What is Rural Surgery?

The concept of rural surgery has been developed in India in the last thirteen years to make modern surgical care accessible to the five billion havenots of the developing world. Only one billion out the total of six billion population of the world has any access to the type of surgical care seen in the hospital of Western Europe and America. In India, out of the population of one billion as of today, not more than 10% has any access to this type of surgical care. Nearly 600 post graduate trained surgeons are churned out of its medical colleges every year. Many of them go out to the middle east or other developed countries and are totally lost to the nation. Some of the rest get absorbed in the teaching institutions of the country, super specializing. Others go out and practice in the impoverished district hospitals or voluntary, hospitals or set up private practices, in small towns, and in semi urban and rural areas. It is this third category of surgeons that reach out to the needs of majority of the population of the country. They work under extreme constraint of resource. They combine their western medical and surgical knowledge together with locally available human and material resources and provide appropriate health care to the people. They not only practice multiple surgical disciplines, they also do general practice and preventive and promotive medicine including maternal and child health. Thus although they are trained as surgeons they go into total health care to live upto the needs of the community.

Who Are We?

In 1986 the Association of Surgeons of India held a symposium on “Surgery in rural areas” with these surgeons. Following this a survey was conducted to find out the working conditions of these surgeons to which 140 surgeons responded. It was found that 45% of them work without a qualified anesthetist, 68% without a qualified radiologist, 68% without a qualified pathologist, 63% without any blood bank facilities. And 32% without any of the above facilities. 96.4% of them performed abdominal surgery, 68.3% performed orthopedic surgery, 80.2% performed obstetric and gynecological surgery, 29.5% performed thoracic surgery, 81% performed urological surgery, 15.5% performed ENT surgery and 66% performed more than three of the above mentioned categories. This survey was done by Dr. R.D. Prabhu, of Shimoga, Karnataka.

56 of such surgeons requested the Association of Surgeons to accept this from of surgical care as a specialty for the benefit of the majority population of the country which was turned down in 1992. This inevitably led to the formation of the Association of Rural Surgeons of India (ARSI) in 29 November 1992, and in September the same year the First National Conference of Rural Surgery was held in the Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, India, A book was released titled Concept and Practice of Rural Surgery, and a newsletter was started on Rural Surgery.
Till today, Sep. 2004, twelve national conferences have been held in different parts of our country and the thirteenth is going to be held this year at Ujjain, Madhya Pradesh in Sep. 2005. The Association of Surgeons of India has now finally recognised this as a specialty.

Rural Surgery as a Specialty

The Indira Gandhi National Open University, New Delhi, has started designing a multidisciplinary course in Rural Surgery in collaboration with the Association of Rural Surgeons of India (ARSI). This is to make qualified surgeons suitable to work under resource constraints in rural areas amongst impoverished communities sharpening their innovative skills and develop the capacity to make optimum use of locally available human and material resources as far as possible. The stress is on providing total health care including basic surgical care to impoverished communities within their socio economic and and cultural milieu.

Through this website, we invite surgeons and other doctors and health professionals to network with us and strengthen this type of health care activity worldwide. Today the pressure of the healthcare industry of the developed world is enormous on developing countries to sell their products in the name of “development”. We, who are working amonst poorer people, and without any health insurance or social security resist this pressure. Sustainable health care development will take place only when we professionals set the right type of priorities for the benefit of the majority population of the world.