With many countries chronically short of surgeons, should laymen be trained in emergency surgery? It is one of the trickier questions in global health.
A new study by surgeons and global health specialists, mostly from Harvard Medical School, concluded that performing Caesarean deliveries extensively in 49 poor countries would save 16,800 mothers’ lives annually and prevent many fistulas — internal tearing that can occur in prolonged or obstructed labor after blood flow to vaginal tissue is interrupted, causing it to die. Such injuries can cause lifelong anguish.
The median cost of a Caesarean in these countries was assumed to be $141. In most countries, the operation would save 2 to 6 times its cost in income created by mothers who otherwise would have been left dead or disabled, said Dr. John G. Meara, an author of the study, which was published last month in PLoS One.
The $141 figure was from the World Health Organization, Dr. Meara said, and seemed to assume the surgeries would be performed in hospitals by doctors. Asked if he would favor training nurses and midwives to do Caesareans, he answered, “Oh yes, absolutely.”
Not only would that save more lives at much lower cost, he said, but trained midwives and nurses would be less likely to emigrate, as many doctors do, because wealthier countries are unlikely to let them practice.
The Global Update on Tuesday, about a study that concluded that performing more Caesarean deliveries in poor countries would save many mothers’ lives and prevent many fistulas, described incorrectly an obstetric fistula. It is internal tearing that occurs in prolonged or obstructed labor after blood flow to vaginal tissue is interrupted, causing it to die — not a vaginal tear in the delivery process that is so severe it reaches the rectum.