Surgery and Healing in the Developing World - Dartmouth-Hitchcock

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Uterine Ruptures in Rural Zaire 329 patients with high risk pregnancies. The use of partographs will be encouraged. 2. The Institute Panafricain de Santé Communautaire (IPASC), in collaboration with the Obstetric department of Nyankunde Hospital will conduct 6 monthly workshops for midwives responsible for rural health programmes within the Nyankunde Health Districts as well as other neighbouring districts. 3. A survey will be made of the communication system between health centres and their district hospital, and with Nyankunde through the ‘Flying Doctor Service’. Necessary improvements will be made where possible. 4. Each case of ruptured uterus will be used as a case study to see where the weaknesses in the system are and how they can be avoided in the future. Particular attention will be given to constraints expressed by patients in reaching adequate medical care. 5. Family planning advice and follow-up will be combined with maternal and child health programmes, using an awareness-raising approach. Grande-multiparous women will be encouraged to deliver in hospital. 6. A prospective study will be done by nurses who have studied at IPASC of the outcome of all women with high risk pregnancies, with special reference to the time interval between the detection of a complication and the transfer of the patient to a referral centre. We would like to anticipate that the problem of ruptured uterus will disappear in the years to come, but we cannot be confident while the constraints abound. Awareness-raising and addressing problems caused by inadequate care and poor communications should reduce the incidence of ruptured uterus in the area. References 1. Barnaud PH, Cazenava JC, Bertram P. Lees ruptures utérines obstétricales en milieu tropical. Soins Pathol Trop 1984; 47:21-4. 2. Barnaud PH, Veillard JM. Traitement chirurgical de la rupture utérine (Obstétrique-Gynécologie). In Techniques chirurgicales. 2 nd ed. Marseille: Agrégés du Pharo, Diffusion Générale de Librairie, 1981:251-3. 3. Lawson JB. Sequelae of obstructed labour. In: Obstetrics and gynaecology in the tropics and developing countries. London: Edward Arnold, 1970: 203-10. 4. Lusanga-Nkwey, Tozin R, Tandu-Umba et al. Evolution des ruptures utérines dans les cliniques Universitaires de kinshasa. J Gyn Obst Biol Repr 1983; 12:755-61. 5. Nasah BT, Drouin P. Review of 70 cases of ruptured uterus in Cameroun. Trop Doct 1978; 8(3):127-31. 6. Heij HA, Te Velde ER, Cairns M. Management of rupture of the gravid uterus. Trop Doct 1985; 15(3):127-31. 7. Dodson MG. In: Aladjem S, ed. Bleeding in pregnancy in obstetrical practice. St Louis: CV Mosby Co., 1980:451-72. 8. Donald I. Maternal injuries in practice obstetric problems. 3 rd ed. Chicago: Year Book Medical Publishers, 1966:600-28. 9. Hibbard LT. Complications of labour and delivery in current obstetric and gynaecologic diagnosis and treatment. 5 th ed. Los Altos: Large Medical Publication, 1984:737-62. 10. Shreve RW, Russo JN. Rupture of the uterus. In: Sciarra JJ, ed. Gynaecology and obstetrics, Chapt 80, Vol 2. Philadelphia: Harper and Row, 1983:1-10. 11. Cazenave JC, Barnaud PH. Dépistage des grossesses à risque outremer. Soins Patho Trop 1984; 47:3-7. 31
31 330 Surgery and Healing in the Developing World 12. Galloway P. SANRU/CONF. ANN.83/Dc 10.3. Séminaire de recyclage organisé par SANRU pour la formation des accoucheuses traditionnelles. In: Accoucheuses traditionnelles. Leur rôle en soins de Santé Primaire. Kasai Zaire 1989. 13. Lambillon J, Beckius C, Rombart R et al. Mortalité maternelle et rupture utérine. Ann Soc Belg Méd Trop 1959; 39:417-23. 14. Vavdin F, Munyemana S, Sebazungu P et al. Les ruptures utérines au Rwanda (A propos de 87 cas). Méd Trop 1983; 43(1):37-43.
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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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CHAPTER 1 CHAPTER 27 Factors Influe
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Page 310 and 311: Metabolic Maladaptation Table 1. Si
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Page 334 and 335: Metabolic Maladaptation 319 25. Lon
Page 336 and 337: CHAPTER 1 CHAPTER 30 Nutrition and
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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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