Surgery and Healing in the Developing World - Dartmouth-Hitchcock

24
224 Surgery and Healing in the Developing World
A
Figure 2. A patient’s head extended back over the “dentiste’s” flexed knee on a straightbacked
chair (A) at an open window for sunlight allows efficient extraction, and also
allows quite a few community kibitzers to admire or make comments on this technique (B).
ciples, and the most impressive instructors in how to stretch the available resources
over the much greater need are the indigenous practitioners who have had to be
pursuing this skill all f their lives in such an environment. A minimalist approach
can have maximum rewards in seeing what are the limits of the healing response to
our interventions in setting s where there are fewer support systems.
What Can I Do Without My Essential Tools and
Techniques?
Learn new ones. An autoclave can be made to function at any altitude and any
power source from a pressure cooker (Fig. 11) or instruments can be boiled (Fig.5B)
Even the gloves used can be recycled in such a system (Fig 12) in a system that is
labor intensive and short of materials.
A crooked knee can be the headrest on a straightback chair (Fig 2) for use of
available light. If more light is needed, solar power (Fig 10) can be harnessed, or
battery-powered headlamp can be used. A mechanical dental chair is a good use of
transported obsolete first-world technology (Fig 4) in distinct contrast to equipment
requiring microchips or reliable electrical power. Local anesthesia is the principle
from of analgesia employed in many of these pain-tolerant populations, but
systemic analgesia and even general anesthesia is safely administrable as well (Fig. 7)
provided it is monitored by pulse oximetry. Nonin Medical Products makes a very
convenient battery powered pulse oximetry unit which is highly recommended for
this purpose.
Open-air dentistry may take place alongside curbside barber shops, ear cleaners
and kiosk salesmen in some parts of the world, as seen in Lhasa, Tibet (Fig 3) This
“low-overhead” space doubles as advertising for the indigenous practitioner in flora
that may be more friendly than many of our selected inpatient germs, but the point
is made to show that dental outreach is less limited by the facilities in which it “takes
B