Surgery and Healing in the Developing World - Dartmouth-Hitchcock

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216 Surgery and Healing in the Developing World
Priority 4: Secondary Repairs of Lips and Palates
If time allows, and priority 1, 2, and 3 patients have been accommodated,
secondary repairs can be scheduled. Each case should be considered on its
merits and the benefits compared to competing cases.
Priority 5: Other Conditions
Despite the temptation to try to help patients with severe hand deformities
and burn contractures, the team should avoid cases requiring prolonged
anesthesia, extensive grafting and prolonged, complicated follow-up or rehabilitation.
Most sites will not be able to provide the follow-up care or
therapy necessary for the patient to gain functional improvement or an
improved appearance. If for political or other reasons those cases cannot be
avoided, be very selective as to what is done and advise patient and family
on the potential for little to no improvement. Identify a local surgeon who
understands the complexity of these cases and is willing to assure the necessary
follow-up.
Surgery
The surgical week can also be a very stressful time for families and patients.
Keeping babies and small children content during preop, surgery, and post-up can
be times of confusion and uncertainty. Providing patients and families with information
about the preop process, surgical and anesthesia procedures, and post-op care and
expectations are all ways to alleviate unnecessary stress for patients and families. Keeping
waiting patients and families out of post-op areas is a good way to minimize views of
post-anesthetic patients and post-op patients who may have swelling and bleeding –
which can often upset waiting patients and families.
Surgery Suggestions
In sending patients to surgery, the anesthesia provider or nurse receiving the
patient should confirm the procedure and review post-op expectations and
procedures with the parent/guardian.
Explain pain-management and common after-effects of surgery immediately as patients
and families arrive in post-op. Arm restraints, blood spit up, tongue
stitches, etc., should be discussed when the patient arrives in post-op. It is
very important to cover these issues with the parents/guardians/patients as
early as possible after their arrival in the unit. In many cultures, spitting
and vomiting blood can be viewed as a sign of impending death, so a lack
of accurate information can cause great concern. Simply treating post-op
symptoms without addressing the concerns of families can cause undue
confusion, worry and tension. Operation Smile recommends that translators
are specifically assigned and designated to work in the post-op area.
The surgical and anesthesia team leaders will make the surgical team assignments.
These assignments should specifically designate which surgeon, anesthesiologist,
operating room nurse and instrument person will be working
together in a specified operating room at a specified table. Previous
mission experience as well as experience and comfort level with pediatric
cleft lip and palate patients should all be taken into account when making
surgical team assignments.