Surgery and Healing in the Developing World - Dartmouth-Hitchcock

Surgery in Developing Countries
Philosophical Concerns
Motivation
There are many reasons for undertaking overseas surgical service. Among the 2
reasons cited by various writers are such factors as to enrich personal growth as an
answer to dissatisfaction with impersonal medicine, and as opportunity for ingenuity,
creativity, and offering an example to young people without expecting monetary
reward as incentives. A spirit of adventure, or desire for a new experience or relief of
boredom, may sometimes provide the impetus for seeking such service. In themselves
these motivations may not provide the staying power and persistence which
are important in carrying out such missions under what may be very trying circumstances.
As a longtime observer and participant in many such missions, it is my
impression that a sincere desire to perform humanitarian service, whether on the
basis of simple compassion or religious incentives, best serves those seeking such
service.
Flexibility
From my perspective, the three most important considerations in overseas service
are flexibility, patience, and accommodation. In developing countries, perspectives
on time and efficiency are markedly different from those in the U.S. On many
occasions anticipated schedules are totally disrupted and the only appropriate response
is graceful acceptance and patience. It is important that as expatriates our
respect for doing things in the mode of national physicians is apparent. Not infrequently,
national physicians and coworkers may not in any way display their appreciation
of such patience, but they will certainly note exasperation and display of
temper and impatience. If the surgeon seeks to serve with the expectation of interruptions
and delays, they are much more readily handled. These problems may on
occasion be on the basis of well-meant attempts of national medical personnel who
wish to help. Another very frequent frustration is in the form of poor and/or sporadically
functioning equipment or the actual absence of equipment which is deemed
necessary by the surgeon. These difficulties offer opportunities to adapt to challenges
with new techniques and solutions that are practical and frequently essential
outside the highly technical and convenient environment of U.S. medicine.
Cultural Sensitive Health Care
On first exposure to medicine and surgery in the Third and Fourth World countries,
the words “culture shock” may very well apply. To say that things are different
is an understatement in may instances. On a recent trip to a Caribbean island to
provide staffing for a continuing medical education conference, those from the U.S.
who participated were exposed for the first time to the practice of medicine and
surgery in an island university hospital. My young colleagues described the condition
seen as “mindboggling” from a perspective of patient care or a lack thereof, lack
of medicine and equipment including sufficient beds, lack of staffing, and in general
a medical environment that would be totally unacceptable from the U.S. perspective.
Patients from other cultures and physicians as well may understand health,
illness and medical care in ways that differ greatly from our health care providers’
understanding. In relatively primitive cultures, many patients have beliefs that exist
outside of biomedicine and they live by those beliefs. Health care providers from the
U.S. and other more advanced countries may not agree with the logic of such beliefs
7