Surgery and anaesthesia at Enga Provincial Hospital.

During a period of over 4 years, general medical officers in an isolated hospital in the Highlands of Papua New Guinea (PNG) performed various major surgical procedures including laparotomy, sequestrectomy, prostatectomy, Caesarian section and hysterectomy Pig bel (enteritis necroticans) was the commonest condition requiring laparotomy (37.5%) and 64% of patients with this diagnosis were adult. Arrow and spear wounds required surgical treatment in 193 adult patients and this group comprised 14.3% of all surgical procedures. Anaesthetics used were ketamine (42.9%), spinal (18.6%) and local (32.1%) and only 3.1% of patients had a general anaesthetic. Minimum essential skills for general medical officers in isolated Highland hospitals in PNG include the ability to perform laparotomy with small bowel segment resection, Caesarian section and familiarity with the use of ketamine and spinal anaesthesia.