Surgery and Healing in the Developing World - Dartmouth-Hitchcock

Preparation Time
prominent official stamp usually makes the document more acceptable to the bureaucracy
of Third World countries.
Immunizations. Generally speaking, there are very few immunization requirements
to enter any country in the world. One exception is the yellow fever vaccination.
Many countries do require it of all incoming travelers. Others require it only if
a person is travelling from a country where yellow fever is endemic. Yellow Fever is
found in much of Africa, (excluding some parts of both North and South Africa) It
is also found in many parts of South America. Yellow fever vaccination is available at
county health departments and usually requires an appointment rather than walk-in.
But, even if there are few requirements for travel, many immunizations may
indeed be strongly recommended. First of all, one’s basic immunizations should be
up to date. This includes tetanus-diphtheria, polio, and for those persons born after
1957, MMR (mumps-measles-rubella) as well. Tetanus-diphtheria is good for 10
years, but if one is coming at all close to the 10 year time, it would be a good idea to
update it and be relieved of the necessity of a booster on the field if an injury should
occur. There is a global polio eradication scheme in operation, but this has not yet
been achieved. Polio should be boosted and IPV (as opposed to OPV) should be
used to bypass the very small risk of contracting polio from the live virus. MMR too
should be boosted if this has not been done since childhood. Hepatitis A vaccine
should be given: the series consists of two shots 6-12 mos. apart but the first dose
will protect for short-term travels to Third World countries if given 3 weeks before
travelling. Doing medical work makes hepatitis B protection mandatory and most
of us assume that all medical personnel have this protection. However, a recent
CDC report shows that as many as 30% of medical personnel (those falling outside
of OSHA regulations) have not been immunized. It should be noted too that Hepatitis
B is endemic in the orient making it doubly important to have on board if
working in this part of the world. Travelling and working in the middle belt of
Africa encompasses the so called “meningitis belt” and the polyvalent vaccine
Menomune (Sanofi Pasteur makes this vaccine) should be administered. Duration
of protection is not precisely known, but this should be repeated every 3 years or
thereabouts if travelling to this area.
Immunization against typhoid is available in both oral and injectable form. The
oral product is manufactured in Switzerland and is available through Berna Products
Corp located in Coral Gables, FL. It is a live vaccine and needs to be repeated
only every seven years. Use of the oral preparation is preferable. There are two injectable
vaccines available, one manufactured by Pasteur Merieux Connaught is single
dose while the Wyeth Ayerst product requires two injections separated by one month.
Cholera vaccine gives little protection, is somewhat reactogenic and therefore its use
is not advised. There have been instances in Third World countries (in response to a
cholera epidemic in that country) in which cholera immunizations have been suddenly
mandated. It may be wise to carry with you a note from your personal physician
saying that you should not have this immunization for medical reasons. If the
status of protection against hepatitis A and B is unclear, antibody titers should be
drawn to clarify this issue.
If working in the Far East, one should check with the CDC for their recommendation
regarding Japanese encephalitis vaccination.
There are a number of simple items that should be carried with you since purchasing
them on site may not be easily possible. These include simple pain medications,
good quality sunglasses, mosquito repellent (should contain DEET), sunscreen
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