Surgery and Healing in the Developing World - Dartmouth-Hitchcock

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462 Surgery and Healing in the Developing World
supervisor and consultant in the front room that John Sutter had occupied yesterday.
I would then float between the room manned by Bill Barrett and Christine
King, who requested to stay together as a team, and Jonathon Schoen and Hadley
Abernathy, which I suggested be reconstituted to move Hadley up front, and move
in the other local doctor as their translator who might enlighten them on local
approaches to common problems. I also knew that when the mob of curious school
children arrived there would be a rush of bodies of the worried well crowding more
than a hundred patients with some form of complaint, and at that time we could
move Hadley, a teacher, and Amy, a former teacher before becoming a medical student,
out into the courtyard for the public health presentations with a translator
team.
The Full Monty: Clinic Processes 160 Patients
with a Target of Completing by 2:00 PM
for the Excursion of the Afternoon
We tried to pick up the pace in going through the patients’ problems, since the
hallways were jamming up with large crowds of colorful people waiting rather patiently
and curiously. Sonia was able to do this better than Elizabeth, perhaps because
she was less cautious, not having a longer list of worries to be missing the
larger list of things Elizabeth had to exclude, picked up in her extra year in GW
medical school. I supervised the two of them quite closely for every patient, and
would drop in on every third patient being seen by the two physicians, Bill and
Jonathan who handled their flow rather well.
We saw the same variety of patients, with Tb, congestive failure, acute respiratory
infections, musculoskeletal complaints—principally osteoarthritis of the knees,
with the ever-present moxabustion scars indicting where they hurt. It seemed that
osteoarthritis may have been common, and present in more than one set of joints,
but it was usually the knees that patients complained about first. “Why is that?”
asked one of the students. “With respect to serious functional incapacitation, you
have seen an Asian toilet?” I responded.
There was a lot of epigastric distress, differentiated about evenly between peptic
and biliary problems. A lot of this was acid reflux disease, presumably because
Helicobacter pylori was endemic and increasing in the area, but we had been told
that with increasing westernization of the diet in the area as more contact had continued
with the outside world, the biliary tract problems of cholecystitis were increasing
in the last few years as well. The local hospital is getting the equipment for
the laparoscopic removal of gall bladders!
Progress! This means they are developing ever more sophisticated technology to
deal with problems they had never experienced until they had developed to the
point of getting the Western problems in concert with the west sending them not
only the disease, but the methods of treating it! Next we will be able to handle
atherosclerosis, gastrointestinal cancers, and strokes with renal failure here, since
they will have “developed “ sufficiently to be able to not afford to take care of these
diseases either!
This means that medical marketing is an almost perfect model of an economic
export system, creating demand for services that become indispensable along with
the technology for half way solutions. Degenerative diseases of civilization create a
lifetime demand for their management, since they are not ever cured—why not
prevented? And, if there are areas of the world where they have not yet developed,