Surgery and Healing in the Developing World - Dartmouth-Hitchcock

Field Notes on a Typical Day in a Himalayan Medical Mission
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why not learn from them what they are doing right? A far more effective means of
health promotion would be to invest in some preventive measures, so that their
health strengths might be used, to be exploited to help control their problems. Ladakh
is in transition here, since they have a rather good basic health state, with a health
care infrastructure that might help maintain that with some form of primary care
without a lot of frills for services not yet fully required.
What this means within a health care education system is that students are always
concerned when accompanying me that they know too little about exotic tropical
diseases, in which I may be particularly well versed, and they are looking for the rare
and endemic conditions not seen elsewhere in their US medical school experience.
There is a chart on the wall of the clinic room I am using with Elizabeth and Amy
that shows the early changes of leprosy, a disease that piques the interest of the
medical student from the US since it sounds so Biblical and pestilential that we
MUST have some exposure to this ancient scourge. But, what about this rather
ordinary garden-variety litany of diseases we have been treating all day?
To this point, now 300 outpatients along in our two day clinical experience, (the
first two days of the professional experience, and the entirety of the clinical experience
of at least five people in my entourage) there has not been ONE patient with
any form of unusual tropical disease requiring treatment! As had been pointed out
to me thirty three years ago in Nigeria when I was first starting out at the level of a
senior medical student in an environment in which tropical disease was endemic
then, and even now, is that to practice medicine in a developing world setting, the
preparation needed is a very good basic understanding of the pathology of the western
worlds’ endemic disease patterns with which we should already be familiar, and
then note two exceptions: The disease patterns are seen in later classic presentation
in more advanced stages when first encountered because of the lack of early secondary
intervention in them. And, second, there are any number of diseases of degeneration
that these populations do NOT have that fill over two thirds of the US
hospital beds. Now, what can we learn from them to avoid the greatest causes of
morbidity in the US health and illness pattern?
One young monk had fallen on his outstretched right hand and sustained a
Colles fracture-this would have been a simple fix with plaster sugar tongs splint, but
there was no plaster for casting here and we had to send him on with his diagnosis—
which he had made before we did. A local practitioner would make a splint of
locally available materials, such as bamboo—lightweight, resilient and strong.
We had a few developmental retardation patients at least one of which looked
post-meningitic to me. The little kids with ear infections and GI distress with diarrhea
do not look different than they do anywhere else, but they did have one feature
which occasioned a short discussion of the advantages and disadvantages of being
born at altitude.
Being born a Kenyan from the highlands may make it possible for you to expect
to win the Boston marathon from the additional “blood doping” of an aerobic advantage.
But, as seen with nearly all the little kids in Peruvian Andes, they have rosy
red cheeks with what looks like frostbite of those cheeks. I suggested they consider
the difference in the hematocrit of these small kids with their own, and consider
whether acquired polycythemia was an adaptive response or not, and at what point
too thick a blood made it possible that flow could became sluggish, however well it
could hold on to oxygen. That the medical students could practically apply a lesson
in renal erythropoetin and blood rheology while standing in a clinic in Thicksay
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