Surgery and Healing in the Developing World - Dartmouth-Hitchcock

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Nutrition and Development in Africa 323 micronutrients, through vertical programs in rural areas such as Nyasa Province in the same country where most of these hypertension consequences are still rare. Promotion of, for example, iodized salt, is clearly intended as a means of combating iodine deficiency, but it may not be seen (perhaps because it is too obvious) that it is first of all a social marketing—of salt. In a population that has been chronically short of both, we should monitor not only the laudable reduction in goiter and cretinism as the benefits we seek, but also the changes in rates of blood pressure abnormalities and perhaps the start of other evidence of urbanization patterns of morbidity, reflected from the century earlier warning from Maputo Province and the onset of possibly preventable epidemics associated with development. Untoward consequences of medical relief and rehabilitation programs should be looked for and honestly reported, even while the laudatory objectives are so easily and rapidly reported. 6 No one should be advocating a retro-dedevelopment, much less celebrating the health advantages of destitution from the privations attending famine, war, overpopulation pressures or economic oppression. “Development”, however is usually assumed quite comprehensively (unfortunately, by many economic advisors,) summed as the iteration of the measurable data of consumption. Consumption of increasing numbers of resources in health care might be viewed as a positive marker of development (particularly by those who receive the benefit of these services—and lest it be forgotten, these nearly always include the professional providers), but the need for such services should fit on the debit scale in such a meta-analysis of nutritional development, for which focus the authors are to be congratulated. Is it the role of healthcare personnel and health educators to point out such tradeoffs that should be mitigated in any development program? Some clearly think not 7-9 and that such “collateral damage” should be relegated, at best, to other specialists. But, it seems, at least in Southern Africa, that the very health care personnel who should be the foot soldiers of this preventive program, who are the most embedded in the culture, 10 are those most severely afflicted by these “diseases of development.” A campaign in the Republic of South Africa to send public health nurses through the schools to warn against the problems of obesity and in case finding for diabetes and hypertension had to be called off, when every single one of the experienced public health nurses (thus, employed professionals) who pitched up to be sent out on the campaign was, herself, morbidly obese! 11 Many of the surprised health personnel did not understand why the preventive program would be contradicted by its very emissaries. It was explained that obesity, far from a stigma, was part of the desiderata of development, like a big house or a motorcar, a mark of achievement, a presumptively apparent negative serology in the context of the dreaded “Slim,” and evidence particularly for a woman, implying a man who cared for her, or at least a disposable income, invested in her overconsumption and underexertion. Such cultural blind spots may have been prevalent in prior decades of First World overachievers, who were really only certifiable as excelling type-A executive class after their coronary bypasses. First world hospitals boasted about the superior high-technology care invested in such individual cases of preventable disease. These may be first and emerging Third World res ipsa loquitor cases of health professionals in transition, dazzled by the immediate economic and technologic numbers, turning blind eyes over the downside of development and the untoward consequences of “advances” in nutritional development and health care. 30
30 324 Surgery and Healing in the Developing World References 1. Geelhoed GW, Denis P. Burkitt “First Order Prevention and Second Order Treatment: The First World Is Too Long on the Latter”. Southern Medical Journal 1991. 2. See continuing debate on the consequences of intervention to reduce inflicted human suffering on www.panetics.org. 3. Data reviewed in continuing personal communication with Dr. Albertino Damascene, chief of Cardiology and Professor of Medicine, Eduardo Mondlane University, Maputo, Mozambique. 4. Geelhoed Glenn W. Metabolic maladaptation: Individual and social consequences of medical intervention in correcting endemic hypothyroidism. Nutrition 1999; 15(No. 11/12):908-932. 5. Daly RW. Medical imperialism in the congo? Editorial Nutrition 1999; 15:936. 6. Sugarman J. Moral Maladaptation? Reflections on a Report of Research Involving the Correction of Endemic Hypothyroidism in Africa. Nutrition 1999; 15:934. 7. Geelhoed GW. An Author’s Editorial: Health Care Advocacy in World Health. Nutrition 1999; 15:940-943. 8. Geelhoed GW. Who will help the helpers as african aids moves from town to country? African Urban Quarterly. 9. Cauvin HE. South Africa confronts another health problem: Obesity (In a series “The Fat Epidemic: Cultural Legacies). New York Times 2000.
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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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Reconstructive Surgery in the Tropi
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Page 288 and 289: Reconstructive Surgery in the Tropi
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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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