Surgery and Healing in the Developing World - Dartmouth-Hitchcock

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406 Surgery and Healing in the Developing World
Figure 2.
operation), another for herniorrhaphy and similar operations in adults and a pediatric
tray (Fig. 2).
We frequently use “home made instruments” that come from the ingenuity of
our colleges either from our country or abroad. For instance, skin hooks made of an
applicator and hypodermic needles. Suction drains made of I.V. tubing and syringes
to create the vacuum mechanism. Safety pins of different sizes are used as auto static
retractors (Fig. 3). Rubber bands kept with slight tension around the intestine and
held by a hemostat are used as intestinal clamps.
Program Strategy
Rural doctors contacted by our personnel do the first screening of patients with
surgical problems. Initially they worked with children in local schools but later we
had requests from adults, so we cover patients of almost all ages.
When the rural doctor has selected a group of patients, a surgeon and an anesthesiologist
from The CINTERANDES Foundation go to the area to make the
preoperative consultation, a carefully history and physical examination are carried
out, the accuracy of the diagnosis is checked, laboratory and image exams are requested
when necessary. Based in numerous reports and our experience, we do not
ask for routine laboratory or image tests.
Selection of patients is very important. We do not take individuals with additional
pathology, patients of very advanced age or when we anticipate a complicate
operation. Once patients have been selected we explain to them or their parents the
operation and its risks, as well as the risks of leaving the pathology unattended, we
give the preoperative instructions and decide the day we are going to bring the MSU
for surgery.
The day of the operation the MSU is properly cleaned and sterilized. It is parked
next to a health center, a school or a community house where a preparation room
and a recovery room are arranged. Sometimes we arrange these facilities in two
tents. Patients are again interviewed and examined to make sure they followed the
preoperative instructions and did not develop any additional pathology as respiratory
or intestinal infections. Children are sedated with 0.4 Midazolam/kg. per os.