Clinical Performance of Emergency Surgical Officers in Southern Ethiopia

Abstract

BACKGROUND: Serious shortage of gynecologists and surgeons for several decades leading to a three-year masters level training was initiated in 2009. However, systematic analysis was not done to assess thegraduates’ performance. The purpose of this study was to assess improvement in access to emergencysurgical and obstetrical care services.METHODS: Both quantitative and qualitative methods were employed to assess the competence ofemergency surgical officers (ESOs) in their decision making and surgical skills in eight hospitalsbetween 2012 and 2014. Anesthesia time, post-operative hospital stay and change in hemoglobin levelwere, among others, used as proxy indicators of their surgical skills.RESULTS: A total of 4075 obstetric and surgical operations was performed in the study hospitals. Ofwhich, 93% were done on emergency base. Of the total emergency procedures, 3570(94%) were done byESOs. Nearly two-thirds (63%) of all the emergency operations were cesarean sections, which were doneby ESOs. Out of 239 uterine ruptures, hysterectomy was done for 58%. The proportion of cesarean andinstrumental deliveries over the total deliveries were 13% and 0.7%, respectively. Explorativelaparotomies and appendectomies were the majority of the non-obstetric emergency operations.Interviewed staff in the respective hospitals stated that ESOs’ clinical decision making, surgical skill andcommitment to discharge their responsibilities were in the best possible.CONCLUSIONS: The study showed that deployment of ESOs made the emergency surgery servicesaccessible to the majority, and their clinical decision making and surgical skills were remarkable.