Surgery and Healing in the Developing World - Dartmouth-Hitchcock

CHAPTER 1
CHAPTER 27
Factors Influencing Geographic
Distribution and Incidence of Tropical
Surgical Diseases
Ricardo Cohen, Frederico Aun and Glenn W. Geelhoed
Introduction
Geographical distribution constitutes the definitive feature in the term “tropical
surgery.” The reductionist view might be that tropical surgical diseases are those
occurring between 23.5* N (the latitude of the summer solstice for northern hemisphere
dwellers, or the Tropic of Cancer) and 23.5 S (the latitude for the winter
solstice for the same northerners, or the Tropic of Capricorn) and the 47* wide
Equatorial belt of the globe in between. The demography that lies within this linear
geography may be described in terms of even starker simplicity.
“The tropics” happens to be where the majority of the world’s six billion people
live, 1 so that tropical surgery, far from being a narrow slice of the needs for surgical
services, represents the principle human need for surgical services. It also happens
that this area of greatest need is where the fewest resources are located with respect
to skilled manpower, socioeconomic and political capital, referral capability, technology
and educational and institutional resources. Therefore, the world’s greatest
need for surgical services is mismatched by the scarcest surgical resources on earth.
It is a truism that has become tragically commonplace in this era of a global HIV
pandemic that diseases do not carry passports, so that the exotic and classically considered
“tropical” abnormalities may show up in any emergency room, doctor’s office
or, worse, unsuspected share any public transportation or facilities that may
spread contagion. Raising awareness 2 of the tropical medical threats in a shrinking
world 3 with all the implications for global health and security 4 have been recent and
increasingly urgent themes in professional and public media. If not for sympathy for
those suffering in tropical environments, but in fear of the threats of emerging infectious
diseases for which resistance to standard therapy appears to have come along
with migration, health care workers everywhere are increasingly alerted to a need to
know the patterns of tropical illnesses and how they may be different from the
behavior learned in temperate environments.
Patterns and Pitfalls
Poverty is a feature that may be the most dominant underlying cardinal condition
in tropical illness, superceding some of those that have been the focus of biomedical
research as those presumed to be more biologically determinative ones. It is
a common feature underlying malnutrition, poor facilities and maldistribution of
manpower and other equipment resources, and ignorance—which is a basic feature
Surgery and Healing in the Developing World, edited by Glenn Geelhoed.