Surgery and Healing in the Developing World - Dartmouth-Hitchcock

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23 214 Surgery and Healing in the Developing World Table 2. Continued 13. General 13a General Comments What is the currency used? Which credit cards can be used? Can travelers checks be used? Do they accept bank notes? Can money be wired into the country? Where can money be exchanged? What is the rate at the time of the fact-finding? How stable has the rate been over the last year? Which financial institution should we deal with? When are they open? 13b Health concerns to the mission members What is the incidence of blood transmitted diseases in the population (AIDS, Hepatitis, etc.) What is the incidence of other infectious diseases in the population (TB, Yellow Fever, etc.) What vaccination is recommended for travel in your area? a. Malaria b. Cholera c. Polio d. Diphtheria e. Dengue Fever 13c Diplomatic considerations 13d Political considerations *An after photograph in which the patient has fully recovered from anesthesia and is aware of the change in their appearance can be very effective (versus an after photograph of a patient still recovering from anesthesia). Addressing Patients Language barriers are present in all mission situations. If English is spoken, it is often spoken by professionals and not necessarily by the families and patients who come for surgery. Operation Smile ensures the accuracy of patient identification, despite language barriers, by issuing every patient an identification number that corresponds to a medical chart number. In many countries, the differences between English and the native language can be great, so the temptation to address patients as numbers or according to their medical conditions is very real. There are times during a mission when accuracy and efficiency dictate that patient numbers are the best way to refer to patients. That being said, every effort should be made to address patients by name when possible. First name, last name, nickname, mispronunciations – any effort to personalize the process is always appreciated by families and patients. Screening Screening is a selective process. There are patients that will be chosen for surgery and those that will have to be turned away. Keeping the inherent stress of this pro-
Cleft Lip and Palate Surgery in Developing Countries 215 cess in mind during screening is important. Providing patients and families with accurate, honest information is essential. Although we work with our in-country partners ahead of the mission to identify patients suffering from cleft deformities, it should not be assumed that patients and families understand the specific surgery that may be performed. A child may have a cleft lip but a parent may be more interested in having the child’s ear microtia addressed. Misunderstandings can be especially common with patients suffering from multiple deformities or syndromes. Accurately portraying the surgical result is also important. It is important that patients and families are given a realistic sense of the surgical outcome. Stating and restating the specific care and likely result throughout the screening process serves to reduce possible misunderstanding and disappointment. Screening Suggestions Assign a translator to a nurse, an in-country volunteer or the speech/dental team members at the end of the screening process to inquire specifically if patients and families understood the screening process. It is also important that they understand the possible surgery that will be performed and when/how they will be notified if they are selected for surgery. Arrange for medical team members to be available at the notification site to address the needs of patients/families that have been chosen as well as those that have not been chosen for the surgery schedule. Have patient charts available to answer specific questions from patients and families. Screening Priorities Priority 1: Primary Repair of Cleft Lip—All Ages This procedure can be accomplished safely, quickly and with near-guarantee of vastly improved appearance and the restoration of a normal face and smile. The mission team should complete all primary lip cases that are healthy enough for surgery. The safe minimum age and body weight of the patient depends on the setting, equipment and experience level of the anesthesia staff and the safety of the recovery room and surgical floor setting. Priority 2: Primary Repair of Cleft Palate—Ages 1-6 These cases have the greatest success in enabling the patient to develop normal speech. The operation can be done safely in most children over 12 months. The younger the patient, the better the chance of developing normal speech, even when no speech therapy is available in the country. Priority 3: Primary Repair of Cleft Palates—Ages 6-Adult When possible, older children and adults will have the opportunity for reconstruction. While perfect speech is not likely, a great deal of improvement can be achieved safely and in a short period of time. Additionally, the psychology benefits to the patient are enormous. These patients will require good follow-up and must be told that additional surgery may be necessary. Primary pharyngeoplasties in conjunction with palatoplasties may be beneficial in this patient population. 23
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Surgery and Healing in the Developi
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Contents Foreword .................
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25. Dentistry .....................
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Editor Contributors Harold P. Adolp
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Foreword Surgery and Healing in the
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“poor, but modern”, as for exam
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There may be at least one considera
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It is that higher accountability th
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1 2 Surgery and Healing in the Deve
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CHAPTER 2 Surgery in Developing Cou
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2 10 Surgery and Healing in the Dev
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CHAPTER 4 International Surgical Ed
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CHAPTER 9 Lab-in-a-Suitcase: Saving
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10 72 Surgery and Healing in the De
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CHAPTER 12 Communication in the Thi
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CHAPTER 13 Anesthesia in the Third
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13 100 Surgery and Healing in the D
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CHAPTER 15 Basic Obstetrics and Obs
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CHAPTER 16 Pointers for American Su
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Reconstructive Surgery in the Tropi
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CHAPTER 1 CHAPTER 27 Factors Influe
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Distribution and Incidence of Tropi
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CHAPTER 1 CHAPTER 28 Population Dyn
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Population Dynamics Of Surgical Tro
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Metabolic Maladaptation 289 Introdu
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Metabolic Maladaptation 291 some of
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Metabolic Maladaptation 293 In this
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Metabolic Maladaptation Table 1. Si
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Metabolic Maladaptation Table 4. Go
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Metabolic Maladaptation 299 the rev
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Metabolic Maladaptation Table 5. As
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Metabolic Maladaptation Table 6. Co
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Metabolic Maladaptation 305 the ris
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Metabolic Maladaptation Table 8. Go
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Metabolic Maladaptation Table 10. G
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Metabolic Maladaptation Table 12. C
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Metabolic Maladaptation 313 cell an
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Metabolic Maladaptation 315 Biologi
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Metabolic Maladaptation 317 from io
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Metabolic Maladaptation 319 25. Lon
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CHAPTER 1 CHAPTER 30 Nutrition and
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Nutrition and Development in Africa
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CHAPTER 1 CHAPTER 31 Uterine Ruptur
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Uterine Ruptures in Rural Zaire Tab
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Uterine Ruptures in Rural Zaire 329
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CHAPTER 1 CHAPTER 32 Vesicovaginal
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Vesicovaginal Fistula in Democratic
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CHAPTER 1 CHAPTER 33 Ophthalmology
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Ophthalmology Figure 2. Refractive
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Ophthalmology Figure 4. A tonometer
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Ophthalmology 341 ml of 40 mg/ml IV
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Ophthalmology Figure 6. Axis determ
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Ophthalmology 345 thalmic set prepa
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Ophthalmology 347 Procedures Region
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Accommodating Deficits in Material
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Abscesses and Other Infections Trea
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CHAPTER 1 CHAPTER 36 Surgical Train
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Surgical Training of Nurses for Rur
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Training of Medical Assitants in Mo
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CHAPTER 1 CHAPTER 38 Training Surge
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Training Surgeons in the Developing
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Mobile Surgery Figure 1. 405 of tec
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Mobile Surgery Figure 3. 407 Childr
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Mobile Surgery 409 We have realized
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CHAPTER 1 CHAPTER 40 Public Health
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Public Health Problems on Burma Fro
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Medical Adventures in the Nigerian
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CHAPTER 1 CHAPTER 42 Wanted Glenn G
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Wanted 431 Studies Center (//www.am
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Wanted 433 MacArthur (The John D. a
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Wanted 435 most pathologic presenta
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Wanted 437 “outliers” in the he
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World Health 439 challenge: name fo
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CHAPTER 1 CHAPTER 44 Treating Other
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Treating Others: Human Sciences in
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Treating Others: Human Sciences in
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CHAPTER 1 CHAPTER 45 The Impact of
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The Impact of a Volunteer Medical M
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CHAPTER 1 CHAPTER 46 Field Notes on
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Field Notes on a Typical Day in a H
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Surgery and Healing in the Developing World - Dartmouth-Hitchcock

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