Training medical assistants for surgery

A successful programme is reported from Mozambique for training middle-leve l health workers to perform fairly advanced surgical procedures in remote a reas where the services of consultants are virtually unobtainable. Manpower and financial constraints obliged Mozambique to train medical assistants t o perform surgical work in rural areas, where three broad priorities were i dentified: pregnancy-related complications, trauma-related complications, a nd emergency inflammatory conditions. Since 1984, 20 health workers have em erged from three-year courses to become tecnicos de cirurgia (assistant med ical officers), and it is expected that there will be 46 by 1999. The train ing comprises two years of lectures and practical sessions in the Maputo Ce ntral Hospital, and a practical internship lasting a year at a provincial h ospital. Three workshops organized since 1989 suggest that the upgraded per sonnel are performing well. More detailed evaluation and follow-up are in p rogress. Throughout 1995 a follow-up was conducted on 14 assistant medical officers. They performed 10 258 surgical operations, some 70% of which were emergency interventions. low rates of complication occurred and postoperat ive mortality amounted to 0.4% and 0.1% in emergency and elective intervent ions respectively.