Surgery and Healing in the Developing World - Dartmouth-Hitchcock

Tropical Nursing
Language acquisition is imperative, as communicating effectively is vital to providing
medical and nursing care. The books Language Acquisition Made Practical
(LAMP) or Language Learning and Mission by Elizabeth PhD and (the late) Thomas
Brewster, PhD are extremely practical and helpful guides in learning and using languages.
The Wycliffe Summer Institutes of Linguistics are superb in language training.
Tapes of some of the more common languages are also helpful. On site, a fearless
language coach is invaluable for correcting pronounciation, inflection and idiom. In
the beginning, a list of helpful common medical phrases enables one to memorize
quickly and get started with patient care. We all have our horror stories of mispronouncing
a word leading to unintended meanings! Practice giving health instructions
and taking histories with someone who won’t mind.
A library for personal reference, teaching, mental refreshment and stimulation is
valuable. Have available great texts on subjects such as surgery (I appreciated Dr S.
Swartz’ surgical textbook), medicine, pediatrics, a PDR, Manson’s Tropical Diseases,
CPR by American Red Cross, Midwifery, public health, nursing, accounting and
economics (how to write grant applications!), immunizations (Epidemiology and
Prevention of Vaccine-Preventable Diseases by CDC), anthropology, children’s books
for young visitors. To remain current in the field of medicine, subscriptions to medical
journals such as the British Journal of Tropical Medicine, are invaluable. For teaching,
it is essential to have a stock of visual aids and charts on nutrition, childbirth, transmission
of disease, hematology and parasites, oral rehydration, skin and eye diseases,
etc. Also books for recreation are appreciated: spiritual and historical bios, poetry,
art, sports, handiman’s journal, encyclopedias and world atlas, history of music or
whatever is of interest to the individual.
Providing Equipment and Supplies
A tremendous challenge in tropical nursing is to remain within budget yet viable
as a healthcare institution. Having a team of friends ever on the lookout for used
equipment in good repair is a great asset. A quick look around our O.R. showed
used tables (nonelectric), stainless steel basins and bedpans that had been replaced
with plastic supplies elsewhere, glass syringes no longer used, glass thermometers.
As hospitals merge or downsize, often this equipment is given away. In a Stateside
O.R. or labor and delivery, sterile equipment that is opened but unused is discarded.
A collection box in the supply room can amass enough equipment to supply a Third
World hospital for a year or more, as labor costs for resterilizing are cheaper than
purchasing it. This method is great for collecting suture, catheters, sponges, ace
bandages, gloves, drains. Inexpensive wraps for reautoclaving equipment can be sewn
from muslin or cotton sheets. I used fabric of various colors to color-code the wraps
and covers to make repackaging easier.
A treadle sewing machine can be a nurse’s best (almost) friend in setting up a
hospital by sewing the patient and fenestrated drapes, equipment and instrument
wraps for autoclaving, Mayo stand covers, glove wrappers, curtains. For maternity, I
enjoyed sewing baby blankets and shirts. I had a carpenter make little cribs to accommodate
the buggy-sized mattresses I had brought from the States, then sewed
soft flannel fitted sheets.
One elderly gentleman whose chest was burned in a flareup while huddled in
front of an evening fire, routinely pulled off his bandages and picked at the wounds.
I sewed several cotton vests with ties that remained secure between dressing changes
until the burns had healed. For mobile village clinics, keeping equipment handy
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