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Surgical Care in Developing Countries- The Limitations of Volunteerism
Michael Curci
Maine Medical Center, Portland, ME

Background: In 2008, a project in Western Tanzania was undertaken to develop an infrastructure to meet the needs of the rural population using non-physician clinicians known as Assistant Medical Officers who have 5 years of training after high school.
Methods: The project was designed to provide comprehensive emergency obstetrical care including the ability to perform emergency C-sections. In each center, infrastructure was expanded to provide an operating room, a maternity ward, a laboratory with a blood bank and transport capability. An educational program for Assistant Medical Officers, supervised by 2 MD non-Tanzanian surgeons, included a 3-month course in advanced obstetrical care as well as basic surgical care. Nurse midwives also received a 3-month course in spinal and general anesthesia. After training, each participant completed a 1 month internship and then returned to a regional health center with a contractual commitment to practice for a minimum of 2 years.
Results: At a 2-year follow-up, the graduate trainees are performing C-sections and basic general surgical procedures with morbidity and mortality rates comparable to those in the district/regional hospitals. This has reduced referrals over long distances and has decreased maternal complications as well as providing improved health care.
Conclusions. In this unique model in Tanzania, non-physician clinicians provide the majority of care in rural settings and a directed educational program has allowed them to expand their role to meet the population's surgical needs. This system, developed by non-Tanzanian volunteer physicians supercedes the usual limitations of surgical volunteerism which although well-intentioned, often focuses on short term sophisticated Western interventions in urban settings and may have limited application to the larger population in need.

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Abstract Submission Deadline:
May 5, 2014

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August 13, 2014

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August 11, 2014
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