Surgery and Healing in the Developing World - Dartmouth-Hitchcock

There may be at least one considerable advantage to practicing in a world
of such constrained resources: we cannot use the first-world redundant excesses
of material goods as a substitute for judgment. Ingenuity is not only
rewarded, resourcefulness is a requirement! A favorite aphorism of my own
in such settings is: “We have no money; therefore, we must think.”
Healing in World Health
The title of this book might be faulted as rather expansive if not overly
ambitious. I am willing to risk that stretching. “World Health” itself is a very
ambitious term, and should be understood to cover the environment as well
as the human populations which are a very major, but not the only living,
part of this green globe. Much of what the surgeon achieves in gaining the
confidence of patients one at a time can be translated to cooperative effort at
addressing some of the other global oppressions of the environment including
the population pressures and the pollution of despair. Surgery is one
humanitarian activity embedded in and a very valued part of the whole society
with which one inter-relates. You already have the basics—after all,
anatomy and physiology are put together very much the same way in form
and function on whichever side of any boundary that humans draw around
themselves, and there is no society which I have yet encountered that does
not value the direct intervention of surgical services—particularly when they
are personally and urgently needed. This is the reason most of us got involved
in the profession in the first place—because of the personal satisfaction
of performing a demanding and needed service for which one can see
an immediate and attributable result. Now, take that individual job satisfaction
and enhance that patient population evaluation an order of magnitude
up to a new plateau.
Medical service in general, and surgical services in particular, are a nearly
ideal bridge across the many barriers human populations have used to separate
us from others who may look, sound, believe or act differently. Most of
those differences dissolve quickly enough during the immediacy of an acute
abdomen. There is an acute and chronic deficiency of healing in the developing
world of the surgical sort, and a lot of understanding can be drawn
from human interaction seen in this model. There is a lot of receptivity to
this sort of exchange on the part of the effected populations if the profession
can make the effort to go half way in their direction. I have been privileged
to observe as whole community self-help action efforts were initiated, including
medical programs (an obvious correlate) population programs, (less
apparent immediately) and an educational, arts and development program
which flourished after the initiative demonstrated in a start-up surgical clinic.
The infrastructure followed, rather than preceded the installation of the curative
services which otherwise would be forever in retreat in the face of the