Surgery in limited-resource settings, such as Papua New Guinea, often face unique challenges and misconceptions. Here are some common misconceptions about surgery in these environments.
In PNG, every doctor that trains to become a surgeon will first complete their masters and become a general surgeon. After successfully completing this training, the general surgeon can then apply to sub-specialise into different fields of surgery to become a specialist in orthopaedics, urology, neurosurgery, cardiothoracic, paediatric surgery and so forth.
Common misconceptions.
1. Lack of Skilled Personnel:
– Misconception: Limited-resource settings lack skilled surgeons and medical professionals.
– Reality: Many limited-resource settings have highly skilled and dedicated surgeons and medical personnel. However, they often face significant challenges due to inadequate support and resources. Skilled health workers such as surgeons, scrub nurses and anaesthetists are all needed to safely manage surgical patients. Despite the lack of specialist training, medical teams around the country adjust and adapt to maintain a high standard of care in their resource limited settings.
2. Inferior Quality of Care:
– Misconception: The quality of surgical care is inferior in limited-resource settings.
– Reality: While resource limitations can affect certain aspects of care, many surgical teams in these settings provide high-quality care through innovative solutions and resourcefulness. The dedication and professionalism showed in many hospitals around the country despite the lack of resources maintains a quality of surgical care that is satisfactory to many. Many people are privileged to even have a surgeon or surgical team that can perform life saving operations.
3. Inadequate Equipment and Supplies:
– Misconception: Surgical procedures cannot be performed effectively due to lack of modern equipment and supplies.
– Reality: Although there is often a shortage of modern equipment, many surgical teams successfully perform surgeries using available resources and by adapting techniques to their environment. Shortage of medical equipment is a daily occurrence in many hospitals in PNG. The increase in population and patient numbers also reduces resources and surgical care suffers. Unfortunately, some surgeries that can be done are often cancelled or patients referred to other hospitals as a result of these shortages.
4. Surgeons can do all types of operations:
– Misconception: Surgeons in every hospital can do any operation.
– Reality: Certain special or complex surgical cases can only be done by specialist surgeons in well-equipped hospitals. But the majority of operations that are needed can be performed by skilled surgeons supported by their surgical teams. Most general surgeons are only limited by their experience and training in doing a wide variety of cases so will often refer cases to other hospitals to be managed.
5. Surgery is free:
– Misconception: All operations are free.
– Reality: Free health care in PNG has reduced the burden of health care expenditure for its citizens. In most limited resource nations health care is free or subsidised. Despite this policy by governments, health care is still not free and is still expensive to sustain for many governments. Minor costs for operations are still charged by hospitals including bed fees and medications. But these costs are only a small fraction of the true cost of medical care, especially surgical care. Many people take advantage of free medical care and misuse this privilege. This has resulted in a decline in medical services and resources to meet the growing population. Private hospitals also take advantage of the public that can afford private care and often charge insane amounts of money for simple procedures that would often be free in public hospitals.
6. Only Basic Surgeries Are Possible:
– Misconception: Only basic surgical procedures can be performed in limited-resource settings.
– Reality: Complex and advanced surgeries, including orthopaedic, cardiovascular, and neurosurgeries, are performed in many limited-resource settings by skilled surgeons who adapt to the available resources. Even though specialist surgeons are limited in provincial hospitals in PNG, general surgeons can perform complex emergency surgeries to save and improve the quality of their patients’ lives.
7. Lack of Anaesthesia and Pain Management:
– Misconception: Adequate anaesthesia and pain management are not available.
– Reality: Anaesthetic care can be provided effectively even with limited resources. Anaesthetists in these settings are often well-trained in using available anaesthetics and techniques to manage pain and ensure patient comfort. Unfortunately, the level of anaesthetic care is not the same for every hospital in PNG and most hospitals cannot fully utilise their surgeons because there is no anaesthetist or lack of anaesthetic specialists to anaesthetise patients for surgery. The lack of drugs and specialised technologies such as bronchoscopes limit anaesthetic teams to provide the best care for their patients.
8. No Training and Education Opportunities:
– Misconception: There are no opportunities for surgical training and continuing education.
– Reality: Many limited-resource settings have established training programs and partnerships with international institutions to provide ongoing education and professional development for surgical teams. Most surgeons in PNG are general surgeons that are required to perform a wide variety of operations in their hospitals. Surgical training in PNG is limited with only a few hospitals providing specialty training in various fields such as orthopaedics, urology, plastic and paediatric surgery. Surgeons who wish to become specialists must move to the Capital or travel abroad to further their training. The number of specialist surgeons in the country is not enough to meet the demands of the growing population. Much more needs be done to increase the opportunities for surgeons to become specialists and improve surgical care in PNG.
9. Most operations are safe:
– Misconception: Most operations are safe and do not have complications.
– Reality: All surgical operations come with risks and the possibility of complications. In resource limited settings it can be challenging for a surgeon to prevent such problems but most are avoidable. People must understand the risks of going for any type of surgery whether minor or major as no surgery is risk free. Most surgical teams work under tough and limited settings where complications are almost unavoidable. An understanding must be made between the surgeon and the patient that undergoes a surgical procedure in limited resource settings to avoid future legal issues. If the risk is high and the patient does not agree for an operation then no surgery should be done. But if the patient understands the risks and limitations of performing operations and is fully educated on the procedure then procedures can be done with full consent.
10. Impossible to Implement New Technologies:
– Misconception: It is impossible to implement new technologies and advancements in surgery in limited-resource settings.
– Reality: New technologies can be adapted and implemented successfully. Mobile health technologies, telemedicine, and low-cost innovations are increasingly being used to improve surgical care in these environments. Diagnostic and therapeutic tools such as CT scans, endoscopes and pathology services can be implemented in our referral hospitals with the right funding. Laparoscopic surgery is another advancement in surgery that has yet to be utilised in PNG and must be introduced in every hospital to align with international standards of surgical management.
11. Patients Prefer Traditional Healers:
– Misconception: Patients in limited-resource settings prefer traditional healers over modern surgical care.
– Reality: While traditional medicine is important in many cultures, there is often a strong demand for modern surgical care. Education and community outreach programs can bridge the gap between traditional beliefs and modern medical practices. Access to modern surgical care is also a huge factor in patients choosing traditional medicine first. More than 80% of PNGs population live in rural areas where even modern medicine is hard to access let alone surgical procedures that can improve or save lives. The Geographical situation accompanied by the low socioeconomic status of the rural population lead most people to traditional medicine first. Those that are within a day’s travel to a major referral hospital and can afford it, almost always present for needed surgical help.
12. Surgery is better in Private hospitals:
– Misconception: Private hospitals provide better surgical care.
– Reality: Private hospitals are well equipped to perform a wide variety of surgical procedures that might not be available in public hospitals. With better resources, limited patient numbers and space this gives private hospitals an advantage. Despite these advantages, surgical teams in public hospitals still can provide the same care and perform the same operations in limited resource settings.
13. High Infection Rates:
– Misconception: Surgical procedures in limited-resource settings have significantly higher infection rates.
– Reality: Infection control practices can be effectively implemented even in resource-limited settings. Proper sterilisation techniques, antibiotic prophylaxis, and good surgical practices can mitigate infection risks.
14. Poor Postoperative Care:
– Misconception: Postoperative care is substandard and leads to poor outcomes.
– Reality: While postoperative care may be challenging, dedicated healthcare workers strive to provide comprehensive postoperative care through innovative practices and community support. The need for facilities such as ICUs or high dependency units to manage postoperative patients is important. Trained health workers in critical care are lacking in most hospitals that can do major surgeries and lack the capacity to manage patients safely after surgery. Despite these challenges teams use the resources and manpower at their disposal to effectively manage patients.
Leave a Reply