Introduction: Nepal is a low-to-middle-income country (LMIC) with a predominantly rural population. Almost 10-20% of patients presenting to hospital require surgical care. The availability of skilled human resources in managing surgical care in rural areas of Nepal has to expand to meet this need. The objective of this study is to describe and demonstrate how General Practitioners (GPs) can be upskilled to provide surgical care in rural district hospitals in Nepal. Method: It is a retrospective review of all surgical procedures performed by GPs from 1st February 2016 to 31st January 2021 at Charikot hospital. Data was collected from a prospectively maintained Electronic Health Record (EHR) system (Bahmini). Details of data collected included name of the procedure and its respective specialty. GP Task shifting and targeted surgical training programs for common orthopedic procedures and pediatric herniotomy were described in detail. Result: A wide range of surgical procedures were performed by GPs over 5 years. This included interventions for obstetric emergencies, trauma and orthopedics, gynecological issues, general surgery of adult and childhood. A total of 2037 surgeries were performed by GPs including: Cesarean section 25%, 19.7% were orthopedics surgeries followed by 13.5% of mesh repair for abdominal hernia, 9.3% eversion of sac for Hydrocele, 8.7% appendectomy, 5.2% hysterectomy, 3% of pediatric herniotomy and others. Conclusion: GPs can be further trained to perform important common surgical procedures to improve access to surgical care for rural communities. Keywords: Continuing medical education, general practitioner, leadership, rural surgery
Introduction: Gender-Based Violence (GBV) is a global challenge and is affecting 1 in 3 women in their lifetime. GBV mainly includes physical and domestic violence, rape, mental torture, child marriage, and human trafficking. There are very few specific programs to address GBV in Nepal and the One-Stop Crisis Management (OCMC) approach started by the Nepal government since 2011, has promising support in addressing gender-based issues. Method: Study was conducted at Charikot Hospital, Dolakha. Retrospectively collected data from Electronic Health Record (EHR) of Bahmini from 2016 September to 2021 August, were used and were verified using the OCMC register. The quantitative data were analyzed using descriptive statistics and presented in relevant tables and frequencies. The nature of the study was exploratory as a researcher had tried to explore the effectiveness of the program and its challenges. Result: Out of 750 cases over 5 years, 695(92.7%) were female, 272(36.2%) were sexual assault cases followed by 259 (34.5%) of physical assault, 73.6% of the victims were among 15-49 years of age and most commonly affected among Janajati (40%) and Brahmin/Chhetri (39.5%). Almost 15% of the total victims had some form of disability. Twenty-one women had difficulties finding safe homes and 7 women committed suicide and died. Conclusion: Initiation of OCMC services at district level hospitals has formed the foundation to support GBV victims. A specific mental health approach is needed to prevent deaths due to suicide. Government should ensure infrastructure for safe homes and give priority to medicolegal cases. Awareness campaigns are necessary to report more cases of GBV.
Emerging and re-emerging infectious diseases are in rise due to rapid climate change, environmental changes and population increase. COVID-19 has taught us about different understanding of health. One Health is a concept that recognizes the interconnections and health interdependencies among humans, other animals and the shared environments. The concept of One Health is in embryonic stage in Nepal. With the One Health approach, implementing systematic zoonotic surveillance, regulated rational use of antibiotics, prevention strategies through wide vaccination campaigns, global collaboration, rapid control of outbreaks with containment measures, development of zoonotic registry in the country, multisector coordination can prevent future pandemics
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