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BACKGROUND: Saudi Arabia is currently passing through a transformational phase. There is a huge demand on the Saudi healthcare system to provide better healthcare facilities to the rapidly increasing Saudi population, as well as the growing elderly population. Lack of trained healthcare professionals and heavy reliance on foreign workers are significant aspects for policymakers to consider and deal with. It is also important to re-examine the healthcare Human Resource Development (HRD) initiatives so as to provide a huge reserve of healthcare professionals with appropriate learning and competence. METHOD: This paper is a critical review based on secondary data collected from various sources including databases, reports, articles, books, government documents and earlier research undertaken in this regard. The paper is an attempt to document and evaluate the various steps suggested and undertaken by the new strategic plan, Vision 2030, and consequently documented in the National Transformation Program (NTP) adopted in April 2016 in the healthcare HRD sphere in Saudi Arabia. RESULTS: It has been shown that appropriate HRD capacity building needs to be adopted along with the aggressive policy regulation. It is also important to ensure that future health sector investment meets the needs of local healthcare HRD. Saudization and the adoption of the 'Nitaqat' program have played an effective role in pushing the Saudization targets in the private sector, and there is a huge scope for the absorption of young trained Saudi boys and girls in the healthcare sector. CONCLUSION: Vision 2030 adopted in 2016 is a testimony to a revolutionary step undertaken by the government and that the healthcare sector is also passing through a major shift in its approach and execution. Vision 2030 has come out with a very clear sense of direction to the healthcare sector, and the projected shift from the existing one-third to two-third Saudi-to-foreigner workforce ratio by the year 2030 needs to be adopted carefully to turn the healthcare HRD challenges into opportunities.
RESUMO
INTRODUCTION: Situs inversus is a rare autosomal recessive condition associated with complete transposition of abdominal+/- thoracic organs. Surgical diagnosis and surgical procedures in patients with situs inversus is tricky because of the mirror image anatomy of intra-abdominal organs. MATERIALS AND METHODS: A retrospective analysis of 2152 and 1497 patients who underwent laparoscopic cholecystectomy and open peptic perforation repair respectively from June 2014-June 2016 was done. 1 patient and 3 patients with situs inversus underwent open peptic perforation repair and laparoscopic cholecystectomy respectively. A 10mm left para-median port 5cm caudally from xiphoid was used for grasping the infundibulum. Two 5mm ports placed 10cm caudally from costal margin in the mid-clavicular and anterior axillary line were used for dissecting and retracting fundus respectively. A 10mm supra-umbilical camera port was used. RESULTS: A 40year male with situs inversus totalis underwent open peptic perforation repair. Laparoscopic cholecystectomy was done in 3 female patients with situs inversus aged 33-46year (mean 41year). Mean operative time for laparoscopic cholecystectomy was 59min (39-93). There were no intraoperative or post-operative complications. Histopathology revealed chronic inflammation in peptic perforation and cholecystitis. CONCLUSION: Perforation peritonitis in situs inversus can cause diagnostic confusion with free gas under the left hemi diaphragm. Laparoscopic cholecystectomy in situs inversus is ergonomically inconvenient and technically difficult for right handed surgeons. We describe an ergonomically convenient port placement for right handed surgeons in situs inversus.
