Surgery and Healing in the Developing World - Dartmouth-Hitchcock

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10 84 Surgery and Healing in the Developing World ent temperature of 32˚C, the daily energy consumption is only about 430 Wh. A single medium-to-large PV module, with its own battery storage system, would provide sufficient power. Several thousand Sun Frost refrigeration units have been manufactured. They are now deployed in over 50 countries with mean time between failure (MTBF) over 10 years. The approximate cost of the Model RFVB in 2004 is US$ 1700 plus shipping. This model is officially approved by the World Health Organization. A complete Sun Frost system, with dedicated PV module, is about US$ 2800, plus shipping. Another example is the Model SFRF-6 made by the Simpler Solar Systems company. This is a chest type refrigerator/freezer with a total capacity of 179 liters. It costs approximately US$ 1540 plus shipping. A large number of these have been sold to clinics in Africa. Vestfrost (a Danish company) also makes a popular PV-powered refrigerator. Historically, water disinfection has been accomplished by chemical processes or by boiling. Recently, disinfection by ultraviolet (UV) irradiation has become popular. This method allows throughput of hundreds of liters per hour from a highly reliable, low-power, compact system. The UV light is supplied by a mercury vapor lamp with a strong emission at 254 nm. The lamp is similar to commercial fluorescent glass tubes used in homes and offices, except that the glass tube is not internally coated with phosphor which would absorb in the UV and emit visible light. It is fortuitous that such lamps are readily available and inexpensive because micro organism absorption and germicidal effect are maximum at about 260 nm. The World Health Organization has developed a standard of performance for official approval of water disinfection systems. This includes the capability of processing contaminated water so that an input concentration of 100,000 colony forming units (CFUs) of E. coli per 100 ml is reduced to less than 1 CFU per 100 ml at the water outlet. Water itself is highly transparent to UV light. Absorption is by the particles and organisms in the water. Thus, for UV water disinfection, it is appropriate to speak of dose in terms of energy per unit area, rather than energy per unit volume. For a sample of water a few centimeters deep, a dose of 80 milijoules per square centimeter (80 mJ/cm 2 ) will disable 99.995% of waterborne viruses and bacteria. However, UV treatment alone will not disable microorganism cysts with protective coverings such as Giardia and Cryptosporidium, nor will it disable larger organisms such as amoebae and worms. A preirradiation filter must be used to remove such organisms and also to remove fine turbidity. This can be done with a 2-micron or 5-micron particle filter. Sometimes a sand filter can be used for this purpose. A carbon filter can be used if chemical contamination is also present. There are now several UV water purification systems on the market. One example of a very successful water disinfection system is the UV Waterworks model manufactured by WaterHealth International, Inc, (Fig. 11). The energy requirement for this unit is about 10 Wh per hundred liters, making it ideal for a PV-powered environment. The standard model can provide enough drinking water for 500-1500 people per day. One of these units at a clinic can insure safe drinking water for an entire village. After preirradiation filtering, the system works by allowing a continuous stream of gravity-fed water to flow into a shallow stainless steel pan. The water is exposed to the UV light for 12 sec and receives a minimum dose of 80 mJ/cm 2 . Extensive independent laboratory testing has confirmed the effectiveness of the disinfection. The disinfection unit has a mass of only 7 kg and the whole system is easy to set up and use. Maintenance is minimal and includes replacing the UV lamp every year, and the transformer every 5 years. An interesting safety feature of the UV
Establishing Electrical Power in Remote Facilities for Health Care A B Figure 11. A UV water disinfection unit specifically for use with PV power. A) UV unit with predisinfection filters in Bangladesh; B) UV unit at a facility in South Africa. (Photos courtesy WaterHealth International, Inc.) Waterworks is that the input water is automatically shut off if electrical power is lost or if the UV lamp is not sufficiently warmed up for full radiation output. Many of these systems have been deployed in Bangladesh, the Philippines, and other tropical countries. After discussing the system requirements and geographical location with the user, the system integrator will calculate four figures-of-merit to correctly size the system. These are the expected minimum daily solar energy for the given geographical location, the required average daily watt-hours (which is energy), the required daily 85 10
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Surgery and Healing in the Developi
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Contents Foreword .................
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25. Dentistry .....................
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Editor Contributors Harold P. Adolp
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Foreword Surgery and Healing in the
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“poor, but modern”, as for exam
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There may be at least one considera
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It is that higher accountability th
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1 2 Surgery and Healing in the Deve
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CHAPTER 2 Surgery in Developing Cou
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2 10 Surgery and Healing in the Dev
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CHAPTER 4 International Surgical Ed
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Page 108 and 109: CHAPTER 12 Communication in the Thi
Page 114 and 115: CHAPTER 13 Anesthesia in the Third
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Page 134 and 135: CHAPTER 15 Basic Obstetrics and Obs
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15 134 Surgery and Healing in the D
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CHAPTER 16 Pointers for American Su
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CHAPTER 20 Chronic Pyogenic Osteomy
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CHAPTER 23 Cleft Lip and Palate Sur
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CHAPTER 24 Outreach Dentistry: A Wo
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CHAPTER 1 CHAPTER 26 Reconstructive
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Reconstructive Surgery in the Tropi
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CHAPTER 1 CHAPTER 27 Factors Influe
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Distribution and Incidence of Tropi
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CHAPTER 1 CHAPTER 28 Population Dyn
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Population Dynamics Of Surgical Tro
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Metabolic Maladaptation 289 Introdu
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Metabolic Maladaptation 291 some of
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Metabolic Maladaptation 293 In this
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Metabolic Maladaptation Table 1. Si
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Metabolic Maladaptation Table 4. Go
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Metabolic Maladaptation 299 the rev
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Metabolic Maladaptation Table 5. As
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Metabolic Maladaptation Table 6. Co
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Metabolic Maladaptation 305 the ris
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Metabolic Maladaptation Table 8. Go
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Metabolic Maladaptation Table 10. G
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Metabolic Maladaptation Table 12. C
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Metabolic Maladaptation 313 cell an
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Metabolic Maladaptation 315 Biologi
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Metabolic Maladaptation 317 from io
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Metabolic Maladaptation 319 25. Lon
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CHAPTER 1 CHAPTER 30 Nutrition and
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Nutrition and Development in Africa
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CHAPTER 1 CHAPTER 31 Uterine Ruptur
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Uterine Ruptures in Rural Zaire Tab
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Uterine Ruptures in Rural Zaire 329
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CHAPTER 1 CHAPTER 32 Vesicovaginal
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Vesicovaginal Fistula in Democratic
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CHAPTER 1 CHAPTER 33 Ophthalmology
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Ophthalmology Figure 2. Refractive
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Ophthalmology Figure 4. A tonometer
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Ophthalmology 341 ml of 40 mg/ml IV
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Ophthalmology Figure 6. Axis determ
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Ophthalmology 345 thalmic set prepa
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Ophthalmology 347 Procedures Region
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Accommodating Deficits in Material
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Abscesses and Other Infections Trea
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CHAPTER 1 CHAPTER 36 Surgical Train
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Surgical Training of Nurses for Rur
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Training of Medical Assitants in Mo
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CHAPTER 1 CHAPTER 38 Training Surge
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Training Surgeons in the Developing
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Mobile Surgery Figure 1. 405 of tec
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Mobile Surgery Figure 3. 407 Childr
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Mobile Surgery 409 We have realized
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CHAPTER 1 CHAPTER 40 Public Health
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Public Health Problems on Burma Fro
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Medical Adventures in the Nigerian
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CHAPTER 1 CHAPTER 42 Wanted Glenn G
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Wanted 431 Studies Center (//www.am
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Wanted 433 MacArthur (The John D. a
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Wanted 435 most pathologic presenta
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Wanted 437 “outliers” in the he
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World Health 439 challenge: name fo
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CHAPTER 1 CHAPTER 44 Treating Other
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Treating Others: Human Sciences in
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Treating Others: Human Sciences in
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CHAPTER 1 CHAPTER 45 The Impact of
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The Impact of a Volunteer Medical M
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CHAPTER 1 CHAPTER 46 Field Notes on
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Field Notes on a Typical Day in a H
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Surgery and Healing in the Developing World - Dartmouth-Hitchcock

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