Introduction
The ministry of Health faces a tremendous challenge of fulfilling the human, financial and material needs for effectively running the newly constructed and expanded health facilities.
The introduction of a new surgeon in Adi Caih Hospital was necessary and strategic decision to attend the patients in a vast and remote area which is about 120 Km away from Asmara
with its population approximately 60,000, where the majority of them lives sparsely in rural zones, where the accident are frequently taken part and other several surgical diseases occurs.
Moreover, the circumstances have obvious limitations such as:
Health workers are not available for the attention to solve the problems and to treat the patients.
Electric energy is only 6 hrs daily.
The Hospital has only one ambulance.
The generator for emergency is out of work frequently.
Fuel is not enough.
Only one Anesthetist Technician.
Lack of full drugs for necessity.
Non availability of instruments and miscellaneous for necessary operations.
Non availability of blood for emergency.
Some patients who are badly sick or complicated get admitted late.
Therefore, this study was done in the following objectives:
To know the principals diagnose in Surgical out Patient Department (SOPD), Surgical Ward (SW) and Operating Room (OR).
To assess to study the magnitude of the surgical attention.
Material and Methods
A retrospective analysis was done during the months, from April 2008 to November 2008, with the patients who had surgical attention in Adi Ceih Hospital. Clinical patient"s record were attended in SOPD, in OR and admitted in SW were reviewed. Data on personal history, diagnostic or principal symptoms, age and surgical procedure, were systematically collected from the patient"s cards.
The results are presented in graphic and some of there are compared with similar period of previous year.
Patients who came for second or more times with the same symptoms or diagnostic in SOPD were excluded.
In general syndromes, some diagnostic indifferent such as headache, body pain, chest pain, digestive disorder, dysuria and urine infections, etc had been included.
We have also included certain surgical diagnostic like: sigmoid volvulus, intestinal stenosis, intussusceptions, appendicular mass, abdominal tumors, Hirsprung disease, digestive bleeding, rectal stenosis, rectal polyp, burns, breast tumors, foreign body, gynecology disease, osteomyelitis, Perthes disease, cryptorchid testis, hypospadia, bladder stone and polyp, varicocele, testicle atrophy and agenesis, phymosis, prostatitis and epididimus cyst.
In miscellaneous in OR Diagnostic includes: mesenteric thrombosis, intestinal stenosis, ulcer perforation peritonitis, urethra stenosis, testicle agenesis and atrophy, sigmoid volvulus, hemoneumotorax, undescend testicle, hypospadia, perinea fistula, etc.
In miscellaneous procedures certain operations are included such as: uretroplastic, amputation, colostomy, Hartman operation, mastectomy, tracheotomy, Heineken Mickuliz Ileoplasty, etc.
MORBIDITY SOPD 2008 ADI CAIEH HOSPITAL
Diagnostic or principals symptoms | Patients | % | ||
1.- Traumas y Politraumas | 179 | 19 | ||
2.- Generals syndromes | 173 | 18 | ||
3.- Soft tissue tumors | 136 | 14 | ||
4.- Abdominal pain | 85 | 9 | ||
5.- Abdominal wall hernias | 53 | 6 | ||
6.- Prostatic hypertrophy | 52 | 6 | ||
7.- Skin infections | 51 | 6 | ||
8.- Perinea and anal diseases | 35 | 4 | ||
9.- Malformations/deformations | 33 | 4 | ||
10.-Hydroceles | 23 | 3 | ||
11.-Tiroid Gland diseases | 21 | 2 | ||
12.-Miscellaneous diseases | 89 | 9 | ||
T O T A L | 970 | 100 | ||
MORBIDITY IN SW 2008 ADI CAIEH HOSPITAL
DIAGNOSTICS | PATIENTS | % | |
1.- Traumas and Politraumas | 123 | 30 | |
2.- Skin infections and wall abscess | 86 | 22 | |
3.- Abdominal pain | 38 | 9 | |
4.- Prostatic hypertrophy | 18 | 5 | |
5.- Abdominal wall hernias | 15 | 4 | |
6.- Hydroceles | 13 | 3 | |
7.- Burns | 13 | 3 | |
8.- Soft tissue tumors | 12 | 3 | |
9.- Back and extremity pain | 10 | 3 | |
10.-Perinea and anus disease | 7 | 2 | |
11.-Miscellaneous | 63 | 16 | |
T O T A L | 407 | 100 | |
DIAGNOSTICS IN OR 2008/2007. ADI CAIEH HOSPITAL.
DIAGNOSTICS | 2008 | 2007 | ||
1.- Soft tissue tumors and cysts | 46 | 13 | ||
2.- Skin and wall wounds | 22 | 1 | ||
3.- Abdominal wall hernias | 17 | 2 | ||
4.- Abscess | 13 | 4 | ||
5.- Hydroceles | 11 | 0 | ||
6.- Cesareans | 6 | 0 | ||
7.- Extremity fractures and dislocations | 4 | 0 | ||
8.- Breast tumors | 3 | 0 | ||
9.- Hand finger malformations | 3 | 1 | ||
10.-Phymosis and paraphymosis | 2 | 21 | ||
11.-Acute appendicitis | 1 | 3 | ||
12. Miscellaneous | 21 | 10 | ||
T O T A L | 149 | 55 | ||
PATIENTS ATENDED IN OR 2007/2008 ADI CAIEH
HOSPITAL. RELATION MAJOR VS MINOR
OPERATIONS.
. 
PATIENTS ATENDED IN OR 2007/2008 ADI CAIEH HOSPITAL. RELATION ELECTIVE VS URGENT
OPERATIONS
OPERATIONS MADE IN 2008. ADI CAIEH HOSPITAL
OPERATIONS | PROCEDURES No. % | ||
1.- Excisions | 50 31 | ||
2.- Sutures and reparations | 21 13 | ||
3.- Herniorraphys | 19 12 | ||
4.- Incisions and drainages | 15 9 | ||
5.- Laparotomys and several procedures | 11 7 | ||
6.- Hydrocelectomys | 7 4 | ||
7.- Cesareans | 6 4 | ||
8.- Orchidopexias | 4 3 | ||
9.- Fractures and dislocations corrections | 4 3 | ||
10.- Miscellaneous | 23 14 | ||
T O T A L | 160 100 | ||
Conclusions
The more frequently diagnostic in SOPD and SW were the traumas and Politraumas, while in OR were the soft tissue tumors and cysts; therefore the excision was the more common procedure.
The study reveled that the surgeons for Adi Caieh Hospital should have a vast, enough and more preparation.
Autor:
Dr: Rosendo Rosel Reyes Rivera.
Surgeon Adi Caieh Hospital.