Surgery and Healing in the Developing World - Dartmouth-Hitchcock

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196 Surgery and Healing in the Developing World
ers” have been used to protect power lines, railways and other infrastructure from
terrorism of insurgents in many countries. It was felt that these tools were a lot less
expensive than human guards.
During the Vietnam war the United States and other countries developed many
new forms of this weapon which rather than just killing one person as a bullet,
would injure or kill a number of soldiers carrying a victim to safety. In the early
1960s the United States also introduced a new class of mines known as remotely
deliverable mines, or “scatterables” to stop the flow of men and material from North
to South Vietnam. Weighing only 20 g, these mines would flutter to the ground
without going off by impact. They were detonated by the compression a foot and
had just enough explosive to tear it off. Many of the US mines were moved by the
opposing forces causing one-third of the American casualties to be from mines—
often American ones.
The United States also developed the M18A1 Claymore mines which has become
one of the most commonly copied above ground fragmentation mine in the
world. Originally designed to be used only on command, it is often rigged with a
trip wire to make it victim-discharged like a true mine. This weapon propels 700
steel balls outward with a 60 degree arc killing at a distance up to 50 meters.
There are three basic types of mines. First the simple mine buried just below the
ground which is set off by pressure. The small ones are antipersonnel mines, the
larger are antitank or antivehicle mines. Then there is the carefully aimed shrapnel
mine usually set of by a trip wire. These may bounce up and kill or injure at a long
distance. Lastly, remotely deployed mines from shells or from helicopters have polluted
vast tracts of land thoughout the world. These butterfly on small mines often
look like toys and injure children as well as adults when they are picked up as toys.
The newest version of mines are often called by the euphemistic term
“submunitions”. These are often cluster bombs which are shot ahead of helicopters
to “pacify the land” to avoid loss of these expensive gunships. In many areas of
Kosovo in the recent conflict up to a third of these bomblets did not explode and
became defacto very strong mines.
In any case we have a worldwide problem of injuries that will need the skills of
surgery in developing countries. As important all traveling expatriot surgeons must,
as the local populace knows, fear ever step especially off the side of a road.
How to Assess the Problem
Before one, as a surgeon or anyone trying to help the landmine victims in a
country, can reasonably work, one must have at least moderately accurate data of the
size of the problem and the capability already existing in the country to handle and
rehabilitate the injured. Too often well meaning physicians and many non governmental
agencies (NGOs) jump into a country to help without diagnosing the problem
or disease (the land mine epidemic).
To avoid wasting valuable resources or time of well meaning volunteers, PHR,
together with many other groups including the World Health Organization (WHO),
the ICRC, and others have developed a simple set of epidemiological tools to assess
any countries epidemic and care capacity.
This set of tools Measuring Landmine Incidents and Injuries and the Capacity to
Provide Care which is published as a manual, can be obtain from PHR.* These tools
*100 Boylston Street, Suite 702, Boston, MA 02116