Uitdagings vir 'n ginekologie en obstetrie departement in die ruimte-eeu

Abstract

The responsibilities of a department of Obstetrics and Gynaecology of a medical school are the following: patient care, teaching and training, research, administration and, lastly, official duties. These tasks should be performed in an atmosphere of characterbuilding and continuous stimulation; THINK should be the motto of all times. Other essentials include good management and a team approach, which should be combined with proper planning, consultation and contact - nationally as well as internationally - with scientists in this particular field. The cost-benefit factor should always feature prominently in all departmental activities, and of particular importance in this connection would be periodical analyses of the departmental activities aimed at ensuring that objectives are being fulfilled. Patient care should have a high priority rating in departmental objectives. A comparison of the departments of Obstetrics and Gynaecology of the three Afrikaans-language medical schools in the country shows that this university attends to approximately 48% of the total number of out-patients and 47% of the total number of deliveries handled by these three units annually, while having only 22% of the total personnel complement. Moreover, as regards apparatus facilities, this department has only 15% of the total number of colposcopes and 23% of fetal heart monitors at its disposal. Specific facilities for which provision should be made include a reproductive biology unit including a gynaecological endocrinology and infertility department, preconception clinic, family planning unit and mature-women clinic; a gynaecological oncology unit including a clinic for colposcopy and cytology and a trophoblastic disease unit; a perinatalogy unit including an intensive-care unit, facilitites for ante-natal fetal monitoring, fetoscopv and pre-natal diagnosis and genetic advisory clinics; uro-gynaecological unit; an ultra-sound unit; and a comprehensive service in the form of social workers and psycologists who must be part of the team. It should also be the responsibility of the department to convey information to patients by every possible means, such as symposia and publications in the lay press. Training on a pre- and postgraduate level is a specific responsibility of this department, and once again when comparing the three Afrikaans universities it appears that this department provides training to 43% of the total number of students but has only 33% of the lecturing staff and 16% of the administrative staff of the three medical schools combined. A specific aim should be to increase the retention of medical scientists by stimulating interest in research and academical medicine. Ongoing training should also be encouraged in order to maintain the standard of practice of medicine at an optimal level in this country. The training of nurses and paramedical staff should also be maintained at a high level, since these people have an important role in the team approach of this department. The value of research cannot be overestimated. Such research should not only be clinically orientated but should include experimental animal and laboratory research as well. The newly established in vitro fertilization research programme of the department is discussed at length, and reference is made to the ethical consequences of this new technique.