Showing papers by "British Hospital published in 1995"

Paediatric nephrology in poor countries: an educational and cultural outlook

Abstract: Eke and Eke [1] investigated the prevalence and significance of renal disease in the eastern part of Nigeria. We were impressed by the high prevalence of obstructive uropathy secondary to circumcision in this study: 8 of 17 cases. All male neonates are circumcised at birth in this region, the majority by non-medical staff. The authors suggest that the procedure should be limited to experienced and qualified medical staff. At present, this is not feasible in the least-developed countries. Firstly, behaviour in these communities is greatly influenced by culture and religions beliefs and it is highly improbable that even with easy access to medical facilities people will deviate from their customs. Secondly, the Sub-Saharian Africa hospital capacity is of the lowest in the world [2] with the fewest physicians and nurses of any region. The population per doctor and nurse was 35.860 and 8.160, respectively, in 1990 [3]. This would make the practical implementation of the suggestions of Eke and Eke [1] very difficult. We consider that an educational approach, taking into account the culture and beliefs of the communities, must be the central line of action. Involvement of community leaders is crucial to achieve changes in people's behaviour, which fit in with local culture and resources [4]. The most cost-effective health interventions involve primary care providers, a category that can include physicians and nonphysicians. In Kenya ophthalmic clinical officers, who are not physicians, have performed cataract surgery on a pilot basis, with acceptable results~ Africa has only one ophthalmologist per 1 million people. Without the use of the services of non-physicians many patients would not be able to have cataract surgery [2]. Extrapolation from this experience to ritual circumcision practices are certainly valid. Circumcision should be performed by trained personnel, experienced in carrying out the procedure, in post-operative care and in handling its complications [5]. Due to choice or shortage of physicians, the majority of circumcisions will be performed by non-physicians in poor countries. The tiny population described by Eke and Eke [1] is certainly indicative of a large population with renal diseases with no access to medical facilities. The educational and cultural approach is valid to emerging paediatric specialities. To face the challenge of the tremendous shortage of health professionals in poor countries, we need to adapt health care to the existing resources in the framework of the community's culture and beliefs.