Surgery and Healing in the Developing World - Dartmouth-Hitchcock

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Metabolic Maladaptation Table 1. Simplified classification of goiter assessment after the recommendations of WHO WHO Goiter Classification 0 No goiter I Palpable, not visible II Visible with neck extended III Visible with neck flexed; massive 295 The soil of the region under study is very poor in both organic content and several measured micronutrients. The results of the soil analysis 26 demonstrated that the selenium analysis showed less than half the minimum adult requirement, roughly equivalent to similar reports of selenium soil deficiencies in the great basin of China where selenium deficiency disease was first reported in its greatest incidence. 5 Principal among the micronutrient deficiencies are iodine, iron and selenium. 27 As is true in most equatorial ecosystems, the vast majority of organic material and the recycling of it in the structure of foodchains within the canopy takes place above ground level and depends very little on nutrient absorption from the thin volcanic rocky soil exposed to periodic cycles of inundation and desiccation. The staple diet of this population include principally root crops, predominantly cassava. This staple, which can be stored year-round as a dried woody root, is varied with foraged forest products, peanuts and plantains and with occasional supplementation from animal fats and proteins from hunting. Samples of the food stock brought to the local market for barter were obtained and analyzed for iodine content which was uniformly low, as was that found in the rather scarce quantities of local salt. The principal caloric intake consists of a once-a-day evening meal of pounded cassava root prepared after soaking it in a stagnant pool to soften the pulpy root. This bulk diet is rich in fiber, poor in calories and vitamins. One of the principal vitamin deficiencies is vitamin A, and when combined with the micronutrient deficiencies in iron, iodine and selenium, the total macronutrient protein-energy is of marginal adequacy. To define caloric balance as stable weight on a given protein-energy intake, an approximate calorie count was carried out on a group of adults and children estimating the proteins and caloric content of the energy-dilute foodstock, based mainly in cassava meal. This caloric survey showed some adults to be in caloric balance at around 800 to 1000 calories per daily intake, while children were suffering significant malnutrition from marginal caloric intake. In addition to the few micronutrients supplied by the cassava, there is the problem of a toxic component as well since a goitrogen, cyanide, is present in the cassava. This does not so much cause as exacerbate the iodine deficiency from the environmental scarcity of iodine. The preparation method of cassava is important, since, particularly in the dry season, it is soaked in pits that have an increasing cyanide content over the season. Running streams that might be preferable for preparation are not always available and might cause the loss of some of the food stock if it escaped downstream during soaking. Assays of water, soil and foodstocks along with local salt (when available) have shown profound iodine deficiency, as well as an increase in cyanide content in the preparation of the cassava when soaked in stagnant pits. 29
29 296 Surgery and Healing in the Developing World Table 2. Goiter distribution among adjacent populations of Efe and Lese to compare with Azande groups Goiter 0 Ia Ib II III Total Efe Female 42 2 1 1 0 46 Male 41 1 0 0 0 42 TOTAL 83 3 1 1 0 88 Lese Female 68 12 8 27 10 125 Male 69 1 1 9 3 83 TOTAL 137 13 9 36 13 208 Others Female 21 4 1 7 3 36 Male 27 4 2 8 1 42 TOTAL 48 8 3 15 4 78 From this table, goiter incidence among tribes was: Lese 34.1%; Immigrant members 38.5%; Efe 5.7%. There is significant difference between the Efe and Lese (Chi Square = 72.26, p
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Surgery and Healing in the Developi
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Contents Foreword .................
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25. Dentistry .....................
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Editor Contributors Harold P. Adolp
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Foreword Surgery and Healing in the
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“poor, but modern”, as for exam
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There may be at least one considera
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It is that higher accountability th
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1 2 Surgery and Healing in the Deve
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CHAPTER 2 Surgery in Developing Cou
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2 10 Surgery and Healing in the Dev
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CHAPTER 4 International Surgical Ed
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CHAPTER 9 Lab-in-a-Suitcase: Saving
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10 72 Surgery and Healing in the De
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CHAPTER 12 Communication in the Thi
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CHAPTER 13 Anesthesia in the Third
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13 100 Surgery and Healing in the D
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CHAPTER 15 Basic Obstetrics and Obs
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CHAPTER 16 Pointers for American Su
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CHAPTER 20 Chronic Pyogenic Osteomy
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CHAPTER 23 Cleft Lip and Palate Sur
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CHAPTER 24 Outreach Dentistry: A Wo
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CHAPTER 1 CHAPTER 26 Reconstructive
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Page 302 and 303: Population Dynamics Of Surgical Tro
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Page 336 and 337: CHAPTER 1 CHAPTER 30 Nutrition and
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Page 340 and 341: CHAPTER 1 CHAPTER 31 Uterine Ruptur
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Page 346 and 347: CHAPTER 1 CHAPTER 32 Vesicovaginal
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Ophthalmology 345 thalmic set prepa
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Ophthalmology 347 Procedures Region
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Accommodating Deficits in Material
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Abscesses and Other Infections Trea
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CHAPTER 1 CHAPTER 36 Surgical Train
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Surgical Training of Nurses for Rur
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Training of Medical Assitants in Mo
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CHAPTER 1 CHAPTER 38 Training Surge
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Training Surgeons in the Developing
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Mobile Surgery Figure 1. 405 of tec
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Mobile Surgery Figure 3. 407 Childr
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Mobile Surgery 409 We have realized
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CHAPTER 1 CHAPTER 40 Public Health
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Public Health Problems on Burma Fro
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Medical Adventures in the Nigerian
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CHAPTER 1 CHAPTER 42 Wanted Glenn G
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Wanted 431 Studies Center (//www.am
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Wanted 433 MacArthur (The John D. a
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Wanted 435 most pathologic presenta
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Wanted 437 “outliers” in the he
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World Health 439 challenge: name fo
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CHAPTER 1 CHAPTER 44 Treating Other
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Treating Others: Human Sciences in
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Treating Others: Human Sciences in
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CHAPTER 1 CHAPTER 45 The Impact of
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The Impact of a Volunteer Medical M
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CHAPTER 1 CHAPTER 46 Field Notes on
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Field Notes on a Typical Day in a H
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Surgery and Healing in the Developing World - Dartmouth-Hitchcock

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