SOUTHAMPTON MEDICAL SOCIETY
President: Dr Nigel Dickson FRCGP
A meeting of the Southampton Medical Society was held on the 5th April 2023.
The President was in the chair. The minutes of the last meeting were approved.
The President introduced our speaker, Dr Oliver Ross, Consultant in Paediatric Anaesthesia and Paediatric Intensive Care who spoke on Nepal and of his experiences in visiting and training Nepali healthcare workers over 15 years with the Nick Simons Institute.
Nepal is a country of 30 million people. There are areas of half a million people with no proper healthcare. The Nick Simons Institute was set up to support district hospitals which are the forgotten branch of health care in Nepal. There is also a significant need for rural GPs in the country areas.
Dr Ross showed a film of a mother being transported from a rural area to have a Caesarian Section for obstructed labour. She is on a stretcher which is being manhandled across mountain tracks with steep ascents and descents on uneven stony ground. A perilous journey. The film ended with a picture taken outside a mission hospital of a group of healthy looking mothers. But this hospital was not able to provide obstetric surgery.
Caesarian Section is the commonest operation in the under 40s in Nepal. Obstructed labour with death in utero causes a significant maternal mortality. There is a delay due to failure to recognise that help is needed. Part of the problem is lack of personal money as everything has to be paid for. But there is another delay due to the difficulty of transporting cases to a surgical unit as demonstrated in the film. There is a 2 hour slot between help being needed and surgery after which there is a steep curve in maternal mortality rates. It takes on average 15 hours to transport the mother to a unit across the mountains. Dr Ross was glad to say that maternal mortality is falling in Nepal. However there is a concomitant rise in the suicide rate amongst women - women who might have formerly died in childbirth. Women do all the work in Nepal. In general there is a correlation between a lack of education of young women and maternal mortality.
But improvements are afoot. GP postgraduate training now involves teaching them to do Caesarian Sections. Programmes are being developed to teach health assistants in specialist areas of treatment. Teaching assistants to do essential surgery is important. The Global Surgery Commission recommends that 80% of the population of an area should have access to surgery [5000/100,000 population].
The Simons Institute is trying to aid this process. It works with 12 hospitals. They have a programme developing Paediatric Clinical Standards with which our speaker is involved along with other paediatric specialists from the UK. They have been concentrating on teaching triage and specialised paediatric care to young doctors. However it is difficult to get changes and to persuade young doctors to serve in rural areas.There is a growth of private hospitals in better off areas with the result that there are 50 paediatricians offering private treatment per 150,000 population as opposed to 5 for the general population.
The President thanked the speaker saying it was an excellent talk to end the season.
and