Surgery and Healing in the Developing World - Dartmouth-Hitchcock

CHAPTER 16
Pointers for American Surgeons Going
to the Developing World
Donald E. Meier and John L. Tarpley
Philosophy
American surgeons going for the first time to developing world (DW) countries
are immediately impressed by the lack of “essential” equipment and supplies, different
standards of cleanliness, and the lack of an identifiable organizational plan in the
operating room where they are supposed to work. The degree of developmental
deficit varies from country to country and from hospital to hospital within a given
country. The easiest defense mechanism for dealing with the inevitable feeling of
hopelessness is to determine when the next flight leaves for home, get out of there as
quickly as possible, and write the trip off as an error in judgment. That is certainly
the easiest solution, but in our opinion not the best one. We offer a few suggestions
for you to try before giving up and heading for home. Attitude is vital; join in as a
partner and coworker. Treat your fellow physicians with respect. The first advice is
the proverbial, “Make sure it’s broke before you fix it.” Study the systems presently
at work in the hospital, realizing that these systems have evolved for a reason and
may end up being the best solution to the problem. Don’t jump to the conclusion
that everything you as an American surgeon do is good, and everything “they” do is
inferior. Find out from the local health care providers what their perceived needs
are. If you work hard to provide solutions for unperceived problems, the changes
you attempt will not last as long as the cloud of dust your vehicle makes as you leave
for the airport.
Only when you have adequately assessed the existing situation can you formulate
a plan for gradual change. The longer you can stay in the situation the better
chance you will have of making significant changes that will last after you have
returned to America. Be sure that the end result is worth the windmills you will have
to fight to get there. Return to the same hospital at a later time. You will have more
knowledge of the situation, and your advance planning will be much more specific
after your introductory trip. With a little bit of assessment and planning and a lot of
patience, you can indeed make a significant contribution to surgical care in developing
countries around the world, especially if you understand that the most important
contribution you will make is in the area of training physicians, nurses, and
other health care workers. The old proverb of giving a man a fish and letting him eat
for a day or teaching him to fish and letting him eat for a lifetime is nowhere more
true than in DW health care. We like to take that proverb one step further to say
that if you teach a man to teach others to fish, then the whole community can eat for
a whole lifetime.
Surgery and Healing in the Developing World, edited by Glenn Geelhoed.