Surgery and Healing in the Developing World - Dartmouth-Hitchcock

24
230 Surgery and Healing in the Developing World
Travel across borders, of whatever kind, brings one in contact with something
new and different—and not only of the pleasant surprises variety. This brings out
the best of most of us under some stress of the little details that can go awry. One of
the only essential ingredients I have recommended to those traveling with me is to
have an “infinite threshold for frustration.” It is not likelihood that all the careful
plans that were made might go “aft agley,” it is a certainty. When it happens, we
must respond as do the people we are serving must on a more regular basis than we,
when bereft of certain equipment or “essential” support services. They are experts in
“making do without,” and the improvisation that comes from simplifying details
down to fundamental principles is a good exercise we often miss by layers of fail-safe
redundancy.
Yes, there are exotic diseases to which one may be exposed, but that is also the
case at home as well. The same standards and precautions that are “universal” should
be observed for practice in either environment to safeguard your own health as well
as that of others close to us. Good travel medicine entails the use of immunizations
against the diseases one is expected to encounter, such as a yellow fever vaccination
and up to date hepatitis and more common immunizations such as tetanus. Antibiotics,
such as a broad-spectrum quinolone, should be carried and used very sparingly,
if at all, for traveler’s diarrhea or upper respiratory ailments. (I have carried
Bactrim and rehydration salts packets for traveler’s diarrhea, and have given out the
latter, but never yet used the former; the same applies to the use of Acetazolamide as
prophylaxis or treatment of acute mountain sickness in my Himalayan and Andean
expeditions.) Anti-malarial prophylaxis is essential in the tropics at lower altitudes
and particularly in the rainy season. One of the plans one might consider is to carry
a “PEP Kit” (“Post-Exposure Prophylaxis Kit”) for potential viral inoculation, and
leave it behind in the clinics one sets up if unused.
But, one should expect to encounter more frequently what one already knows
and should be familiar with than that which is exotic and new to a First World
practitioner. The surprises will be in what later stages of untreated and neglected
disease already familiar to the practitioner from first-world experience these patients
present, rather than in the unexpected encounter with leprosy or rabies or other
diseases for which most travelers carry a book to look up details they had once
learned but soon forgot in the absence of such patients in regular practice. It is true
that there are some endemic diseases such as filariasis or schistosomal diseases, but
the oral health problems will be very much more commonly presented to the medical
mission participant with which he or she is very familiar except in the context of
these unique patients in which they present very late in a pain-tolerant population
that makes few complaints about what they view as a common human condition.
I have fond the principle risk to the participants who have joined me is that the
experience itself becomes habit forming! As was reported of me in a review of the
exotic experiences I had accumulated: “Dr. Geelhoed’s proudest achievement may
be that he has never taken any of his medical proteges on their last medical mission.”
4
What about the New World Plague of Terrorism and
Political Instability with which these Poor Countries Are
Notoriously Rife?
I had written this article in response to the AGD’s request for their special fiftieth
anniversary edition before packing up and planning to leave on a multi-venue