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Rural surgery

Posted by: Philip Alex | Posted on: February 17th, 2019 | 0 Comments

Ms. X was a young lady who presented to us with altered sensorium after a fall.  She was arousable but not responding  relevantly and there was a difference between the size of her pupils. A ct showed a huge extradural hematoma pushing the midline across to the other side. This is a life threatening condition and needs immediate surgical attention. 

Today in any city she would be referred to a neurosurgical centre. The centres in most cities are in large tertiary hospitals, mostly corporate in nature. Government facilities that handle cases of this nature are in capital cities. Most district hospitals will refer to state capitals. This will invariably mean further travel, time , and money, all scarce resources that further jeopardise the chances of survival. 

What does a doctor in a rural hospital confronted with this situation do? 

The breadth of the art and science of basic surgical training has departed from the curriculum of the general surgeon today, abdicated to the genre of specialist surgeons. Not that the specialist surgeons do not have elective rights over such surgeries, but I enter my plea that general surgeons also need to be equipped with skills and science to handle such situations on emergent grounds. 

We were able to evacuate this hematoma. There was a sagittal sinus bleed which was controlled with difficulty. The lady left us with no residual deficit. While I write this, I testify to what I call the “G factor”, which operates in situations where we have no one else to turn to. In my fifteen years of work in this place, I testify to the healing that comes from God. This operant factor may get displaced into the wings by “advancement” and technology, but in their  absence occupies centrestage. 

What does rural India need to handle such emergencies? Referral is an abdication and a wilful death sentence inscribed with every stroke. I am not a neurosurgeon, but I was trained at Christian Medical College Ludhiana to handle such emergencies. Are our young surgeons of today being similarly equipped or denied the skill under the guise of a sacrosanct speciality? 

What do we do as faculty to equip our surgeons for the rural patients of tomorrow? 


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