Impact of rural medical care in remote mountainous region of Pakistan: challenges and opportunities

ABSTRACT

To share the experience of developing rural medical care and the impact on the health indicators of the population. The clinical data was collected prospectively using ICD-9 coding and data base was developed on a desk top computer. Information about the operative procedures and outcome were separately collected on a excel work sheet. The data from January 1998 to December 2001 were retrieved and descriptive analysis was done on epi info-6. Thirty one thousand seven hundred eighty two [31,782] patients were seen during this period, 53% were medical, 24% surgical, 16% obstetric and 7% with psychiatric illness. Out of 1990 surgical operations 32% were general surgery, 31% orthopedic, 21% pediatric, 12% obstetric and 4% urological cases. There were 21 surgical mortality including 6 operative deaths, 15 non operative deaths and 89% of the mortalities were unavoidable. The crude in hospital mortality decreased significantly from 5.5% in 1992 to 1.1% in 2001 and the contributing factors were improved structure and process of care. The impact of secondary care rural medical centre [AKMC] is obvious from the clinical audit including accessibility, sustainability and quality of care. This could be a model of care in rural Pakistan where accessibility, affordability and quality of care is lacking