Surgery and Healing in the Developing World - Dartmouth-Hitchcock

Tropical Nursing
feeding slowly to encourage retention of the feeding. Often the mother or a relative
can express breast milk until the baby is strong enough, and the sucking/swallowing
reflexes are coordinated. The neonates of cretins and hypothyroid mothers are very
delayed in their sucking reflexes, and these babies need gavage or preemie bottles
with the intake monitored carefully. The cretin mother’s production of breast milk
is usually delayed by several weeks, necessitating supplementation to ensure a weight
gain of at least 25 grams per day. She also needs careful training in breastfeeding
skills, as, while the milk production is a natural process, the skill to coordinate
baby’s mouth to the areola usually needs to be taught and monitored. The joy that
the mother experiences with having a satisfied and growing baby is worth all the
midnight and early morning hour trips over to maternity to feed these tiny newborns!
One significant influence on having full term babies and healthier children is the
level of education of the mother. According to the World Bank studies in 25 countries,
even one to three years of maternal schooling reduces child mortality by about
15 percent. Educated women are more likely to access prenatal care, delivery assistance,
and information on health and safe drinking water. For this reason, maternal
education was encouraged during the prenatal visit classes, well child clinics, and
community meetings. I worked closely with the local school teachers to assist in the
health education curriculum, maintain the health of the students and faculty, and
obtain supplies for the school. One of the best investments for health promotion is
education of children, particularly girls as their education affects the lives of their
offspring to a greater extent than that of the fathers.
Immunization clinics are profoundly important to protect the lives of the babies
and children. Often these children are already poorly nourished, anemic,
immunocompromised, and a childhood illness which may cause a mild illness for a
child in a First World environment, often proves fatal for a Third World child. The
ever present challenge for vaccines is transport and storage which maintains the
cold/freezing temperatures required. This is particularly difficult in hot climates.
The refridgerator models with solar energy have worked well if maintained properly.
Immunization, growth and development records are vital for the parents to protect
and present at the clinics. The measles vaccine can be safely administered to a baby
of six months of age during an epidemic if a second dose to raise the antibody level
is given after 12 months of age. This vaccine is highly efficacious, providing protection
within seven days and saving the lives of many, many children.
The nursing career in a Third World country is extremely diverse, requiring
creative approaches to time-honored principles of application, constantly assessing
the outcomes. The satisfaction and joy exceed the frustrations when one reflects on
the healthier and more comfortable lives one has touched.
Selected Reading
1. In: Atkinson, William, ed. Epidemiology and Prevention of Vaccine-Preventable
Diseases. CDC. 3rd ed. Department of Health and Human services, 1996.
2. Johnson Osa. I Married Adventure. Philadelphia: Lippincott Co., 1940.
3. Brewster, Thomas, Elizabeth. Language, Acquisition Made Practical. Colorado
Springs, Colorado: Lingua House, 1976.
4. World Bank. World Development Report 1993: Investing in Health. Oxford: 1993.
5. Wilcocks, Manson-Bahr. Manson’s Tropical Diseases. Baltimore: Williams and
Wilkins Co., 1972.
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