Challenges and advantages of modern rural surgery: an experience of two secondary care centres of rural India

Authors

  • Arijit R. Baruah Department of Surgery, Jorhat Medical College and Hospital, Assam, India
  • Darpana Kalita Department of Radiodiagnosis, Jorhat Medical College and Hospital, Assam, India
  • Shyamanta M. Baruah Teok First Referral Unit, Jorhat, Assam, India
  • Rajib K. Baruah Titabor Sub-Divisional Civil Hospital, Jorhat, Assam, India

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20241199

Keywords:

Limitation, Superstitions, Resources, Pressure, Environment

Abstract

Background: Rural surgery refers to the practice of surgery in rural communities and geographically remote areas, facing multiple challenges like limitation of resources and manpower, poverty, multiple co-morbidities and superstitions. Assam has geographical and population diversity with more than 85 percent of rural population. This study was done to analyse the various challenges and advantages faced during surgical practice in two secondary care centres of rural Assam.

Methods: This is a retrospective study done from 228 cases which were operated in Teok First Referral Unit and Titabor Sub-Divisional Civil Hospital, both secondary care centres of rural Assam, India between July 2022 to August 2023 by a single surgeon. Inclusion criteria were all patients who were operated following written and informed consent. Patients who opted not to operate and pregnant women were excluded from the study. Data collected were placed in charts and tables and statistical analysis done using IBM statistical package for the social sciences (SPSS) statistics version 2.0.

Results: Study population has 46 percent adult male, 51 percent adult female and 3 percent children. 1.3 percent (3 patients) were operated under general anaesthesia, 14.5 under regional anaesthesia and 73.2 percent under local anaesthesia. 11 percent (25 patients) opted not to operate. Challenges were lack of manpower, lack of resources, infection control, fatigue, trust issues and socio-political pressure. Advantages are financial relief, homely environment, better diet and care, community support, avoiding unnecessary referral and better follow-up.

Conclusions: Rural surgery can be a boon to modern healthcare if available resources and manpower are properly managed and challenges are overcome.

References

The World Bank Group. India. 2019. Available at: https://data.worldbank.org/country/india. Accessed on 24 May 2023.

Singh MP, Luikham A, Synrem W. Basic Statistics of North Eastern Region 2015. Shillong: North Eastern Council Secretariat, Government of India. 2015. Available at: https://necouncil.gov.in/sites/ default/files/uploadfiles/BasicStatistic2015-min.pdf. Accessed on 24 May 2023.

Dhar S. Socio-Economic and Demographic status of Assam: A comparative analysis of Assam with India. Population (crore). 2014;31169272.

Nakayama DK, Hughes TG. Issues that face rural surgery in the United States. J Am Coll Surgeons. 2014;219(4):814-8.

Sariego J. Patterns of surgical practice in a small rural hospital. J Am Coll Surgeons. 1999;189(1):8-10.

Nealeigh MD, Kucera WB, Artino Jr AR, Bradley MJ, Meyer HS. The isolated surgeon: a scoping review. J Surg Res. 2021;264:562-71.

Shively EH, Shively SA. Threats to rural surgery. Am J Surg. 2005;190(2):200-5.

Glazebrook R, Harrison S. Obstacles and solutions to maintenance of advanced procedural skills for rural and remote medical practitioners in Australia. Rural Remote Health. 2006;6(4):502.

Heneghan SJ, Bordley IV J, Dietz PA, Gold MS, Jenkins PL, Zuckerman RJ. Comparison of urban and rural general surgeons: motivations for practice location, practice patterns, and education requirements. J Am Coll Surgeons. 2005;201(5):732-6.

Kim EK, Dutta R, Roy N, Raykar N. Rural surgery as global surgery before global surgery. BMJ Global Health. 2022;7(3):e008222.

Upadhyayula PS, Yue JK, Yang J, Birk HS, Ciacci JD. The current state of rural neurosurgical practice: an international perspective. J Neurosci Rural Pract. 2018;9(01):123-31.

Chamania S. Training and burn care in rural India. Indian J Plastic Surg. 2010;43(S 01):S216-30.

Johnson JE, Bleicher J, Blumling AN, Cain BT, Cohan JN, Savarise M, et al. The Influence of Rural Healthcare Systems and Communities on Surgery and Recovery: A Qualitative Study. J Surg Res. 2023;281:155-63.

Green C. The Rural Surgical Workforce: Current and Future Challenges. University of North Carolina at Chapel Hill. 2012. Available at: https://core.ac.uk/ works/60761982?source=1&algorithmId=15&similarToDoc=74216264&similarToDocKey=CORE&recSetID=486491a9-78c2-4e2b-af11-6875d6b101d3& position=4&recommendation_type=same_repo&otherRecs=74218656,83400785,60760615,60761982,44739500. Accessed on 24 May 2023.

Sarap MD. Strategies to Improve the Rural Surgical Workforce. Am Surgeon. 2022;88(9):2132-5.

King J, Fraher EP, Ricketts TC, Charles A, Sheldon GF, Meyer AA. Characteristics of practice among rural and urban general surgeons in North Carolina. Ann Surg. 2009;249(6):1052-60.

Shelton J, MacDowell M. The aging general surgeon of rural America. J Rural Health. 2021;37(4):762-8.

Humber N, Dickinson P. Rural patients’ experiences accessing surgery in British Columbia. Canad J Surg. 2010;53(6):373.

Georgeades C, Young SA, Nataliansyah MM, Van Arendonk KJ. Characterizing rural families’ experiences receiving pediatric surgical care: A qualitative study. J Rural Health. 2023;39(4):833-43.

Halverson AL, Johnson JK. Surgical quality and patient safety in rural settings. Surgical Patient Care: Improving Safety, Quality and Value. 2017:827-36.

Wilkinson E, Aruparayil N, Gnanaraj J, Mishra A, Bains L, Bolton W, et al. Barriers and facilitators of laparoscopic surgical training in rural north-east India: a qualitative study. IJS Global Health. 2020;3(6):e29.

Borle FR. Determinants of superficial surgical site infections in abdominal surgeries at a Rural Teaching Hospital in Central India: A prospective study. J Fam Med Prim Care. 2019;8(7):2258.

Bhatia MB, Mohan SC, Blair KJ, Boeck MA, Bhalla A, Sharma S, et al. Surgical and trauma capacity assessment in Rural Haryana, India. Ann Global Health. 2021;87(1).

Downloads

Published

2024-04-30

How to Cite

Baruah, A. R., Kalita, D., Baruah, S. M., & Baruah, R. K. (2024). Challenges and advantages of modern rural surgery: an experience of two secondary care centres of rural India. International Journal Of Community Medicine And Public Health, 11(5), 1994–1998. https://doi.org/10.18203/2394-6040.ijcmph20241199

Issue

Section

Original Research Articles