Surgery and Healing in the Developing World - Dartmouth-Hitchcock

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32 Surgery and Healing in the Developing World
Appropriate Technology
Appropriate technology is the kind that will be emphasized for remote field hospital
use. I have stressed the simplicity and elegant sophistication of some forms of
low technology, since it is the most easily maintained and most highly effective. But
“appropriate” does not always mean “low-tech”; some very useful high tech machinery
is very useful if it is hardy, reliable, and gets information that cannot otherwise
be obtained without resort to fragile and fallible techniques. For example, a
battery-operated portable ultrasound is a highly useful device, supplanting much
X-ray and all scanning for practical purposes in the settings with which we are here
concerned. Small plastic plates coated with immunofluorescent antibody are highly
useful in making diagnoses. I had already discussed the high utility of solar panel
electrical generation. A laptop computer is a great way of storing large amounts of
information in a compact space without the perishability of paper records and can
be recharged through solar panel or D/C adapter to a storage battery. The great
utility of photography and a small tape recorder have made them essential parts of
every one of my trips.
The kinds of technology that work best are any that can be produced or serviced
locally with a minimum of moving parts to “go missing.” The fewer embedded
chips the better, since one small part that malfunctions makes for an immediate pile
of expensive trash, and our purpose for being out in this environment is not the
diversion to field strip and service First World machinery.
What do you need to practice medicine effectively in a Third World setting?
Always more than you do know now, but that is true also for the First World, and
the intensity of this learning experience is one of the greatest of yields from traveling
abroad. But, a much higher yield can be expected in the management of patient
problems, especially considering the lack of alternatives the patients generally face.
If I do not fix someone’s hernia in Washington DC, the patient looking for an
operation will be seen minutes later by another surgeon, often by health management
plans or other providers elbowing to the fore claiming they had seen him first.
If a similar patient’s problem is not fixed in the setting where there is a doctor/
patient ratio of >1/250,000 this rare encounter may be this patient’s only hope. It is
hard to fail in primary treatment of obvious illness. This experience must be one of
the most rewarding in medicine, if seconded only by the thrill of witnessing healthcare
protégés carrying on the successful sustainable practice of medicine that has been
passed along.