Bringing Surgery to Rural Children: Chittagong, Bangladesh Experience

Abstract

There is unequal access to surgical health care in underdeveloped countries such as Bangladesh. Bangladesh has a large young population, with 70 % of the population living in rural areas. All of the pediatric surgical services of the country are situated in major cities. We therefore organized an outreach service with the aim of providing surgical services to these rural children by utilizing the existing facilities of primary and secondary care centers. The program originated at the Department of Pediatric Surgery, Chittagong Medical College and Hospital in Sept 2008. The data presented here are from its 2008 beginning to Nov 2011. A yearly plan is sent to the Divisional Director of Health Services for Chittagong Division, who notifies all of the concerned district hospitals (DHs) and Upazila Health Complexes (UHCs). A member of the outreach team contacts each center via telephone 1 month prior to the visit to help organize it. Doctors at each participating hospital in which day surgery is possible are informed as to which commonly performed day surgeries are available, and they then select the appropriate patients to be examined at that visit. The local doctors are also advised to choose other pediatric surgical patients as outpatients. The local doctors perform the follow-up. If necessary, patients are referred to our department for further management. During the study period, we made 32 visits to 5 DHs and 10 UHCs. In all, 674 children were seen as outpatients, and 407 underwent surgery, of which inguinal hernia repair was the most common. There were no deaths. Outreach service is a good way to extend curative care to the grass-roots population.

Reasons why specialist doctors undertake rural outreach services: an Australian cross-sectional study

“…However, developing and developed countries [1–7] alike face significant challenges ensuring adequate access to specialist medical care in rural areas, where it is most needed. One of the causes of maldistribution of specialist services is that they are often not viable in rural communities on a full-time basis.…”

“…Yet access to local specialists is important to contribute to the management of more complex and severe illnesses in rural areas, mitigating out-of-community referral and can improve continuity of care [8]. Various service models are used around the globe to increase access to local specialists, including outreach or visiting consultant models, where specialists travel away from their main practice to provide regular services in a rural location [1, 9–11]. …”

Evaluation of the medium‐term outcomes and impact of the Rowan Nicks Scholarship Programme

“…The evidence to support this comes not only from the scholarship reports and survey but also from publications in the medical literature. The best documented of these are improved trauma management systems in India, development of paediatric surgery in rural Bangladesh, cardiac surgery outcomes in Myanmar (Table ) and better head injury outcomes in Papua New Guinea . We believe that the impact of the programme has been a reduced burden of surgical disease in the scholar's country, this burden being measured in terms of less death, disability or deformity.…”

Health and Disease among Primary School Children: A Snapshot from Rural Bangladesh

“…School performance reports, pre-visit questionnaires and psychosocial screening questionnaires may be useful [7]. There have been scattered efforts to improve the health conditions of the school aged children in the country [37]. But for more effective and sustainable results, school health programs run by the government need to be expanded to address these issues [38].…”