Surgery and Healing in the Developing World - Dartmouth-Hitchcock

Accommodating Deficits in Material and Assistance
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Figure 1. Surgical gloves
drying in the sun.
The surgeon oversees anesthesia while operating. If additional bodies are necessary
in the operating room, nearly anybody can learn quickly how to bag a patient
or hold a retractor. It has been encouraging to witness the speed at which people
learn these new tasks.
Anesthesia
Spinal anesthesia with xylocaine and bupivicaine and regional blocks are frequently
utilized because they require minimal patient monitoring. When giving
spinal anesthesia, the patient is loaded with 500 mL of intravenous fluid and an
alpha-agonist vasocontrictor should be kept available for rapid administration. The
surgeon can monitor the patient’s airway by leaving his or her head uncovered. If
general anesthesia is required, a combination is typically chosen from a selection of
thiopental, ketamine, succinylcholine, ether and halothane.
Rural Camps
When setting up surgical camps in rural areas, a team of three individuals is also
sufficient. A surgeon and an assistant perform the cases, while the nurse is typically
in charge of equipment and acts as a circulator. In addition, a local health worker
may be used for monitoring of the patient.
Methods of Coping with Deficits in Equipment
Equipment shortages can be handled by reusing everything possible. Described
here are methods we have used for sterilization of equipment at the Lady Willingdon
Hospital and during our surgical camps.
Gloves
After use, gloves are thoroughly washed and allowed to dry in the sun (Fig. 1).
they are then soaked in a sterilizing solution and autoclaved for ten minutes. The
gloves used during surgical procedures are made of relatively thick latex, similar to
orthopedic gloves; thinner latex gloves do not withstand the autoclaving process.
Even when thick gloves are used, it is important to inspect them for integrity following
sterilization.
Gauze
Gauze can also be resterilized and reused. It is washed, bleached, refolded and
then autoclaved. If it is too shabby to use as a gauze sponge it can be used for other
purposes. For example, it can be transformed into a wad by tying it into a ball, and
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