Surgical outreach program in poor rural Nigerian communities

Introduction: The majority of the world's population resides in rural areas without access to basic surgical care. Taraba State in North-Eastern Nigeria consists of rural communities where approximately 90% of the State's population resides. Methods: This was a prospective study of patients whose surgical conditions were treated during surgical outreach program in rural North-Eastern Nigeria communities between February 2008 and July 2009. Results: A total of 802 patients had 903 procedures due to the co-existence of multiple pathologies in 97 patients (12.1%). There were 506 males (63.1%) providing a male to female ratio of 1.7:1. Ages ranged between one month and 91 years (mean 35.2 +/- 18.8 SD). Hernia repair 404 (44.7%), hydrocelectomy +/- orchidectomy 133 (14.7%), lumps excision 143 (15.8%) and appendicectomy 66 (7.3%) were the most frequent procedures. The surgical conditions were frequently long in duration and huge in size. The duration of goitres ranged from 2 to 28 years (10.3 +/- 7.4) and 4 to 42 years (15 +/- 13.9) in patients with cleft lip and palate. The procedures were performed under spinal, general and local anaesthesia in 7.6%, 34.3% and 58.2% of patients, respectively. No mortality was recorded but the complications encountered included: surgical site infection 46 (5.1%), scrotal haematoma and oedema 6 (0.7%), haemorrhage 3 (0.3%) and partial wound dehiscence 3 (0.3%). Conclusion: Surgical pathologies in rural communities are often multiple, wide ranging and of long duration. Such conditions can be successfully managed under local or spinal anaesthesia. Based on the authors' experience, a remarkable reduction in surgical disease burden is feasible in these communities using available, simple but effective options.