Every senatorial district needs a paediatric surgeon”: pioneer paediatric surgery experience

Background: Specialist paediatric surgical care is absent in most senatorial districts across the nation, either for the few numbers of paediatric surgeons in the country or for the perceived government policy to employ only general surgeons in general hospitals. The experience garnered in the first twenty months of specialist paediatric surgery practice in Irrua Specialist Teaching Hospital, the tertiary centre in Edo Central senatorial district highlights the necessity of having at least one paediatric surgeon in each senatorial district in Nigeria. Materials and Methods: A review of the first twenty months of Paediatric Surgery practice (September 2014 – April 2016) was compared with the last twenty months of General Surgery practice (January 2013 – August 2014). Surgeon-Paediatrician interaction and co-management of cases in both periods of study was compared with General Surgery practice using questionnaire administered to paediatricians in the facility who had worked actively with the two sets of surgeons. Results: The number of paediatric surgical cases seen in the clinic (593), admissions (211) and emergency cases (71) increased with specialist practice. These figures were more than doubled when compared with 254, 101 and 33 respectively recorded in the last twenty months of general surgeons practice. Surgeon-Paediatrician understanding, professional intermediation, co-management and referral system/response to call assessment for general surgeons were 59%, 65%, 69% and 64% respectively while that for paediatric surgeons were 84%, 83%, 77% and 97% respectively. Review of post-operative complications however was similar for paediatric surgeons compared to general surgeons. Conclusion: This pioneer experience shows that the cases seen have always existed in the locality; the awareness of the availability of specialist paediatric surgical care must have contributed to the increased hospital attendance. The better appreciation of the paediatric patient by paediatric surgeons is a likely factor in the improved co-management of cases with paediatricians. There is therefore the need for at least one paediatric surgeon in each senatorial district. Keywords: Paediatric surgical care, Paediatric Surgeon, Inter-specialty consultation, Senatorial district