M. M. Shah1, M. Azhar1, Z. N. Rifat1, S. Khan1 1Aga Khan University, Karachi, Sindh, Pakistan
Introduction: Pakistan faces a crisis of maldistribution of surgical workforce, forcing patient in rural areas to travel to urban areas to seek care. Rural healthcare facilities often lack the availability, or combined presence of surgical, obstetric or anesthesia specialists. This issue has been amplified by the structure of modern-day general surgery training programs, which do not train in obstetric care. Exposure to orthopedics, pediatric surgery, and neurosurgery is during early training, where emphasis is on understanding disease pathology rather than acquiring procedural competency. We feel that a training program that targets essential emergency procedures across disciplines is a potential solution to address access to surgical care in resource-constrained settings.
Methods: We designed and implemented a unique, year-long Rural Surgery Leadership Program (RSLP) to develop a surgeon who is competent in defined emergency surgical procedures and skilled to enhance systems for surgical service delivery in resource-limited environments. The program enrolls qualified general surgeons and trains them in emergency obstetric and anesthesia interventions and basic radiologic screening. Trainees spend 4 initial months in urban Pakistan. Trainees are then placed in secondary care facilities in resource-constrained settings, under supervision. A 2-month supervised, clinical elective is undertaken in a rural hospital. The leadership component of the program requires trainees to complete two graduate courses in health leadership and a 2-month leadership elective. The RSLP targets Sustainable Development Goals 3.1, 3.4 and 3.6 (reducing maternal and premature mortality and mortality from traumatic injury) and provides protection against financial hardship, SDG 3.8.
Results: The program’s inaugural year (2022) inducted one general surgeon, who undertook the first half of the training in Karachi- a urban city. The trainee rotated among two secondary care facilities and two teaching hospitals, learning obstetric and anesthesia care and basic radiological intervention. Rural training was carried out in Gilgit-Baltistan, a mountainous region where access to timely, quality surgery is limited. As part of the leadership training, the candidate took graduate courses in organizational management and strategic planning. The trainee also successfully completed a clinical elective at a private, rural clinic in Chachro, a remote town on the border of the Thar desert. The trainee carried out a leadership elective with the hospital management in Gilgit-Baltistan.
Conclusion: Upon completing of the program, the resultant “rural” surgeon-leader from our inaugural year can improve accessibility to surgical care in resource-constrained settings. The trainee has since secured full-time employment in Gilgit-Baltistan. This cadre of medical professionals can assist in capacity building of other healthcare personnel and be a catalyst for meaningful change in surgical care.