Surgery and Healing in the Developing World - Dartmouth-Hitchcock

Chronic Pyogenic Osteomyelitis in Rural Africa
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physical labour, and neglected microtrauma all contribute to the predominance of
this disease in the lower limbs.
What are the short and long term consequences of CPO? The average of a hospital
stay was 88.1 days. Children and adolescents would thus lose 3 months attendance,
which represents one-third of the school year. Our average length of stay is
much higher than that found by Burgess in Nepal back in 1982 (33 days). This
difference can easily be explained by the fact that our patients’ lesions were generally
more severe at the time of presenation, due to the fact that most of them delayed
treatment as they lacked the means to pay for the cost of medical care. Thie prolonged
absence from school severely affects the education of youth, who are the
hope the future development of a nation. The young person becomes handicapped
from a physical and intellectual point of view, while the country waits for his contribution,
which, perhaps will never come.
Our country is also presently stricken by an economic crisis that had far-reaching
effects in many areas. Consider that the salary of a university professor receives less
than $20 US per month, and that of a physician employed by the state is less than
$15. How then is a poor, simple villager supposed to find the means to care for his
or her child when a university professor or physician would be unable to do the
same?
The cost of $2.77 per patient per day at our hospital was much higher than that
found by Burgess 6 who had a cost of $0.79 (50 pence sterling). As emphasized
above, the reason for this high cost is due to the severity of the lesions, which demanded
longer, stronger and more frequent treatment. This situation causes an entire
family to become deeply indebted in order to fund medical care.
The patients who came from villages or localities where there was either a physician
or nurse able to adequately care for osteomyelitis accounted for 75.55% of the
cases. So why then, despite this availability of healthcare, do patient come to us in
such an advanced stage of osteomyelitis? Many reasons are possible among which
are the ignorance and traditional beliefs which lead patients to consult folk doctors
before they come to the health centre or hospital. From the medical teaching standpoint,
it is necessary to stress to young physicians and nurses that a febrile state can
mask other things (for example CPO) and does not necessarily indicate a malaria!
CPO is a frequent pathology that strikes our youths and children during their
active period of life. Due to the long term consequences such as physical handicap,
depleted socio-economic ressources and therapeutic difficulties, we agree with
Ogunjumo 5 that a policy of rigorous intervention is necessary.
From our perpective, in order for us to have victory over this disease, the following
preventive strategies must be employed:
• We must take into account the fact that nurses play a role of major importance
in our health system. 7 It is necessary to insist during their training
(both pre- and post-graduate) on early and adequate treatment of acute
osteomyelitis.
• We must also see health education as the first and foremost responsibility
of all medical personnel to the population that they follow.
• We must realise that only a general improvement in socio-economic conditions
will enhance a country’s development and subsequently the standard
of medical care. If these improvements do not take place, CPO will continue
to be a rampant attestation to our poverty and underdevelopment.
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