Surgery and Healing in the Developing World - Dartmouth-Hitchcock

CHAPTER 2
Surgery in Developing Countries
John E. Woods
Surgery in the developing countries may be one of the most rewarding and fulfilling
experiences in a surgeon’s professional life provided that his/her expectations
are realistic.
The purpose of this chapter is not to persuade those who have such an inclination
to undertake such an endeavor. Rather it is an attempt to provide a screening
process whereby one can determine if this type of service is suitable for the individual
surgeon. There is often a perception that overseas service, especially in countries
with less well-developed medical systems, is a rather glamorous undertaking
and one about which one might very well be enthusiastic. This may well be the case,
but not too infrequently the experience for the ill-prepared is a negative one, prompting
a volunteer to say “altogether an unpleasant experience and one that I will never
attempt again,” or “I simply could not work there again.”
Without attempting to dissuade U.S. surgeons, my objective is to provide reasonable
information about what such service entails—the obstacles, the frustrations,
and the difficulties, as well as the fulfillments. 1
Over the past several decades physicians, nurses, and paramedical personnel from
the U.S. have frequently been involved in voluntary medical service overseas. With
our increasing consciousness of the responsibility of the relatively privileged and
affluent has come an increasing volume of volunteer work serving the indigent and
underserved in developing countries. There are many organizations now involved in
such care, varying from the large and well-organized such as AmeriCares, Doctors
Without Borders, Operation Smile, to the smaller organizations, some supporting a
single site. Some of these organizations provide partial financial support for the
endeavors, but in the great majority of instances such missions are carried out at the
volunteer’s own expense, and not infrequently on vacation time. In addition to the
clinical practice of surgery, medical volunteers have frequently participated in CME
conferences overseas aimed at educating professionals in developing countries with
support for indigenous care. Such legitimate professional educational activities are
in some instances supported by parent organizations. Because of fewer time restraints,
retired physicians will often have greater opportunity to serve.
Again, this chapter is prompted in part by the desire to provide information to
physicians who have not as yet been involved in overseas service and who have a
keen interest in doing so. It is hoped that the following considerations will better
inform and prepare those who anticipate such service. This will provide only a brief
overview of the basics both from the practical and philosophical perspectives.
Surgery and Healing in the Developing World, edited by Glenn Geelhoed.