Surgery and Healing in the Developing World - Dartmouth-Hitchcock

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308 Surgery and Healing in the Developing World
Table 9. Subtotal thyroidectomy was carried out in 38 patients for indications
and results illustrated
Indications for operation:
Impending airway obstruction 10
Massive Lipiodol-resistant glands 21
Chronic draining sinuses 2
Patient dissatisfaction with appearance 5
Thyroid gland removal median 0.5-1 kg (largest 1.8 kg)
Thyroid gland remnant 20-30 grams
Deaths:
Surgical 3
1 postoperative airway obstruction (cretin)
1 postoperative pulmonary embolus
1 collapse second postoperative day, cause uncertain
Medical 2
1 suffocation
1 thyroid storm
Patients undergoing thyroidectomy. Thirty-eight adults, representing 50% compliance of
the 76 recommended for medical pre-operative preparation with at least four days Lugol’s
solution (10 drops in water three times a day). Local anesthesia and cervical block (all),
with Ethrane supplementation (four).
tion was immediately stopped for all women of reproducing age and was broadened
for inclusion of most children approaching school age. 39
Forty village leaders conducted a survey at ten years from the first intervention
(June 1993) and unanimously reported remarkably positive changes in each of the
individuals that had had iodine repletion. With respect to each individual treated,
there was qualitative improvement (with the already noted exceptions of the complications
of hyperthyroidism that were made possible by iodine repletion—a condition
known as Jod-Basedow’s syndrome—and complications due to regrowth of
intrathoracic goiter or other postoperative events). Statements made by those administering
the program within Sasaland were very enthusiastic. Kongonyesi, the
untiring logistical assistant for the extended project, said, “Thank you for the goiter
project. It heals people very much, their minds and bodies as well.” Of the other
health initiatives attempted within this decade and this region, it is the most successful
program in terms of compliance, sustainability and behavioral changes.
The immediate effect of medical intervention in relief of hypothyroidism is dramatic
in individual terms. With the rare exception of some medical complications
of overactivity (as in the rare events of Jod-Basedow’s syndrome) the effects of iodine
repletion in nearly all individuals seem positive. Converting from the low-energy
hypothyroid state to normal metabolic rate is a revolution in development potential
measured in the individual patient. The individual successes within the program
can be viewed in summation in smaller groups of that population before looking at
the overall impact.
Neuromotor response change was measured by several functions. Table 10 demonstrates
the results of testing the grip strength with the right hand (the Azande of
the Congo are permitted to only be right-handed) dynamometer for a population
sample (n=50). Three years following iodine repletion, the mean was 24.88 kg