Surgery and Healing in the Developing World - Dartmouth-Hitchcock

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152 Surgery and Healing in the Developing World
Don’t assume your patients have been immunized against tetanus. The most
trivial wound can be lethal. Always immunize. Debride widely. Be quick to leave
wounds open unless conditions are ideal. Think like a military surgeon.
Perhaps the greatest challenges are patients with burns and spinal cord injuries.
Management of such devastating injuries will vary greatly by locale, economics, and
the infrastructure available—or not. Seek the guidance and input of the physicians
at your host hospital. Heroic effort on a hopeless cause can deplete scarce supplies
needed for patients who can recover. Think “triage” and couple realism with your
idealism.
Travel Tips
Because the success of your medical experience may be dependent on having the
minimum basic supplies and equipment required for your surgical subspecialty, find
out in advance your baggage allowances and restrictions. Most airlines permit each
passenger to carry two items, weighing up to 70 pounds each. Extra bags may be
permitted for an additional fee, but most airlines require notification several days
before the flight of the exact number of excess pieces. Sturdy boxes such as those
obtained from truck rental agencies and heavy duty plastic footlockers make excellent
supply carriers. Be cautious about excessive amounts of drugs and ask your host
to find out if permits are required for drugs as well as supplies. Airlines do not
permit dangerous or flammable items and some medical supplies fall into these
categories. As already mentioned above, the electrical variations in many areas necessitate
transformers for electrical items which hopefully will be available at the
host institution. Check before you travel. If possible, consider leaving behind any
bulky item as a gift.
References
1. In: King M, ed. Primary Anaesthesia. Oxford: Oxford University Press, 1986.
2. In: King M et al, ed. Primary Surgery. Oxford: Oxford University Press, 1990:1.
3. In: King M, ed. Primary Surgery. Trauma. Oxford: Oxford University Press, 1987:2.
4. Meier DE, Tarpley JL. Improvisation in the developing world. SG & O 1991;
173:404-406.
5. Meier DE, Tarpley JL et al. Hematogenous osteomyelytis in the developing world—
A practical approach to classification and treatment with limited resources. Contemporary
Orthopedics 1993; 26:495-505.
6. Meier DE, Tarpley JL, Imediegwu OO et al. The outcome of suprapubic prostatectomy:
A contemporary series in the developing world. Urology 1995; 46:40-44.
7. Meier DE et al. Ketamine—A safe and effective anesthetic agent for children in
the developing world. Pediatric Surgery International 1996; 11:370-373.
8. Meier DE, Tarpley JL. Typhoid intestinal perforations in Nigerian children. World
Journal of Surgery 1998; 22:319-323.
9. OlaOlorun DA, Meier DE, Tarpley JL. Operative management of thyroid abnormalities
in a general medical practice in sub-Saharan Africa. Tropical Doctor 2000;
30:6-9.
10. Tarpley JL, Meier DE. Surgery in the developing world. In: Strickland GT, ed.
Hunter’s Tropical Medicine. 8th ed. Philadelphia: WB Saunders, 2000.