Surgery and Healing in the Developing World - Dartmouth-Hitchcock

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26 Surgery and Healing in the Developing World
problem. The skin is painted with an iodine tincture and is draped with the towels
and sheets taken out of our “Third World autoclave”—the highly effective pressure
cooker.
Sterilizing and Autoclaving Sheets, Instruments, Gowns,
Gloves
No organisms survive the high pressure steam of our very practical autoclave—a
large capacity pressure cooker, available from WHO and other international sources.
The family participates in even this part of the “nursing services” by washing the
drapes and other items by hand until they are clean and hung out to dry. The patient’s
family (who will later serve as the diet kitchen and nursing monitors and rehabilitation
supervisors postoperatively) gather the firewood and get the water from the
local stream to add to the “kit” picked and packed by the theatre personnel, whereupon
the pressure cooker is put on the fire for the required period of time signaled
by the indicator. This kit is every bit as sterile as any that has come out of any
gas-operated autoclave and does not run the added problems of venting toxic gases
from the kit and into the environment. Its cost of operation, given the abundant
and cheap labor force in the developing world, is close to nil.
Surgical Gloves and Dressing Material
Anything labeled “Disposable” or “Single Use” in the developed world that might
make its way to the developing world will be assured of seeing reincarnation into a
long and useful life! “Disposable” means “Use and ReUse Until There Is Not One
More Useful Purpose To Which This Discardable Item Can Be Put.” This is especially
true of surgical gloves. For those of you who may not have worked in such
developing world settings, you may not recognize the “Glove Drying Tree” behind
Kigale where she hangs out the used gloves after washing and twirling them to test
them for leaks before packaging them up for the next cases.
Is it not illegal to reuse medical disposable equipment? Well, where are you at the
time?
And does not reuse run the risk of transmitting communicable disease? Just what
virus do you assume might survive a half hour of superheated steam in the doubled
atmosphere of the pressure cooker?
The answer is that reuse of disposable equipment (and the permanent equipment,
such as instruments, for that matter) is perfectly safe when you put the investment
into the training of personnel in how to handle such devices rather than the
presumably “fail-safe” materials-intensive systems of an affluent disposable society.
It is one way that the redundant waste of the First World comes to be recognized as
the aberration, and not the more reasonable practices of the “ROW”—”Rest of the
World.”
Good-hearted people back home have sent out to the field long strips of wound-up
rolls of woven material which serve as bandages, likewise recycled after cleaning.
Disposable gauze, if available at all, should come from local sources of production,
like the “mechanics’ waste” once did for fluffy bulk dressings in First World settings.
Since tape is a premium commodity, many of the dressings are tied in place by their
own knots or strings are substituted, or may be used in the fashion of the ancient
and venerable Scultetus binder.