A private complication of a public problem

It is difficult to write about surgery in South Asia with any sense of pride. In most of the region health care, and especially surgical care, is concentrated in major hospitals in big cities. In villages and small towns the health infrastructure exists on paper, but even minor procedures are not carried out because equipment does not work, and surgeons are reluctant to undertake operations for which they are not well trained.

In a community survey of surgical emergencies in the northern areas of Pakistan, the incidences of acute abdominal, trauma, and obstetric emergencies therefore far exceeded the rates of acute surgical intervention.1 In rural areas of Pakistan the overall rate of surgery was 124/100 000 patients per year compared with 8253/100 000 in the United States. Death rates were correspondingly high. Even in city hospitals the situation is not much different. …