Rural surgery; experience at rural and backward desert region of Pakistan

ABSTRACT

To study the pattern of Urological and Non-Urological cases and their management at rural hospital. Descriptive and case series study. All surgical patients managed at civil hospital Mithi, from 3rd June 2009 to 3rd June 2012. In this study 4657 patients were enrolled. All patients presented with symptoms suggesting surgical disease and managed as surgical cases were included in the study. These patients were either admitted via outpatient department [OPD], emergency department or operated as OPD cases. The patients who received 1st aid medication and referred to tertiary care were not included. The variables noted and analyzed were patient's demographic data, provisional and final diagnosis, disease pattern, presentation, mode of admission, mode of treatment, nature of operation, complications and final outcome. All the data was analyzed by SPSS version-16 on computer. During three year study period, 4657 patients were managed either conservatively or operated upon. Out of total, 2591[55.6%] were emergency and 2066[44.36%] were elective admissions. The male female ratio was 41 .The mean age of patients was 36.5 Years. Urinary tract diseases were responsible for 1638 [35.17%], alimentary tract diseases 1242 [26.6%], trauma 932 [20.01%], soft tissue infections 546 [26.9%], superficial lumps 367 [18.13%] admission. Most common operative procedures for urinary tract diseases 409 [20.20%], soft tissue infections 546 [26.9%]. superficial lumps 367[18.13%], alimentary tract diseases [15.06%] 305, trauma [soft tissue repair and fractures 14.9%[303], were major bulk for operations. Regarding procedures Abscesses incision and drainage in 197 [22.6%] patients, cystolithotomy in 153 [17.6%], Hernioraphy [130] 14.9%, appendecectomy 105 [12.09%], haemorrhoidectomy 51[5.8%],breast abscess 38 [4.3%] breast lump [fibroadenoma] 25 [3.6%], hydrocele23 [2.6%], Ureterolithotomy 22 [2.5%] laparotomy 15 [1.7%], pyelolithotomy12, [1.3%] fissure in ano 13, [1.4%] undecended testis 12 [1.3%] Orchidectomy11 [1.3%] and abscesses psoas, perinal, scrotal 13 [1.4%], 18 [2.07%], 12 [1.3%] respectively. The concluded that the most common cause of seeking surgical care at back ward rural Tharparker was urinary tract diseases. Presence of surgical specialist at remote and back ward region Tharparker is candle in the dark. Main reason of patient referral to tertiary care was deficient in skill medical and surgical professionals, paramedic staff and medical equipments