Surgery and Healing in the Developing World - Dartmouth-Hitchcock

Medical Adventures in the Nigerian Bush
Table 4. Surgical procedures in which we participated totaled 249 operations;
the total excludes minor procedures in the outpatient clinic, listing
only operations done in the theater, including:
Herniorrhaphies 60
Dilatation and curettage 27
Extensive incision and drainage 21
Caesarian section 13
Hydrocelectomy or orchiectomy 13
Extensive skin grfat 12
Sequestrectomy and orthopedic operations 11
Ophthalmologic operations 11
Ovarian cysetctomy 8
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Lesser numbers of other operations were performed: hysterectomies, biopsies, lipomas,
vagotomies and pyloroplasties, thyroidectomies, insertion of chest tubes, repairs of vesicovaginal
fistulas, ruptured uteri, ectopic pregnancies, plastic reconstructions, amputations,
cystostomies, and removal of lumps and bumps ranging from onchocercal nodules
to a bullet.
the blood found at laparotomy was sucked out of the peritoneal cavity, filtered and
returned to the patient by vein.
In addition to the unusual technique sof transfusion, fluid therapy generally was
unique. The most common route for rehydration was by clysis, proctoclysis or “rectal
drip” being the route most frequently used in adults. Because this fluid route was
not parenteral. Sterile equipment was unnecessary and used intravenous bottles and
tubing could be reused economically with fluids tailor-made on the spot with clean
salt, sugar and boiled water. This also avoided he complications of precarious intravenous
therapy under the conditions of substandard nursing staffs; one never had to
worry about a patient gurgling under a rapid infusion from an unintended intravenous,
or about circulation open to the infusion of air or sepsis. The solutions by
clysis were remarkably well retained, even if the primary illness were diarrhea. We
experimentally administered a few drugs by this route cautiosly, and they seemed to
be effectively absorbed through the rectal mucosa. Hypodermoclysis was used occasionally
in infantile diarrhea. The standard intravenous route was used during operations
and in our critically ill patients.
Perhaps the most sophisticated surgical procedure performed was for an infant.
A baby boy was delivered by one of the midwives one night, and was found to have
abdominal distension the next morning. A quick check revealed an imperforate
anaus as the etiology for the infant’s distress. Referral of such a patient was impossible,
since there were no means of getting the patient to any of the medical centers
on the opposite side of the divided country. The patients always refuse colostomy, a
temporary operation that makes them social outcasts for the rest of their lives. So
the alternative in this infant with anal atresia was to do something definitive or
nothing. After a quick huddle over a few of the textbooks, we opted for the former,
and performed Takum Christian Hospital’s first abdominoperineal pull-through!
The operations performed durign our term are listed in Table 4. Hernia repairs
are seen to be the staple major operations, and a variety of every other surgical
subspecialty procedure except major thoracic and neurosurgical operations Some of
the biggest operations were gynecologic, including repair of a ruptured uterus with
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