Academic journal article Bulletin of the World Health Organization

Training Medical Assistants for Surgery

Academic journal article Bulletin of the World Health Organization

Training Medical Assistants for Surgery

Article excerpt

Voir page 690 le resume en francais. En la pagina 691 figura un resumen en espanol.

Mozambique's protracted war, which ended relatively recently, created several million internally displaced persons and brought about the destruction of about half the country's schools and health units. About 70% of the population of some 17 million live in rural areas and suffer extreme poverty. The infant mortality rate is approximately 150 per 1000 live births, and life expectancy at birth is around 49 years. There are only about 400 doctors, or one per 45 000 population. The small numbers of surgeons and obstetricians/gynaecologists practise only in the main towns.

After 1975, when the country became independent, it became clear that there was an unmet need for emergency surgical care and for life-saving skills in the field of maternal care, especially in rural areas. The exodus of more than 85% of the country's doctors made it necessary to reorient the training of health staff. New careers in health care were created in laboratory and pharmaceutical services, preventive medicine and other fields. Candidates for basic health staff training were required to have attained the fourth grade in education. It was possible to proceed to middle-level training and eventually to become a doctor. Unfortunately, it was only possible to train about 15 doctors a year in the years following independence. Plans were made during the early 1980s to create tecnicos de cirugia (assistant medical officers) with surgical skills. It was decided that middle-level staff should be given the opportunity to acquire such skills in a three-year training course. Similar training programmes were initiated in anaesthesiology, ophthalmology and psychiatry, and in laboratory, X-ray and pharmaceutical services. The tecnicos de cirurgia were required to tackle surgical emergencies at district hospital level. Each district hospital covers between 50 000 and 200 000 people, and should have about 100 beds for medical, surgical, obstetric/gynaecological and paediatric services, including laboratory and X-ray services.

Training

Training programmes were started in 1984, 1987, 1994 and 1996. All entrants are required to have reached a level corresponding to that of a medical assistant with three or more years of professional experience in rural areas and preferably with some surgical experience. The dedication, behaviour and motivation of candidates for places on the programmes are considered to be particularly important. The most suitable applicants take an examination and are interviewed.

The first two years of the course are devoted to lectures and practical sessions in Maputo Central Hospital. The curriculum has been approved by the Ministry of Health and the Ministry of Education, and the lectures are delivered by specialists with several years of clinical experience. The departments involved in the theoretical and practical sessions are those of general surgery, obstetrics/gynaecology, orthopaedics and traumatology, emergency and intensive care, neurosurgery, urology, and maxillofacial and plastic surgery. All the students participate twice weekly in a 12-hour emergency service under the direct guidance of a specialist in one of these departments. Progress during the first two years is evaluated after three months and subsequently at intervals of six months, and examinations are held on material in a specially prepared textbook in the Portuguese language. The third year is a practical internship in a provincial hospital under the direct supervision of a surgeon. So far 20 persons have qualified as assistant medical officers in surgery and it is hoped that there will be 46 by 1999.

Quality of care

Since 1989 three workshops have been organized in order to assess the work in rural hospitals of medical assistants trained in surgery or anaesthesiology. So far the evidence indicates that their performance has been remarkably good, given the difficult logistic conditions under which they carry out their duties. …

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