Surgery and Healing in the Developing World - Dartmouth-Hitchcock

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23 216 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.
Cleft Lip and Palate Surgery in Developing Countries 217 Not all criteria are set in stone. Some patients may have traveled extraordinary distances or may have been screened and rejected several times in the past. These patients deserve special consideration if time and safety permits. 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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Page 216 and 217: CHAPTER 23 Cleft Lip and Palate Sur
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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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