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PubMed1993

Developing district health systems in the rural Transvaal. Issues arising from the Tintswalo/Bushbuckridge experience.

District health systems are increasingly acknowledged as a foundation for national health services based on primary health care. Initial efforts to institute a demonstration district health system in the Bushbuckridge area of the eastern Transvaal are described. These include efforts to overcome the organisational and administrative fragmentation caused by homeland and provincial boundaries. Close attention needs to be given to district-level health management, the complementary roles of district and regional health authorities, working relationships and accountability among professional staff from different disciplines, involvement of the community in a district health authority and the district health system as an element of local government.

Community Health Services↗
PubMed1992

Small rural hospitals with long-term care: 1983 to 1987.

Rural hospitals were under tremendous stress in the 1980s, as evidenced by decreasing use and closures. Rural populations increased in the two proportions of people older than 65 years relative to urban areas. Rural communities had more chronically ill residents than urban areas. Population aging and hospital stress have opened an option for small rural hospitals to develop long-term care units. Analysis of a national cohort of 750 small rural hospitals was undertaken in 1983, 1985, and 1987 to identify the characteristics of these hospitals, their communities, and the relative contribution of the small rural hospital to long-term care bed supply. Hospitals more likely to have long-term care during this period of time had lower occupancy rates and higher expenses per admission both prior to and after developing long-term care. While only 14 percent of the 750 hospitals studied had long-term care, they contributed nearly 30 percent of the total long-term care bed supply in their counties. Population-based need and bed supply measures were not significantly different in counties having a small rural hospital with long-term care. Areas of further analysis of the small rural hospital as a resource for long-term care are suggested. The implications for the health care system of small rural hospitals with long-term care are discussed.

Bed Conversion↗
PubMed2002

Assessing the performance of rural hospitals.

This study developed population-based and hospital-based indicators to examine the performance of Manitoba's 68 rural hospitals. Analyses of the indicators revealed considerable differences in the populations served and their use of rural hospital services. Hospital type was also an important factor for performance. The rural hospital indicators would be useful to hospital planners and regional policy makers for comparison purposes and for highlighting issues that need to be addressed.

Bed Occupancy↗
PubMed2006

Rural surgery in southern Sudan.

INTRODUCTION: This article reports a retrospective analysis of a 6-year experience of providing surgical care in remote areas of southern Sudan under extremely adverse conditions. METHODS: Teams of expatriate consultants (surgeon, anesthetist, scrub nurse) carried out 28 "surgical missions" with the aims of treating surgical cases previously selected and of training local personnel in basic surgery on the job. RESULTS: A total of 1642 patients (71% males, 30% under the age of 16) have undergone an operation. Altogether, 1264 elective procedures (77%) and 378 emergency procedures (23%) were performed. Hernia surgery comprised the main workload, followed by proctologic and gynecologic operations. Most operations were performed under spinal anesthesia. Other cases required ketamine, and a small number of patients had local anesthesia. There were 14 fatal complications, most of them related to the delay in obtaining medical attention. Based on the training results, the Sudanese personnel of two of the five health centers involved in the program are already fully autonomous. Two doctors and two nurses are proficient in essential surgery; two not qualified nurses are proficient in "primary" anesthesia; and others are proficient in scrubbing and surgical nursing. CONCLUSIONS: This report demonstrates that it is feasible to establish surgical services in rural areas of developing countries by utilizing simple facilities, providing them with basic equipment, and employing local personnel selected and trained on the job by teams composed of a consultant surgeon, anesthetist, and scrub nurse. This seems to be the only realistic possibility for providing surgical care to the rural populations of the least developed countries.

Anesthesia↗
PubMed2003

Re-thinking approaches to undergraduate health professional education: Interdisciplinary Rural Placement Program.

The Interdisciplinary Rural Placement Program involved the development, implementation and evaluation of a common rural primary health care module. Designed for undergraduate nursing, medical and pharmacy students of the University of Tasmania, students undertook clinical experiences and a collaborative primary health care project at two different Rural Health Teaching Sites across Tasmania. The aim of the project was for interdisciplinary students to work and learn together to enhance their understanding of the cooperative and collaborative nature of professional practice among rural health care workers. This paper will describe the development and implementation of the Interdisciplinary Rural Placement Program and critically discuss the outcomes in relation to nursing. In this paper, three issues will be explored. Firstly, how student nurses questioned their sense of subordination when in fact the level of recognition by their interdisciplinary peers led them to refute this. Secondly, concerns with overcoming the difficulties of coordinating student recruitment and conflicting timetables, while working within existing curricula, will be discussed. The final issue explores the student nurses' recognition that despite inherent tensions and conflict, the need to work as a cohesive and cooperative interdisciplinary team was vital. This project highlighted the challenges that health professions continue to work through in contemporary practice and education sectors. A key recommendation for education providers is that true interdisciplinary education must be achieved through an experiential framework.

Attitude of Health Personnel↗
PubMed2004

Time as a source of conflict: student nurse experiences of clinical practice in a rural setting.

INTRODUCTION: Conducted in rural Tasmania, this study explored the experiences of undergraduate student nurse first engagements with rural clinical practice. While the purpose of the overall study was to explore how the experience of nursing practice in a rural setting influenced the way undergraduate students shaped their professional identity, this article concentrated on the way the students came to use their time during their placement. METHODS: This study used a fusion of ethnography and hermeneutic philosophy using participant observation, field notes, interviews and reflective journaling to collect data. Data analysis took place concurrently with the data collection, which is consistent with the hermeneutic circle framework. RESULTS: Three major themes were developed and explored throughout the study: (1) navigating rural spaces; (2) time as a source of conflict; and (3) developing rural nurse identity. The theme described in this article concerns how the nursing students' assumptions regarding how time would be used during the rural placement were dislodged. This first involved a shift from regarding time as a background feature of daily life to seeing it as an explicit, foreground feature of everyday life. Second, it involved a shift away from conceptualising time as a cyclical unit of hours, instead focussing on the meaning the students came to attach to time in the rural practice setting. CONCLUSIONS: The findings shed light on how undergraduate student nurses used their time during clinical practice in a rural community. With no clinical experience, on the commencement of the rural placement they initially expected to spend their time caring for people, but realised they first needed to spend their time learning about rural nursing before they could then do the work of rural nursing.

Journal Article↗
PubMed1998

[Value of anterior chamber lenses in developing countries. Results of a clinical study].

UNLABELLED: There are estimated to be 20 million people blinded by cataracts, 80-90% of whom live in rural areas of developing countries where expert surgical resources are scarce. The majority of all cataract operations are still intracapsular extractions (ICCE). Aphakic correction using spectacles is problematical in developing countries. This study was undertaken to evaluate the safety of multiflex open loop anterior chamber intraocular lenses (AC IOLs). METHODS: A total of 2000 people attending Lahan Eye Hospital, South-east Nepal, with bilateral cataract were randomly allocated to receive in their first eye either ICCE with AC IOL (AC IOL group) or ICCE with aphakic correction (control group). All operations were performed by two ophthalmologists using a standardized technology and 4.5 x operating loupe magnification. Functional and best corrected vision was recorded. The primary outcome measure was poor vision after surgery, which was defined as a visual acuity of less than 6/60 at 1 year follow-up (WHO definition for severe visual impairment and blindness). FINDINGS: The median time needed to perform ICCE was 4.1 min and to perform ICCE with AC IOL 6 min. Of all study patients 91% were examined after 1 year. Five percent of the AC IOL group and 5.4% of the control group had a functional visual acuity of less than 6/60. Causes of reduced vision in the AC IOL group versus the control group were: correctable refractive error (22 vs 29), uveitis/secondary glaucoma (13 vs 2), endophthalmitis (4 vs 7), pre-existing eye diseases (4 vs 5), retinal detachment (0 vs 4), and corneal decompensation (0 vs 1). Of the control group, 24 patients were found to be functionally blind in the operated eye (vision < 3/60) because they did not wear their aphakic spectacles. Normal vision (WHO definition: > or = 6/18) was achieved best corrected in 89.9% of the AC IOL group and 93.2% of the control group. Analysis of additional long-term follow-ups (2-5 years post-operatively) has not yet been completed. INTERPRETATION: This study provides evidence that in developing countries well-manufactured multiflex open loop AC IOLs can be implanted safely by experienced ophthalmologists after routine ICCE, avoiding the disadvantages of aphakic spectacle correction.

Anterior Chamber↗