BACKGROUND: In low-income countries, unmet surgical needs lead to a high incidence of death. Information on the incidence and safety of current surgical care in low-income countries is limited by the paucity of data in the literature. The aim of this survey was to assess the surgical and anesthesia infrastructure in Rwanda as part of a larger study examining surgical and anesthesia capacity in low-income African countries. METHODS: A comprehensive survey tool was developed to assess the physical infrastructure of operative facilities, education and training for surgical and anesthesia providers, and equipment and medications at district-level hospitals in sub-Saharan Africa. The survey was administered at 21 district hospitals in Rwanda using convenience sampling. RESULTS: There are only nine Rwandan anesthesiologists and 17 Rwandan surgeons providing surgical care for a population of more than 10 million. The specialty-trained Rwandan surgeons and anesthesiologists are practicing almost exclusively at referral hospitals, leaving surgical care at district hospitals to the general practice physicians and nurses. All of the district hospitals reported some lack of surgical infrastructure including limited access to oxygen, anesthesia equipment and medications, monitoring equipment, and trained personnel. CONCLUSIONS: This survey provides strong evidence of the need for continued development of emergency and essential surgical services at district hospitals in Rwanda to improve health care and to comply with World Health Organization recommendations. It has identified serious deficiencies in both financial and human resources-areas where the international community can play a role.
BACKGROUND: In low-income countries, unmet surgical needs lead to a high incidence of death. Information on the incidence and safety of current surgical care in low-income countries is limited by the paucity of data in the literature. The aim of this survey was to assess the surgical and anesthesia infrastructure in Rwanda as part of a larger study examining surgical and anesthesia capacity in low-income African countries. METHODS: A comprehensive survey tool was developed to assess the physical infrastructure of operative facilities, education and training for surgical and anesthesia providers, and equipment and medications at district-level hospitals in sub-Saharan Africa. The survey was administered at 21 district hospitals in Rwanda using convenience sampling. RESULTS: There are only nine Rwandan anesthesiologists and 17 Rwandan surgeons providing surgical care for a population of more than 10 million. The specialty-trained Rwandan surgeons and anesthesiologists are practicing almost exclusively at referral hospitals, leaving surgical care at district hospitals to the general practice physicians and nurses. All of the district hospitals reported some lack of surgical infrastructure including limited access to oxygen, anesthesia equipment and medications, monitoring equipment, and trained personnel. CONCLUSIONS: This survey provides strong evidence of the need for continued development of emergency and essential surgical services at district hospitals in Rwanda to improve health care and to comply with World Health Organization recommendations. It has identified serious deficiencies in both financial and human resources-areas where the international community can play a role.
Authors: Luke M Funk; Thomas G Weiser; William R Berry; Stuart R Lipsitz; Alan F Merry; Angela C Enright; Iain H Wilson; Gerald Dziekan; Atul A Gawande Journal: Lancet Date: 2010-07-02 Impact factor: 79.321
Authors: K A Kelly McQueen; Doruk Ozgediz; Robert Riviello; Renee Y Hsia; Sudha Jayaraman; Stephen R Sullivan; John G Meara Journal: Health Hum Rights Date: 2010-06-15
Authors: Alex B Haynes; Thomas G Weiser; William R Berry; Stuart R Lipsitz; Abdel-Hadi S Breizat; E Patchen Dellinger; Teodoro Herbosa; Sudhir Joseph; Pascience L Kibatala; Marie Carmela M Lapitan; Alan F Merry; Krishna Moorthy; Richard K Reznick; Bryce Taylor; Atul A Gawande Journal: N Engl J Med Date: 2009-01-14 Impact factor: 91.245
Authors: Thomas G Weiser; Martin A Makary; Alex B Haynes; Gerald Dziekan; William R Berry; Atul A Gawande Journal: Lancet Date: 2009-09-26 Impact factor: 79.321
Authors: Robert Riviello; Doruk Ozgediz; Renee Y Hsia; Georges Azzie; Mark Newton; John Tarpley Journal: World J Surg Date: 2010-03 Impact factor: 3.352
Authors: Reinou S Groen; Thaim B Kamara; Richmond Dixon-Cole; Steven Kwon; T Peter Kingham; Adam L Kushner Journal: World J Surg Date: 2012-08 Impact factor: 3.352
Authors: Marguerite Hoyler; Samuel R G Finlayson; Craig D McClain; John G Meara; Lars Hagander Journal: World J Surg Date: 2014-02 Impact factor: 3.352
Authors: Barclay T Stewart; Robert Quansah; Adam Gyedu; James Ankomah; Peter Donkor; Charles Mock Journal: World J Surg Date: 2015-10 Impact factor: 3.352
Authors: James Ankomah; Barclay T Stewart; Victor Oppong-Nketia; Adofo Koranteng; Adam Gyedu; Robert Quansah; Peter Donkor; Francis Abantanga; Charles Mock Journal: J Pediatr Surg Date: 2015-03-26 Impact factor: 2.545
Authors: David A Spiegel; Mohit Misra; Peter Bendix; Lars Hagander; Stephen W Bickler; C Omar Saleh; Martin Ekeke-Monono; Dinah Baah-Odoom; Amber Caldwell; Beryl Irons; Sheik Amir; Robert Taylor; Maya Layne; Helena Hailu; Syed Mohammad Awais; Raymond R Price; Sarah Crockett; Monir Islam Journal: World J Surg Date: 2015-09 Impact factor: 3.352
Authors: T K Timmers; E Kortekaas; Bpc Beyer; E Huizinga; S M V Hezik van; E Twagirayezu; M Bemelman Journal: Afr Health Sci Date: 2016-09 Impact factor: 0.927