"The lack of appropriate numbers of anesthesia and surgical care providers in many resource-poor countries around the world, especially in rural populations, prevents adequate care of the large numbers of patients who require surgery in these settings. This article provides a 10-year review of a rural hospital located in East Africa which developed a training program based on parallel training of anesthesia and surgical care providers. We report the process of building the foundational aspects of a customized medical education program that addresses specific concerns related to the work in a rural African context, which may be very different from medical care provided in the urban settings of low income countries (LIC). We analyzed how the parallel training can provide the clinical tools needed to have a practical impact on the surgical burden in rural Africa. The parallel training program combining training of nurse-anesthetists with the training of multiple levels of surgical care providers, from interns to fellows, led to a fourfold increase in the number of surgical cases. Surgical subspecialty training and the development of an anesthesia care team with anesthesia consultant(s) oversight can serve to maintain a high level of complex and expanding surgical case volume in a rural African hospital setting. This model can be applied to other similar situations in LIC, where the anesthesia and surgical care can be coupled and then customized for the unique clinical rural setting."

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