Surgery and Healing in the Developing World - Dartmouth-Hitchcock

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4 24 Surgery and Healing in the Developing World about us gives them hope. To this universal hope we should respond, building more effective bridges across the many barriers.The mission of internationalism within surgery helps spread that new hope to peoples on all sides of the many artificial barriers and is an ideal bridge to understanding. Understanding is never wasted.
CHAPTER 1 CHAPTER 5 Medicine Writ Large in the Raw, without Power or Plumbing Glenn W. Geelhoed How Can I Practice Surgery without the Tools that I Am Used to Using Available in a Setting I Do not Understand? It is not easy. But, it is not impossible. Medicine is not professional “stuff” it is specialized information that is very easily portable and adaptable, even if its plumbing and power fixtures are not. Adaptation of fundamental principles makes far better sense for sustainability than the importation of fancy tools with embedded chips, or nursing the cast-off obsolete equipment discarded by First World facilities, often shipped (without spare parts) as “white elephants” to encumber the recipient. I have operated on each continent in settings which were not equipped with running water, autoclaves, electricity for light and power tools, relying often on the ingenuity of those who are already there and who did not think it odd that some indispensable (to my mind) piece of equipment was missing. Having never had the experience of the use of such sine qua non they struggled on with what they do best—getting the job done with what they can rig up at hand. Scrub Sinks and Preop Prep “Running water” is what I had described in my Congolese scrub sink when Kigale would run for the water. After masking with cloth mask and donning the cloth hats (in preparation for the later sterile cloth gown) I would scrub my hands and arms with a bar of soap and a scrub brush. I had previously proven in the decidedly First World setting of the National Institutes of Health that Rodac culture plates had proven that mild hand soap was as good as most other prepping methods, and was superior to stiff-bristle prolonged brush scrubbing with toxic bactericidal soaps. At the conclusion of the scrub, Kigale would pour the water from a pitcher over my hands for the rinse, and then a second pouring of a Hibiclens (or whatever other solution was available, usually reconstituted from powder and made up fresh locally) over the rinsed arms and hands. The “theatre sister” had meanwhile prepped the patient over the area of the operative field. This did NOT mean a razor shave for hair removal. Again, in my First World studies of alternate skin prepping and hair removal methods in the first-world context of George Washington University Hospital, the lowest bacterial counts were obtained by means of the simplest skin preps and the worst were achieved through razor shave and iodophor patient skin scrub. Deprivation, in this instance, had made for superior preparation efficacy and timing, and our exotic “theatre time” is not cluttered with a lot of nonoperative ritual preceding getting directly to the Surgery and Healing in the Developing World, edited by Glenn Geelhoed.
Page 1 and 2: Surgery and Healing in the Developi
Page 3 and 4: Contents Foreword .................
Page 5 and 6: 25. Dentistry .....................
Page 7 and 8: Editor Contributors Harold P. Adolp
Page 9: Foreword Surgery and Healing in the
Page 12 and 13: “poor, but modern”, as for exam
Page 14 and 15: There may be at least one considera
Page 16 and 17: It is that higher accountability th
Page 18 and 19: 1 2 Surgery and Healing in the Deve
Page 22 and 23: CHAPTER 2 Surgery in Developing Cou
Page 26 and 27: 2 10 Surgery and Healing in the Dev
Page 34 and 35: CHAPTER 4 International Surgical Ed
Page 84 and 85: CHAPTER 9 Lab-in-a-Suitcase: Saving
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10 74 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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Distribution and Incidence of Tropi
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CHAPTER 1 CHAPTER 28 Population Dyn
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Population Dynamics Of Surgical Tro
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Metabolic Maladaptation 289 Introdu
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Metabolic Maladaptation 291 some of
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Metabolic Maladaptation 293 In this
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Metabolic Maladaptation Table 1. Si
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Metabolic Maladaptation Table 4. Go
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Metabolic Maladaptation 299 the rev
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Metabolic Maladaptation Table 5. As
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Metabolic Maladaptation Table 6. Co
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Metabolic Maladaptation 305 the ris
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Metabolic Maladaptation Table 8. Go
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Metabolic Maladaptation Table 10. G
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Metabolic Maladaptation Table 12. C
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Metabolic Maladaptation 313 cell an
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Metabolic Maladaptation 315 Biologi
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Metabolic Maladaptation 317 from io
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Metabolic Maladaptation 319 25. Lon
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CHAPTER 1 CHAPTER 30 Nutrition and
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Nutrition and Development in Africa
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CHAPTER 1 CHAPTER 31 Uterine Ruptur
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Uterine Ruptures in Rural Zaire Tab
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Uterine Ruptures in Rural Zaire 329
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CHAPTER 1 CHAPTER 32 Vesicovaginal
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Vesicovaginal Fistula in Democratic
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CHAPTER 1 CHAPTER 33 Ophthalmology
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Ophthalmology Figure 2. Refractive
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Ophthalmology Figure 4. A tonometer
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Ophthalmology 341 ml of 40 mg/ml IV
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Ophthalmology Figure 6. Axis determ
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Ophthalmology 345 thalmic set prepa
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Ophthalmology 347 Procedures Region
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Accommodating Deficits in Material
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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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