'clinicians may still generally prefer paper, but among currently available technologies only the internet has the potential to deliver universal access to up-to-date health-care information.' One of the key successes has been the development of the WHO's HINARI programme, which enables practitioners in low-resources settings to access to up-to-date information online. It provides access to many journals and e-books covering a wide range of current topics, including tropical medicine, epidemiology and public health. Tropical Medicine and International Health, for example, is freely available to professionals and students, in resource-poor countries, through the HINARI programme (WHO 2013). HINARI is available for free in 71 countries, with an additional 45 countries receiving a reduced cost subscription. At the time of writing, 12 700 medical journals and nearly 25 000 e-books are available through HINARI. This compares to only 1500 journals that were available through HINARI in 2002.It is well documented that 'journals are one of the least useful information sources for health professionals in practice' (Godlee et al. 2004). Thus, in 2010, we addressed one particular issue regarding information relevancy and its usability by asking the question 'Is HINARI appropriate for medical students in the developing world? ' (Van Essen et al. 2012). In our study, we found that in 2010, there were 447 e-books and 7961 journals available on HINARI. Only 6 of 31 subjects in a standard medical school curriculum would have e-books appropriate for the syllabus on HINARI. Since 2010, the number of e-books available on HINARI has increased significantly from 447 to over 25 000. This means that nearly every major subject in a medical school curriculum is now covered by e-books freely available on HINARI. This can certainly be celebrated as one step closer to health information for all.As we seek to further achieve health information for all, it is important to ask how this resource and others like it can be better used. What are the new barriers that have arisen? It is widely agreed that it is better if professionals 'pull' information through resources, such as HINARI, rather than have it 'pushed' in their direction.One issue that has arisen is the need for evidence-based practice. Health professionals/students may feel overwhelmed by the volume of information availabl...

The Health InterNetwork Access to Research Initiative (HINARI), which arose in response to medical literature needs in developing countries, gives online access to scientific information to a variety of institutions throughout the world. This is a great resource; however, little research has been performed on the effectiveness and usefulness of HINARI, specifically to medical schools. Our study sought to find out whether the textbooks (e-books) available on HINARI could form a virtual library that would cover the curriculum of a medical school. After categorising and reviewing the medically relevant e-books on HINARI, we found that they were insufficient in providing adequate subject material relevant to medical school curricula from Rwanda, the United Kingdom and the United States. This literature gap could be closed by additional medical textbooks being made available from contributing publishers. An increase of only 14% in HINARI e-book resources would provide material for the entire medical school curriculum.

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Inguinal ultrasound (US) has a high sensitivity and specificity for the diagnosis of inguinal hernias but is often performed unnecessarily, adding cost and time to treatment. The aim of our study was to assess the rate and necessity of US before clinical examination by a hernia surgeon. Medical records of patients referred for an inguinal hernia from April through July 2017 were reviewed. These cases were analyzed for patient demographics, physical examination (PE) findings, previsit imaging, health-care system of surgeon, and case outcome. Twenty-nine per cent of patients had an inguinal US before visiting a surgeon. Sixty-three per cent of patients who underwent an US had a palpable hernia on PE, and 76 per cent had a positive PE by the surgeon. Patients without a hernia on referring provider's PE underwent US 59 per cent of the time. Inguinal USs are being ordered unnecessarily by referring providers. Physical examination by referring providers and surgeons should be the primary tool for diagnosis of an inguinal hernia.