Theatre and emergency services rendered by generalist medical practitioners in district hospitals in the Western Cape

Abstract

District hospitals play an important role in rendering comprehensive health sendees to communities. The district hospital is an integral part of the district health system providing not only curative level-one hospital services but also outreach and support to primary health care sendees. District hospitals are staffed by generalist medical practitioners who are required to perform a wide range of clinical duties and procedures. A situation analysis to identify the range of duties performed by medical practitioners in rendering emergency and theatre services at district hospitals in the Western Cape was conducted in 2001. Data was collected from the casualty' register, theatre register, routine monthly hospital report, a medical officer questionnaire and a questionnaire collecting general information about all the district hospitals in the Western Cape province. The 27 district hospitals were staffed by 147 full time, part-time and community service practitioners at the time of the study. The part-time practitioners had statistically significant more experience. Fifty percent of the respondents had done an ATLS or equivalent course, whilst only 5% were qualified family physicians. Musculo-skeletal problems were the most commonly presenting complaint at casualty departments, followed by lacerations and assaults. Female sterilization was the most trequently performed surgical procedure, and secondly caesarean section. General anaesthesia was die most common anaesthetic method used. The results of the study underlined the importance of district hospital medical officers being competent generalists, able to deal with undifferentiated problems ranging for simple primary health care complaints to multiple trauma. The need to perform procedures such as caesarean section and general anaesthetic in district hospitals has important implications for appropriate training of clistiicl hospital medical practitioners.