Surgery and Healing in the Developing World - Dartmouth-Hitchcock

severe deficiencies of everything to support it, not least of which were the
skills and materials thought necessary to be in place before the pyramid
could be developed.
The Intents and Contents of this Book
You have brought your own motives; this book should suggest some help
for you with the means. It may inspire you to confirm your commitment to
go abroad, but would be a disservice if you arrived unprepared for what will
confront you. A realistic, not very dreamy, encounter awaits you, and if this
book gives a cushion in the culture shock of the first exposure to the unexpected,
it is good preparatory reading.
In terms of motivation, four perspectives are offered along a spectrum of
experience from medical student to surgeons very experienced in both First
and Third Worlds upon retirement from busy practices in each. In answer to
“What is it going to be like?” a very realistic answer to that question is the
best preparation for a successful encounter without disillusionment. Tricks
of ancillary trades add to the resourcefulness that can be brought to the field
in laboratory, anesthesia, nursing services, and even such taken-for-granted
supply of your own utility services such as water, electricity and basic materials
like IV fluids and suture. Specific surgical treatments can be adapted to
the resource constraints by applied ingenuity in a section on the tools and
techniques that can be improvised to accommodate fundamental surgical
principles. And an important component of the medical mission is the
sustainability of it through the training and continuing encouragement and
assistance to those who will carry on at the field site, passing on and
indigenizing hope. Through your service, teaching and learning, lives should
be enhanced on either side of the exchange. These goals are outlined in the
intents and contents of this book.
The experience of traveling abroad to work as a volunteer is never a oneway
exchange. It is a very intensive learning experience for the First World
learner, who can appreciate fully that the principles and concepts he or she
may have originally learned when they were married to a tool or technique
in the system in which he or she originally learned it—now separated from
the plumbing and abstracted in application to a very much larger sphere of
medical practice, are you still in command of the concept and can you adapt
it around critical pieces of the plumbing that may be missing? It is the ultimate
in sophistication to use the simplest means to achieve a satisfactory
end result. This skill is honed beyond most of our imaginations on a daily,
nearly case-by-case basis by most of the Third World’s practitioners, and this
is a postgraduate course we must learn from them in an era of retrenchments
as our own redundant medical resources are constricted to a higher outcome
accountability.