Surgery and Healing in the Developing World - Dartmouth-Hitchcock

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16 148 Surgery and Healing in the Developing World Figure 2. “Roll your own”. If you do not have a supply such as rolls of POP, improvise. What is the challenge? What are the available resources? Figure 3. “Ropes, Pulleys, and Physics”. Orthopedic surgeons are a rarity in most of the developing world. Adapt your treatment to the appropriate level of technology at your host hospital. With each visit develop the infrastructure to elevate the level of practice. Anesthetic capability varies dramatically between DW hospitals. A pulse oximeter fits well into a small area of a suitcase and is a wonderful contribution to the safety of patients in a DW country (Fig. 4). Local and regional anesthetics can be use extensively. Ketamine, which is inexpensive and safe, is often used as the sole anesthetic agent in children. It can also be used effectively in adults, but diazepam should be added in adults to moderate emergence reactions.
Pointers for American Surgeons Going to the Developing World Figure 4. “Essential equipment”. Every hospital, whether in the developed or developing world, needs pulse oximeters, especially in the OR and recovery room. 149 American general surgeons are comfortable handling most intra-abdominal problems in the DW. One unfamiliar problem, however, is perforated typhoid enteritis. These patients have usually been ill for over a week and are grossly septic, volume depleted, and malnourished. The best plan of attack is volume repletion, antibiotics (whatever is available), and operation. The simplest operation is debridement and primary closure of the perforation. If perforations are multiple, resection of the affected segment should be considered. These patients are ill for several days postoperatively, and many of them go on to develop multisystem organ failure. The mortality rate is as high as 35%. Inguinal hernias are ubiquitous in the DW, many of them quite large. The American surgeon going to a DW country needs to forget that Dr. Lichtenstein ever existed. A good Bassini or Cooper’s ligament repair in the DW is much more appropriate than sticking in a piece of mesh. Utilize a generous relaxing incision to decrease tension. If a prosthetic patch is absolutely required, harvest the appropriate size of fascia lata from the patient’s ipsilateral thigh. Fascia lata is available, affordable, sterile, and versatile. (Additionally, we have utilized fascia lata additionally to close chest wall defects and dural deficits). Patients with malignancies tend to come late in the course of their disease. Chemoand radiotherapy are often not physically or economically available, and operation is the only chance for cure. However, because of late presentation, most operations are directed at palliation i.e., toilet mastectomy for breast cancer and bypass procedures for pancreatic or gastric carcinoma (Fig. 5). 16
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Surgery and Healing in the Developi
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Contents Foreword .................
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25. Dentistry .....................
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Editor Contributors Harold P. Adolp
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Foreword Surgery and Healing in the
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“poor, but modern”, as for exam
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There may be at least one considera
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It is that higher accountability th
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1 2 Surgery and Healing in the Deve
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CHAPTER 2 Surgery in Developing Cou
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2 10 Surgery and Healing in the Dev
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CHAPTER 4 International Surgical Ed
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CHAPTER 9 Lab-in-a-Suitcase: Saving
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10 72 Surgery and Healing in the De
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CHAPTER 12 Communication in the Thi
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22 198 Surgery and Healing in the D
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CHAPTER 23 Cleft Lip and Palate Sur
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CHAPTER 24 Outreach Dentistry: A Wo
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CHAPTER 1 CHAPTER 26 Reconstructive
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Reconstructive Surgery in the Tropi
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CHAPTER 1 CHAPTER 27 Factors Influe
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Distribution and Incidence of Tropi
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CHAPTER 1 CHAPTER 28 Population Dyn
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Population Dynamics Of Surgical Tro
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Metabolic Maladaptation 289 Introdu
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Metabolic Maladaptation 291 some of
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Metabolic Maladaptation 293 In this
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Metabolic Maladaptation Table 1. Si
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Metabolic Maladaptation Table 4. Go
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Metabolic Maladaptation 299 the rev
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Metabolic Maladaptation Table 5. As
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Metabolic Maladaptation Table 6. Co
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Metabolic Maladaptation 305 the ris
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Metabolic Maladaptation Table 8. Go
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Metabolic Maladaptation Table 10. G
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Metabolic Maladaptation Table 12. C
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Metabolic Maladaptation 313 cell an
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Metabolic Maladaptation 315 Biologi
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Metabolic Maladaptation 317 from io
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Metabolic Maladaptation 319 25. Lon
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CHAPTER 1 CHAPTER 30 Nutrition and
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Nutrition and Development in Africa
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CHAPTER 1 CHAPTER 31 Uterine Ruptur
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Uterine Ruptures in Rural Zaire Tab
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Uterine Ruptures in Rural Zaire 329
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CHAPTER 1 CHAPTER 32 Vesicovaginal
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Vesicovaginal Fistula in Democratic
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CHAPTER 1 CHAPTER 33 Ophthalmology
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Ophthalmology Figure 2. Refractive
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Ophthalmology Figure 4. A tonometer
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Ophthalmology 341 ml of 40 mg/ml IV
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Ophthalmology Figure 6. Axis determ
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Ophthalmology 345 thalmic set prepa
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Ophthalmology 347 Procedures Region
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Accommodating Deficits in Material
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Abscesses and Other Infections Trea
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CHAPTER 1 CHAPTER 36 Surgical Train
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Surgical Training of Nurses for Rur
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Training of Medical Assitants in Mo
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CHAPTER 1 CHAPTER 38 Training Surge
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Training Surgeons in the Developing
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Mobile Surgery Figure 1. 405 of tec
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Mobile Surgery Figure 3. 407 Childr
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Mobile Surgery 409 We have realized
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CHAPTER 1 CHAPTER 40 Public Health
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Public Health Problems on Burma Fro
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Medical Adventures in the Nigerian
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CHAPTER 1 CHAPTER 42 Wanted Glenn G
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Wanted 431 Studies Center (//www.am
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Wanted 433 MacArthur (The John D. a
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Wanted 435 most pathologic presenta
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Wanted 437 “outliers” in the he
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World Health 439 challenge: name fo
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CHAPTER 1 CHAPTER 44 Treating Other
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Treating Others: Human Sciences in
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Treating Others: Human Sciences in
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CHAPTER 1 CHAPTER 45 The Impact of
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The Impact of a Volunteer Medical M
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CHAPTER 1 CHAPTER 46 Field Notes on
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Field Notes on a Typical Day in a H
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