Surgery and Healing in the Developing World - Dartmouth-Hitchcock
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Surgery and Healing in the Developing World - Dartmouth-Hitchcock

Surgery and Healing in the Developing World - Dartmouth-Hitchcock Surgery and Healing in the Developing World - Dartmouth-Hitchcock

dartmouth.hitchcock.org
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21.06.2013 Views

Medical Adventures in the Nigerian Bush 427 Medicine The fellowship offered experience with a wide spectrum of medicine, with a high volume of patients with most of the diseases known to civilized countries as wella s exotic afflictions. Tuberculosis, as an example, was widespread, with an inpatient colony and a whole outpatient clinic full of complications of TB. We saw scrofula, Pott’s disease, lupus vulgaris, and enteric tuberculosis as well as complications of pulmonary TB such as pneumothorax, massive hemoptysis, and heart failure. One of the most feared admission diagnoses written on a new patient’s chart was the simple phrase “drank native medicine”. The local medicine men believed in rigorous purgatives for any disorder, and would administer caustic potions as remedies for most diseases. The “native medicine” was a potent nephrotoxin and hepatotoxin, which caused a rather rapid failure in the patient whatever his original disorder might have been. As seen in Table 2, “drank native medicine” figured prominently in the mortality bills, most of the patients becoming jaundiced and then progressively obtunded in liver failure and uremia. One of the most fascinating medical problems with which we became familiar with the management of snakebite. A common hemotoxic snake that accounted for almost all of the victims we treated was the common viper, Echis carinatus. We heard of, but did not see, victims of the tree snake, the dreaded green mambs; its potent neurotoxin was instantly lethal far before ineffectual hospital care could be provided. The Echis venom, however, antcoagulated the victim ot the extent that hemorrhage occurred at every interface with the patient’s environment. The patients had time to get to the hospital after being bitten, but arrived with hematuria, melena, hemoptysis, gingival bleeding, and profuse bleeding from the envenomation site and other superficial skin abrasions. Since most of the victims arrived later than a few hours after being struck, our therapy was not so much directed at getting the venom out (as with cruciate incisions, tourniquet, and so forth) as toward neutralizing the local and systemic effects of the venom already circulating. The bites would usually be on the hand or feet, and the most common victims were farmers working the earth and children playing in the grass. There would be enormous swelling of the extremity that had been bitten; in a few cases the edema caused such tension that the arterial supply was compromised. These cases were treated by fasciotomies to restore blood flow, and the others were wrapped and elevated. Since there existed no precise knowledge of where the venom acted in the clotting mechanism, a specific treatment was not available. However, antivenom for the Echis toxin was available and was injected regionally and systemically. If blood could be obtained, it was given to the patient as well. Some of the unproven treatment such as injection of Vitamin K and steroids were used in those patients who did not respond to the antivenom. I wanted to obtain a few Echis specimens for my own interest, and many of the patients obligingly brought in the snakes they killed after they had been bitten. I wanted a live snake, however, instead of only the skins of the snakes that had bitten patients. I figured the Echis venom could be investigated to see where it acts in blood clotting, not only so that treatment for viper victims would be more rational. But also because this purified venom might make a wonderful therapeutic coagulant. But for reasons of quite understandable fear, no patient could be persuaded to procure the live venomous specimen for me! 41

41 428 Surgery and Healing in the Developing World The exposure to worls health problems that this fellowship afforded has great shock value. The fellowship placed in perspective the narrow world of esoteric medical care in the health centers of civilization by showing us the other side of the 10 th century world health enigma—population masses dying of disease that can be simply controlled. It was a kaleidoscope of specialty practice, practically reinforcing the forgotten points of medicla school lectures, as we ran through the spectrum of health practices every day. It was the high point of our clinical education, and an experience enjoyable enough to be contagious.s

41<br />

428 <strong>Surgery</strong> <strong>and</strong> <strong>Heal<strong>in</strong>g</strong> <strong>in</strong> <strong>the</strong> Develop<strong>in</strong>g <strong>World</strong><br />

The exposure to worls health problems that this fellowship afforded has great<br />

shock value. The fellowship placed <strong>in</strong> perspective <strong>the</strong> narrow world of esoteric medical<br />

care <strong>in</strong> <strong>the</strong> health centers of civilization by show<strong>in</strong>g us <strong>the</strong> o<strong>the</strong>r side of <strong>the</strong> 10 th<br />

century world health enigma—population masses dy<strong>in</strong>g of disease that can be simply<br />

controlled. It was a kaleidoscope of specialty practice, practically re<strong>in</strong>forc<strong>in</strong>g <strong>the</strong><br />

forgotten po<strong>in</strong>ts of medicla school lectures, as we ran through <strong>the</strong> spectrum of health<br />

practices every day. It was <strong>the</strong> high po<strong>in</strong>t of our cl<strong>in</strong>ical education, <strong>and</strong> an experience<br />

enjoyable enough to be contagious.s

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