Surgery and Healing in the Developing World - Dartmouth-Hitchcock

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426 Surgery and Healing in the Developing World
a twinge of farsighted guilt that we performed hysterosalpingograms and other studies
designed to restore fertility to patients in whom we thought contraceptive measures
were better indicated.
Public Health
Some of the most interesting experiences we enjoyed were in trekking on preventive
medicine missions into outlying villages. Our welcome was always enthusiastic,
and entire district populations would turn out for the mystic touch of the
‘bature’ mai magani’ (the visiting white man of medicine). The Chief of Jibu led out
his whole town’s population to welcome the guests who were visiting to organize a
new outpost dispensary. We made rounds at several of the dispensaries in outlying
villages, staffed and supplied by Takum Christian Hospital. The ‘dispensers’ are the
general practitioners of the bush, trained at the hospital in the diagnosis and treatment
of the everyday tropical disease, and taught to send into the hospital serious
cases and emergencies. They settle into the widely scattered communities with their
chest of medicine and treat what they can, storing up their problem cases until the
doctor can make dispensary visits. The dispensers literally “drum up” patients for
the day when the doctor’s schedule of visits is radioed to the scattered stations. A
long line of the sick and a thick crowd of the curious always greeted us during our
overnight treks to the dispensaries.
Another type of public health practice was our trip to areas where there were not
even rudimentary dispensaries, in which we accompanied a public health nurse in
rural preventive medicine visits. These were largely for immunization and public
health lectures on basic principles such as sanitation, encouraging the people to
build and use latrines to prevent the transmission of parasitic epidemics. The instruction
was carried out with the help of rather graphic charts illustrtaing proper
hygiene in the performance of several body functions. One of the most important
achievements of these visits was the massive number of inoculations given. Tetanus,
smallpox and pertussis were widely distributed in these high risk populations, and
BCG was given as protection against several endemic mycobacteriae—tuberculosis,
leprosy, and some forms of cutaneous ulcers. Perhaps the most dramatic preventive
measure was in the introduction of measles vaccination to theis highly susceptible
population. Measles is a dreadful disease among these tribes that have not been
exposed to it. Some of the sickest children we saw suffered from the acute stages of
measles with pneumonia, extensive rashes, high fevers, conjunctivitis and stomatitis;
some of the most pitiful children were those with the late complications of measles
developed after surviving the acute exanthem with blindness, deafness, diffuse encephalitis,
and spasticity. The measles immunization program took on a grave urgency
after we were exposed to a small epidemic of measles.
As a bonus of our public health side trips into outlying villages, we often returned
with gifts from the patients we treated—a few yams from some families, a
bull’s horn from another, and usually a loud squawking rooster. I always felt as
uncomfortable as the chicken when this disgruntled gift was presented, since we
knew this was a significant gift which might have been a whole family’s protein
intake for a month. But there was no refusing their hospitality because they were too
elated that the threat of measles and tetanus was lifted form their hut to worry about
malnutrition.