Surgery and Healing in the Developing World - Dartmouth-Hitchcock

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422 Surgery and Healing in the Developing World
Table 3. Morbidity of Parasitic Diseases, 1967
Diagnosis Outpatients Inpatients
Falciparum malaria 2125 53
Hookworm 1447 41
Filariasis 1234 11
Onchocerciasis 601 12
Schistosomiasis hematobium 554 45
Ascariasis 538 15
Chronic tropical skin ulcer 433 38
Diarrheal dehydration 364 227
Amebiasis 250 124
Scabies 163 4
Pulmonary TB 125 97
Trachoma 46 9
Yaws 30 0
Typhoid fever 0 16
Surgery
Surgical therapy is a particularly gratifying mode of health care under the primitive
conditions of bush medicine. Only a few simple diagnostic steps are necessary
to recognize acute or morphological lesions that are treated by the immediate and
definitive cure of surgery. An operation circumvents the sociologic impediments of
communication, education and all of the facilities of civilization such as transportation,
the absence of which makes chronic medical management impossible. Surgery
stands next to the antibiotic therapy of infectious disease as the most successful form
of medicine that can be practiced under limited control of patient environment.
Surgery is not without its problems under primitive conditions, however, and
much of the postoperative care taken for granted in medical centers is missing. An
example of one difficulty experienced constantly was with the surgical essential of
blood transfusion. Before an elective procedure in an anemic patient could be scheduled,
the patient would be sent to his compound until he could accumulate a token
payment for the operation, but also, and more importantly, round up friends and
relatives to serve as blood donors. The latter blood requirement was the rate-limiting
factor in the speed with these surgical patients returned. Most often, their acquaintances
were quite reluctant to part with the blood in which they invested a great deal
of man’s life spirit. Many of them were quite justified in their animistic reluctance to
give blood because the Robin Hood blood bank policy was to take from those with
hematocrits in the twenties and to give to those with values in the teens. A prominent
man in Takum was brought to the hospital one Sunday afternoon suffering
from a massive gastrointestinal hemorrhage. The strong men and boys quickly faded
into the bush after carrying their friend to his bed, leaving only old women and
pregnant mothers at the bedside. After we pumped the intravenous fluid and pumped
out the coffee ground material in the patient’s stomach, we turned our attention to
regrouping his companions for blood typing. They were so hard to find that in the
time it took to find a couple of donors their friend exsanguinated and died. In some
acute hemorrhages such as that occurring in ruptured ectaopic pregnancy, the unavailability
of blood causes us to resort to the simple trick of auto-transfusion; i.e.,