Surgery and Healing in the Developing World - Dartmouth-Hitchcock

The Prevention and Treatment of Landmine Injuries
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are an effort to standardize data collection. The tools can be used easily and quickly
to get accurate data and can be repeated every few years to measure change.
The first tool is a Hospital Data tool design to either prospectively or retrospective
gather data on all mine victims with details on outcomes and the demographics
of the injury. This tool can be set up as a surveillance system from ongoing reporting
of hospitals to ministries of health and then to WHO and the Geneva International
Humanitarian Demining Center. From personal experience ongoing data collections
systems are hard to maintain due to fatigue of the permanent staff data collectors.
Repeated short surveys using the same tool with record reviews by outside
NGOs may be able to get more reliable date.
The second tool is the Community Survey tool which actually uses standard
sampling methods to do field studies in local villages and towns. This latter tool is
essential to pick up, what we expect from experience, is the close to half of the
victims that never survived long enough for hospital care. These tools together can
quickly let any health planner or outside agency know the extent of the mine problem
in the country. The community tool also gives data on the perceived fear of
mines. If a community thinks a field is mine infested, that land is of no use until
inspected inch by inch with metal detectors or dogs.
The third tool or Hospital Capability tool measures a country’s capacity to handle
the surgical needs of victims. This assesses the hospital’s water and electrical systems
as well as laboratory and blood systems. This tool is really a hospital inspection of
the physical plant and documents the surgical staffing of a hospital. Many donors
want to give aid to landmine victims, when their most important gift may be helping
out the infrastructure of the medical system. This tool cannot document well
the motivation of a hospital staff but does determine manpower needs. Surgeons
wanting to help victims of landmines often are most useful teaching their peers in
developing countries how to accomplish good surgery with minimal equipment.
The fourth tool is a Prosthetics Center Capability tool to physically assess prosthetic
facility capacities. Before one starts new prosthetic programs, one must know
in detail the number and production capacity already in the country.
The last tool is the Social Reintegration tool to measure the effectiveness of all of
the above work. Here victims found from hospital discharge data or rehabilitation
units are interviewed to see if they are using their prostheses and if they are back in
school or working. This last tool is the most important. It is not enough to say that
surgery has been done or thousands of prostheses made unless these interventions
are actually successful in returning a mine victim to a fully participatory citizen of
his country and for his or her family. In some areas we found that no one was using
their above knee prostheses. In another country we found victims with three or four
prostheses from different shops and none were being used. Without feedback of an
intervention, donors may be wasting their efforts in poorly designed projects.
Treatment of Injuries
For surgeons simple basic skills are needed and should be taught for treating
mine injuries. The International Committee of the Red Cross (ICRC) has classified
three patterns of injuries:
Pattern 1 injuries are blast injuries caused by stepping on a mine which usually
results is the loss of one leg and often injures the other leg and genitalia. Dirt, clothing
,and mine fragments are driven into the leg and surrounding tissues.
Pattern 2 injuries are caused by above ground mines,usually detonated by a trip
wire. These mines cause chest and abdominal injures often to two or three people in
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