Where are general surgeons located in South Africa?

Background:Human resources are the backbone of health-care delivery systems and the lack of surgical workforce in developing countries is often the greatest challenge to providing surgical care. The workforce availability and composition is an important indicator of the strength of the health system. This study aimed to analyse the distribution of general surgeons within South Africa. Methods: A descriptive analysis of the general surgical workforce in South Africa was performed. The total number of specialist and non-specialist general surgeons working in the public sector in South Africa was documented between the periods from the 1 October 2014 until 31 December 2014. Results: There were significant disparities in the number and distribution of general surgeons in South Africa. There were 1.78 specialist general surgeons per 100 000, of which 0.69 per 100 000 specialist general surgeons were working in the public sector. There were 2.90 non-specialist general surgeons per 100 000. There were 6 specialist general surgeons per 100 000 insured population working in the private sector, which is comparable with the United States (US). Urban provinces such as Gauteng, the Western Cape and KwaZulu-Natal had the largest number of specialist general surgeons per 100 000. These areas had the largest number of medical aid beneficiaries and nearly 60% of specialist general surgeons were estimated to work exclusively in the private sector. Conclusion: There was a major shortage of surgical providers in South Africa, and in particular the public sector

Surgical resources in South Africa: an analysis of the inequalities between the public and private sector

Background:The full extent of the global burden of surgical disease is largely unknown, however, the scope of the problem is thought to be large. Despite the substantial burden of surgical disease, surgical services are inaccessible to many of those who need them most. There are disparities between public and private sectors in South Africa, which compound inequitable access to surgical care. This study forms part of a series analysing surgical resources in South Africa. Methods:This study involved a descriptive analysis of surgical resources and included the total number of hospitals, of hospital beds, the number of surgical beds, the number of general surgeons (specialist and non-specialist), and the number of functional operating theatres in South Africa. A comparison was performed between the public and private sectors. Hospitals were contacted during the period from 1 October 2014 until 31 December 2014.Results: Surgical resources were concentrated in metropolitan areas of urban provinces. There were striking differences between the public and private sectors, where private resources were comparable to those available in high income countries (HICs).Conclusion: Improving access to surgical services in lower middle income countries (LMICs) requires addressing gaps between the public and private sector regarding infrastructure, personnel, as well as equipment. These data identified disparities between geographic regions which may be contributing to ongoing inequity in South Africa, and by doing so allows for evidence-based planning towards improving surgical infrastructure and workforce

Surgical resources in South Africa: a review of the number of functional operating theatres

Background:Surgery has previously been neglected as a development initiative, despite the obvious effect of surgical illnesses on morbidity and mortality. Recently, greater attention has been given to surgical services, as there is growing evidence of cost-effectiveness of surgical interventions. Operating theatre numbers have been used as a measure of surgical capacity, despite there being limitations associated with this use of this metric. This study aims to analyse part of the surgical resources in South Africa. Methods: A descriptive analysis of surgical infrastructure in all nine provinces was performed. The total number of functional operating theatres was documented for all public and private hospitals in South Africa. Hospitals were contacted during the period from 1 October 2014 until 31 December 2014.Results:The results showed 3.59 operating theatres per 100 000 population. This fell below the global average of 6.2 operating theatres per 100 000 as well as other developed countries. Theatres were concentrated in metropolitan areas, and there were a greater number of private operating theatres per insured population than in the uninsured public sector. Conclusion: Strengthening surgical systems will reduce the surgical burden of disease and improve health outcomes globally. Little is known about the available surgical resources such as operating theatre density, although using this metric to evaluate surgical capacity has its limitations

Registrar working hours in Cape Town

The number of hours worked by general surgical registrars in Europe and the USA has been reduced so as to reduce fatigue and the possibility of errors. The impact of these restrictions on surgical training remains unresolved. To date there are no officially reported data on the number of hours worked by registrars in South Africa. The aim of this study was to document the hours worked by registrars in general surgery in Cape Town. Thirty-three general surgical registrars at the University of Cape Town were asked to complete a time sheet over a 2-week period; indicating hours spent in hospital as part of a normal working day; hours spent in hospital outside of a normal day; hours at home on 'cold call' and hours off duty. Of the 33 registrars; 25 completed the time sheet. Registrars at Groote Schuur Hospital worked an average of 105 hours per week (68 hours in hospital and 37 hours on call at home). Registrars at New Somerset Hospital worked 79 hours per week (70 hours on site); while registrars at Red Cross Children's Hospital; G. F. Jooste Hospital and the Trauma Unit worked 60 - 69 hours per week. In the Surgical Intensive Care Unit (SICU) registrars worked 75 hours per week. In conclusion; general surgical registrars at the University of Cape Town work hours in excess of European and American work-hour restrictions

Restoration of liver mass after partial hepatectomy - implications for living donor liver transplantation

Abstract In living donor liver transplantation; the recipient liver undergoes more rapid regeneration than the remnant liver in the donor. In this study we investigated the factors which may be responsible for the difference in the regenerative response between the donor and the recipient. Long Evans rats were subjected to either partial hepatectomy (PH) or sham operation (SH) and were treated with liver cytosol (C) and cyclosporine (Cy). The rats were sacrificed at 24; 48; 72 and 96 hours and 1 and 2 weeks postoperatively. The livers were removed to determine the liver weight/body weight (LW / BW) ratio and the mitotic index. The mitotic index; serum aspartate transferase (AST) and serum alanine transferase (ALT); although unchanged in the SH groups; were increased in the rats treated with PH + C + Cy; and were greater than after PH only. However LW / BW ratios increased after PH but had returned to preoperative levels by 2 weeks. The changes in LW / BW ratio were not modified by the cytosol or cyclosporine

Registrar working hours in Cape Town : general surgery

The number of hours worked by general surgical registrars in Europe and the USA has been reduced so as to reduce fatigue and the possibility of errors. The impact of these restrictions on surgical training remains unresolved. To date there are no officially reported data on the number of hours worked by registrars in South Africa. The aim of this study was to document the hours worked by registrars in general surgery in Cape Town. Thirty-three general surgical registrars at the University of Cape Town were asked to complete a time sheet over a 2-week period; indicating hours spent in hospital as part of a normal working day; hours spent in hospital outside of a normal day; hours at home on 'cold call' and hours off duty. Of the 33 registrars; 25 completed the time sheet. Registrars at Groote Schuur Hospital worked an average of 105 hours per week (68 hours in hospital and 37 hours on call at home). Registrars at New Somerset Hospital worked 79 hours per week (70 hours on site); while registrars at Red Cross Children's Hospital; G. F. Jooste Hospital and the Trauma Unit worked 60 - 69 hours per week. In the Surgical Intensive Care Unit (SICU) registrars worked 75 hours per week. In conclusion; general surgical registrars at the University of Cape Town work hours in excess of European and American work-hour restrictions

Hypoalbuminaemia in brain-dead donors for liver transplantation: transplantation

Liver transplantation has become established as the treatment of choice for most patients with end-stage liver disease and is performed on a routine basis in most major centres throughout the world. The majority of donors for liver transplantation are brain-dead cadaver donors following either a severe head injury or a massive intracranial haemorrhage. Potential liver donors undergo a rigid screening process before being accepted. This includes a thorough clinical examination to assess the haemodynamic status of the donor and to exclude any overt evidence of liver disease. Blood samples are also taken for viral studies to exclude HIV infection and hepatitis B and C infection; and for liver function tests to exclude liver disease or liver injury. Over the years we have noted that our liver donors often had low serum albumin levels; although this has not been formally documented. A review of the literature revealed that hypoalbuminaemia associated with severe head injury has been documented previously. However the impact of brain death on serum albumin levels has not been studied previously. The present study was therefore undertaken to document serum albumin levels in brain-dead cadaver donors

Restoration of liver mass after partial hepatectomy - implications for living donor liver transplantation : transplantation

In living donor liver transplantation; the recipient liver undergoes more rapid regeneration than the remnant liver in the donor. In this study we investigated the factors which may be responsible for the difference in the regenerative response between the donor and the recipient. Long Evans rats were subjected to either partial hepatectomy (PH) or sham operation (SH) and were treated with liver cytosol (C) and cyclosporine (Cy). The rats were sacrificed at 24; 48; 72 and 96 hours and 1 and 2 weeks postoperatively. The livers were removed to determine the liver weight/body weight (LW / BW ) ratio and the mitotic index. The mitotic index; serum aspartate transferase (AST) and serum alanine transferase (ALT); although unchanged in the SH groups; were increased in the rats treated with PH + C + Cy; and were greater than after PH only. However LW / BW ratios increased after PH but had returned to preoperative levels by 2 weeks. The changes in LW / BW ratio were not modified by the cytosol or cyclosporine