• Michelle R Notrica, Faye M Evans, Lisa Marie Knowlton, and K A Kelly McQueen.
• Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. mnotrica@cox.net
• World J Surg. 2011 Aug 1;35(8):1770-80.

BackgroundIn low-income countries, unmet surgical needs lead to a high incidence of death. Information on the incidence and safety of current surgical care in low-income countries is limited by the paucity of data in the literature. The aim of this survey was to assess the surgical and anesthesia infrastructure in Rwanda as part of a larger study examining surgical and anesthesia capacity in low-income African countries.MethodsA comprehensive survey tool was developed to assess the physical infrastructure of operative facilities, education and training for surgical and anesthesia providers, and equipment and medications at district-level hospitals in sub-Saharan Africa. The survey was administered at 21 district hospitals in Rwanda using convenience sampling.ResultsThere are only nine Rwandan anesthesiologists and 17 Rwandan surgeons providing surgical care for a population of more than 10 million. The specialty-trained Rwandan surgeons and anesthesiologists are practicing almost exclusively at referral hospitals, leaving surgical care at district hospitals to the general practice physicians and nurses. All of the district hospitals reported some lack of surgical infrastructure including limited access to oxygen, anesthesia equipment and medications, monitoring equipment, and trained personnel.ConclusionsThis survey provides strong evidence of the need for continued development of emergency and essential surgical services at district hospitals in Rwanda to improve health care and to comply with World Health Organization recommendations. It has identified serious deficiencies in both financial and human resources-areas where the international community can play a role.

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