Public health breakthrough never to reach 1st world #Science #Kindle

This is some of the research that contributed to the recently released Darwin’s Paradox: An international science mystery One of the main characters, Nga, is a  técnico de cirurgia or surgery technician in Mozambique.

Rift Valley Africa, along with much of the third world, is experiencing a health crisis. The reality of international mobility has exposed these areas to disease and armed conflict, while simultaneously providing exit strategies for educated medical professionals. In short: more demand and less supply.

There is a bright spot. What might be the most important innovation in medical education began at a desperate time in little-known African country bordering the Great Rift Valley — the same rift valley that gave Earth Homo habilis, Homo erectus, and the notorious Homo sapiens — Mozambique.

After centuries of Portuguese rule, Mozambique achieved dependence in 1975. This was immediately followed by a mass exodus of educated Europeans and the onset of civil war. The exact recipe for human suffering and death mentioned above: more demand and less supply.

However, Mozambique did not sit still while women died in childbirth and others died from war traumas. In 1984, Mozambique did the what was, and still is, unthinkable in the first world. They trained people who were NOT doctors to be surgeons. In Mozambique, these people are called técnico de cirurgia or surgery technician.

TRAINING: Rather than starting with medical doctors of which only a handful remained, técnico de cirurgia (TC) prospects were nurses or other mid-level health workers with experience in rural areas. They prospective TCs spent two years at Maputo Centro Hospitalar and one year in a provincial hospital. After this training/internship, they were TCs.

RESULTS: Today TCs are an integral part of the medical infrastructure in Mozambique. Planning reports speak of a provincial hospital being typically staffed by a general practitioner and a TC. Employment agencies recruit TCs.

With all these non-MD surgeons, the 1st world wonders about their efficacy beyond reported costs saving of 60-75%, worry based more on tradition than data. For in Mozambique, TCs perform 92% of cesarean sections, obstetric hysterectomies, and laparotomies for ectopic pregnancy, with results comparable to obstetricians.

In spite of their excellent performance, TCs face a mixed environment. The people (both patients and doctors) that they work with at their provincial hospitals appreciate and respect their work. However, the health system (government) “does not recognize and motivate them enough,” which is code for they are not paid enough. Proposals to double their pay are suggested.

As the need for medical staff increases throughout the world, we would be advised to look again the the Great Rift Valley for innovative approaches. Perhaps if the first world embraces TCs, the situation in their country of origin will also improve. Thus, history will repeat itself, solutions begin in Africa and spread around the world before returning to Africa.


PRI podcast about técnico de cirurgia in Mozambique

Turning the World Upside Down: the search for global health in the 21st Century by Nigel Crisp

African Health Leaders: Making Change and Claiming the Future by Nigel Crisp et al

British Journal of Obstetrics and Gynaecology (2007): Economic evaluation of surgically trained assistant medical officers in performing major obstetric surgery in Mozambique.

The use of non-physician clinicians (NPCs) to provide surgical interventions  throughout Africa

WHO Study (2007) Major surgery delegation to mid-level health practitioners in Mozambique: health professionals’ perceptions

History of Mozambique

Categories: Mozambique | Tags: , | Leave a comment

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