Ann. Pak. Inst. Med. Sci. 2010; 6(1): 36-39

Objective: To evaluate the practical, psychological and social consequence of ostomies on patients in our setup. To judge the level of patient satisfaction and knowledge about stoma care. To high-light common post-operative concerns of patients.
Study Design: Cross sectional descriptive study
Place and Duration: Department of General Surgery, Pakistan Institute of Medical Sciences from April 2007-June 2007.
Materials and Methods: 30 patients aged 18-80yrs of both sexes were purposively sampled. Data collection using a proforma and data analysed using SPSS version 14.0 for windows software.
Results: A total of 30 patients aged between 18-80yrs were sampled, mean age was 35 yrs. 77% of our sample underwent a temporary diversion and 23% a permanent one. 60% of patients had no idea or were inconclusive about their diagnosis during admission. At discharge 6 patients were able to manage their stoma independently.
Conclusion: In-patient specialist stoma nurse care and out-patient stoma clinics for rehabilitation and follow-up are essential components lacking in the management of ostomy surgery to patients in our setup.
Key words: Ostomy surgery, Stoma care.

Introduction


To the professional eye, an ostomy refers to a surgically created opening in a patient’s body for discharge of body waste products. To the ostomate however, it means substantive changes not only in bodily appearance and functional ability but also in overall personal hygiene; this has major impact both on the manner in which they perceive themselves and on their quality of life in general.^1,2 The World Health Organization (WHO) defines quality of life as "individuals’ perceptions of their position in life in the context of the culture and value systems in which they live, and in relation to their goals , expectations , standards and concerns".³ This statement focuses on four broad domains: physical/occupational function , psychological state , social interaction, and somatic sensation all of which are to be borne in mind as impact factors when approaching a patient for ostomy counseling. It is important for us to realize however, that for patients in a developing country such as ours, these aspects must be applied in context to their level of awareness and understanding.

Figures suggest that it takes an average of four to twelve months for patients to adjust on an ostomy⁴ and that patient access to specialist ostomy care nurses is particularly important during the first 3 to 6 months following surgery.⁵ The Montreux study gave results that were fairly consistent in all patients throughout Europe. ‘Stoma Care Quality of life Index’ (SCQLI) scores were significantly higher in patients who had a good relationship with the stoma care nurse and felt confident about changing the appliance than those who did not . Stronger feelings of self efficacy shortly after surgery predicted fewer psychosocial problems in the course of first post-op year.6 With this in mind we are forced to envisage the practical and psychological impact osteomies are having on patients in the developing world where no such facility or alternative is available to the majority. Raising awareness about the medical/socioeconomic implications this is having on our society and implementing changes to further raise the level of care received by patients facing ostomy surgery is our central goal. For this we must highlight problems encountered by patients at the grass root level and provide solutions that not only recognize various limitations but also seek to resolve them in keeping with the exclusive needs of ostomates in the developing world.