Surgery and Healing in the Developing World - Dartmouth-Hitchcock

Surgery in Developing Countries
necessary, very careful explanations should be made to the nursing personnel with
their full comprehension so that the operative result is not compromised. There are
special concerns with some types of procedures even so elementary as skin grafting
because the dressing materials available may be limited, and heat and perspiration
may make graft survival less certain. In pediatric patients inability or unwillingness
to maintain arm restraints may result in disruption of suture line—for example, in
cleft lip. In many Third and Fourth World situations the surgeon should be mindful
that Murphy’s Law all too frequently applies: anything that can go wrong, will go
wrong.
A complicating factor for short-term overseas surgery especially is that the surgeon
may require a few days simply to grasp the situation appropriately and thus
have inadequate time to implement the use of the knowledge he or she has gained.
Needless to say, those who go for longer periods of time make a more satisfactory
adjustment and are able to carry on surgical practice quite reasonably. It has been
helpful to me, when on occasion I indulge in feeling sorry for myself, to realize that
the national surgeons practice under these same conditions all the time without any
hope of relief. This enhances one’s respect and admiration for those who operate all
of their lives under very difficult circumstances.
The above descriptions and cautions are not given with the idea of discouraging
surgeons from practicing overseas. Rather the idea is to thoroughly prepare them as
much as possible for what they may find because forewarned is forearmed. It is
especially important for patience to be exhibited under trying circumstances, and if
one knows what to expect it is easier to prepare oneself.
Long-Term Postoperative Follow-Up
In many situations this is simply impossible inasmuch as it is very expensive for
some patients to travel, especially those that live at a distance, and they are not likely
to return unless there is a specific problem. One is often left to judge what the
ultimate outcome will be on the basis of what the immediate postoperative status of
the patient is. Another problem is that any patient requiring postoperative routines
on a relatively long-term basis may simply be noncompliant, either through lack of
understanding or lack of appreciation of the importance. Postoperative situations
which in the U.S. might immediately be brought to the attention of the surgeon or
his staff may simply be neglected with unfortunate consequences. It is important to
review each patient with a national staff physician before their discharge in order to
provide the best follow-up possible under the circumstances.
Travel and Living Cost
Some large organizations pay most of the cost from airfare to living accommodations,
but that generally applies only for long-term volunteers. Most frequently the
volunteer bears the entire expense of travel, board, etc. It is advisable for the traveler
to bring with him various medications such as those to treat bacterial diarrhea, amoebiasis,
and giardiasis which are endemic in many areas, and also malaria prophylaxis
may be important if appropriate. In addition to updating standard immunizations,
the surgeon should ascertain the appropriate up-to-date immunizations that might
be necessary to the particular area where he is traveling. These are usually available
from medical travel clinics and for the particular area to be served.
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