Surgery and Healing in the Developing World - Dartmouth-Hitchcock

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350 Surgery and Healing in the Developing World
Figure 2. A wooden
armboard.
then be used to apply betadine during the prep, or to wash the patient at the end of
the procedure.
Instruments
Although not recommended by authoritative sources, in our experience there
have been no known problems from boiling instruments for twenty minutes when
an autoclave is not available. This option may be important during surgical camps.
Because of the slight risk of HIV and hepatitis resistance to boiling, careful judgement
will be necessary to balance the risks and benefits of this practice—especially
in areas where HIV and hepatitis infections are common.
Armboards
An armboard is easily fashioned out of a four foot length of 1 inch x 4 inch wood
(Fig. 2). This can be positioned under the patient’s bedding material and the arms of
the patient anchored with rubber tubing.
Drapes
Plastic, rather than cloth, sheets are used as drapes at surgical camps. These can
be cleaned and dried quickly and then boiled for ten minutes. In the presence of an
autoclave, newspaper can be sterilized in an autoclave.
Gowning
A reusable plastic apron and sterile surgical sleeves may be used instead of traditional
OR scrubs (Fig. 3). These can be cleaned more quickly than a full surgical
gown, minimizing surgical down time.
Battery-Powered Headlights
When reliable lights are not available, battery-powered sports headlights provide
an adjunct or alternative (Fig. 4). Some feature halogen bulbs and can be
focused to provide a narrow of wide beam of light. In areas where power outages
are common, wearing a headlight as a backup is a good idea. Petzl and Princeton
Tec make good headlights that cost between $20 and $60. In our experience the
Petzl Zoom has proven itself to provide a strong, versatile, long-lasting beam.