Surgery and Healing in the Developing World - Dartmouth-Hitchcock

CHAPTER 34
Accommodating Deficits in Material
and Assistance
William L. Barrett, Laji Varghese and Malini Anand
Introduction
The aim of this chapter is to summarize our experience at the Lady Willingdon
Mission Hospital in the Indian Himalayas where resources are scarce and pathology
is abundant. Two general surgeons perform approximately 750 operations annually
in this hospital, encompassing all areas of surgery apart from cardiac. In addition to
regular hospital operations, surgical camps are organized four times per year in rural
mountainous areas where there is otherwise no formal surgical care. Our methods
may not be optimal, but experience has shown them to be safe and beneficial. Our
hope is that the methods described in this chapter may provide an example of ways
to conserve and recycle resources and inspire confidence to try new practices through
our recommendations and experience.
Great benefit can be offered with modified methods and tricks. One must, however,
responsibly and carefully weigh the potential risks and benefits when offering
less than optimal care. When organizing a surgical camp, rather than setting up a
separate, new facility, it may be of greater benefit to all if efforts are coordinated
with local health care systems and practitioners. It is important not to undermine
existing local health care systems with temporary services. Preexisting facilities should
be utilized if available and modifications of traditionally accepted practices may be
employed when no other reasonable alternatives exist. One must always be mindful
of the Hippocratic principal, “do no harm.”
Building the Surgical Team
Nothing can replace an abundance of skilled and qualified individuals. At times,
however, one must make do with the few people available. With sincere motivation
and proper direction most will rise to nearly any challenge.
Three Person Team
Nearly all aspects of operations can be completed with three people: a surgeon, and
two operating room technicians. At the Lady Willingdon Hospital, a single technician
runs the two-room operating suite. This technician maintains and sterilizes equipment
and attire, selects tools for cases and organizes transport of the patient to the
operating room. During the procedure one technician monitors the patient, maintains
anesthesia and manually ventilates the patient if necessary, while another, scrubbed
in, acts as the surgical assistant and scrub nurse. These technicians can be trained in a
relatively short period of time through observation and limited formal teaching.
Surgery and Healing in the Developing World, edited by Glenn Geelhoed.