Surgery and Healing in the Developing World - Dartmouth-Hitchcock

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420 Surgery and Healing in the Developing World
Table 1. During our stay in Takum, Nigeria, many diseases impressed us as
endemic in or unique to the area, whereas other familiar diseases
were conspicuously absent
Common Diseases Uncommon Diseases
Pyomyositis Arthritis
Myocarditis Coronary artery disease and angina
Tropical ulcers Arteriosclerosis obliterans
Lobar pneumonia Pulmonary emphysema
Pertussis Diphtheria
Endemic goiter Grave’s disease
Periodontitis Dental caries
Typhoid fever Thrombophlebitis and
pulmonary emboli
Hypertension Strokes
Hepatic and renal failure from native medicine Cholecytitis
Hepatitis Appendicitis
Head and neck tumors and sarcomas Actinic skin ulcers
Cervical carcinoma Breats carcinoma
Anemia, hemoglobinopathies and hookwork Toxemia and eclampsia
disease can be subdued in the bush there must be all the ancillary services necessary
for the delivery of life-saving health care to underdeveloped peoples—such as communication,
transportation, education, sanitation and other riders that accompany
a healthy economy. We had the opportunity to experience the frustrations and opportunities
of public health service in this developing country as we will describe
below. But to demonstrate the need for control of infectious disease, we kept record
of the mortality during our stay (Table 2) pointing out that infectious disease is the
leading killer. Of the 75 inpatient deaths that occurred while we were there, the
majority were late-coming infectious diseases that are both treatable and preventable.
Parasitic Morbidity. Parasitic problems also caused a great deal of morbidity.
Filariasis is almost universal; on several occasions during operations adult filaria
would crawl out of the wound. A random droplet of blood or skin snip suspended
in saline in the majority of patients would demonstrate the active filaria under the
microscope. The lymphatic blockage of these adult worms and resultant elephantiasis
may indirectly contribute to the high incidence of other endemic disorders in
which the common denominator is tissue stretching—such as some of the hernias,
scrotal skin necrosis and cutaneous ulcers.
One of the most common filaria in the area is Onchocerca volvulus (O.V.) carried
by the plentiful Simulum fly. O.V. produces a wide spectrum of pathology,
probably the most devastating of which is blindness. In a village near Takum 5% of
the population were blind secondary to the pigmentation deposited through cornea
and iris during the migration and death of O.V. larvae. In Takum itself, the leading
casue of blindness was trachoma and corneal scarring secondary to entropion. Subcutaneous
nodules are very common, and we occasionally saw the “hanging groins”