Surgery and Healing in the Developing World - Dartmouth-Hitchcock

Surgery in Developing Countries
Practical Considerations
Finding the Right Opportunity
One of the most important aspects of overseas service is finding the right oppor- 2
tunity for the physician or surgeon to use his or her abilities optimally. It is important
also for the surgeon to be familiar with the quality of postoperative care. For
example, one of the major problems in most developing countries for a cardiac
surgeon would be to find the cases and the diagnostic and therapeutic technical and
nursing resources needed. A pathologist would scarcely be able to find enough work
to justify his efforts in a small remote facility except by immediate conversion to a
nonspecialist general practitioner. Most commonly the greatest needs in developing
countries are for primary care physicians and pediatricians, and certainly for general
surgeons and some surgical specialists such as orthopedists, ob/gyn surgeons, urologic
and plastic surgeons, ENT specialists and ophthalmologists. Where possible it
may be helpful to bring support personnel if this is acceptable in the host hospital or
clinic. Operating and recovery room nurses are very often able to perform yeoman
service which may compensate in part for inadequate nursing on the part of the
nationals.
Operating Room Experience
Lack of materials and equipment are almost inevitable. With some of the largest
and most well-established organizations, this is less apt to be true inasmuch as they
are able to bring with them materials and equipment they expect to be in short
supply. Many smaller missions, however, are constantly short of nearly everything,
even such commonly used materials as gloves, sutures, gauze, bandages, syringes,
etc. If possible, it is advisable for the surgeon to bring with him not only such
supplies as are listed above, but also any special instruments that he may need in his
particular type of practice. In my own experience, I have on occasion wished for
what I thought were very basic instruments but very important for a certain procedure,
only to find that they were not available and thus had to do with what was
available and as a consequence, with less optimal results achieved. The surgeon should
try to anticipate what he is going to need for any special procedures and, if possible,
bring such instruments and equipment with him. Again, when possible, if equipment
can be brought which will be left behind, this is especially helpful not only in
the surgeon’s own practice, but in the practice of those of the national surgeons who
work there on a continuing basis. It is almost standard practice in developing countries
to use disposable supplies and equipment (e.g., disposable cauteries) over and
over again.
If the volunteer is bringing drugs, he/she should be aware that in some countries
there are strict customs regulations prohibiting the introduction of outdated drugs.
Since many drugs are perfectly safe and usable for several months after the expiration
date, repackaging may circumvent this problem when it seems appropriate.
An affidavit from a parent organization indicating that the materials are for charitable
use with some sort of official-looking stamp may be very helpful in passing
through customs.
Use of Time and Other Concerns in the Operating Room
Many who practice surgery in the U.S. are accustomed to a relatively rapid turnover
between cases or the use of more than one operating room to stagger cases and
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