Surgery and Healing in the Developing World - Dartmouth-Hitchcock

Colombia). I once made the observation that the two full time jobs that I
could see in Southern Africa were “Standing Guard” and “Lying in Wait”,
with sometimes the same ambitious individuals working in each sector, changing
roles at the changing of the night shift!
We have neighbors in each camp, but they are disproportionately distributed
globally. It is a commonplace to speak of all the things we have in
common among “all God’s children”, but it is far more comfortable to speak
of the disadvantaged in the abstract than in the smelly concrete. Most of the
readers of this book regularly encounter a majority of their daily contacts in
First Worlders, so it must seem that most or much of the world lives “like
us.” Not even close to us.
Most of the globe’s citizens live and die without benefit of a physician’s
attention. More than 90% of the world’s surgical needs exist outside Europe
and North America, yet all our training and technology are geared to service
this minority representation of the world’s needs, while the vast majority of
the world’s needs for further surgical services are comfortably outside our
view. The fact that you hold this book in hand means that you are interested
in raising the blinds to look toward that larger world. There is a very great
deal of it around you, often closer and more accessible than you might think.
But, you may say, “ I have skills that are useful and could be employed to
help, only if the very large system in which they have been developed comes
along with them in an integrated team. Just what can you expect one person
to do when taken out of his or her element and injected into a very foreign
field facing such overwhelming demands with so little to offer? Surgery is a
very labor- and equipment-intensive process, and we deal with concentrated
effort invested in single individual patients, one at a time! Shouldn’t these
developing countries just forgo curative services such as surgery and concentrate
on population-wide preventive services in public health instead?”
I would hardly be one to disagree with the primacy of public health approaches
to populations there—or here—as a “wholesale” approach to health
care needs. But what credibility would preventive services have when any
curative services are denied or disparaged and these very visible and quite
understandable indices of health care are declined to be offered since they
may not be cost effective? It is fatuous if not cruel to make the specious
statement “If only you were healthier, you would not be so sick just now!”
akin to lecturing on the efficacy of safety belts to trauma victims in the
emergency room. There is a very large role for surgeons in public health,
sanitation, potable water and population projects based in two things that
are quite viscerally apparent to the patient population: concern and credibility
in curative care.