Surgery in the tropics

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role of surgery in public health

• primary prevention
  • circumcision - 60% protective against HIV
  • protective bilateral mastectomy for genetically susceptible women
  • protective salpingo-oophorectomy to prevent breast cancer
• secondary prevention
  • reduce disease morbidity and mortality
    • inguinal hernia
  • improve QOL
    • cosmetic surgery
• diagnostic roles
  • biopsy
  • diagnositic peritoneal lavage
• curative surgery
  • early solid tumor resection
  • appendectomy
• palliative care
  • obstructive colon cancer
  • tumor debulking
  • colostomy placement
  • draining pleural effusion in lung metastasis
• trauma care

epidemiology

• global burden of surgical diseases 11%
• 28-32% amenable to surgical care
• 2 bil. people who need surgery do not undergo surgery
• 4.8 bil. people unable to access to surgery

• common surgical operations in district hospitals (<100 beds, covers 500,000-1mil.) Uganda, Tanzania and Mozambique

1. trauma
2. obstetric emergencies
3. intra/extra abd emergencies
4. simple elective procedures

essential and emergency surgery

• injury
  • primary trauma care
  • simple soft tissue injuries - laceration
  • hemorrhage control
  • closed/open fracture care
  • craniotomy, thoracotomy, laparotomy
  • rehabilitation
• obstetric emergencies
  • obstructed labor
  • antepartum/postpartum hemorrhage
  • rupture of ectopic pregnancy
  • c-section
• intra/extra abd emergencies
  • acute abdomen
  • abscess and inra
• elective surgical procedure
  • hernia
  • hydrocele
  • superficial tumors