Surgery and Healing in the Developing World - Dartmouth-Hitchcock

To My Son, the Urologist
Doug: What is it like to work in the Third (even Fourth) World?
Dad:
If a phrase can capture the difference between the technological marvels of modern
medicine and what one finds in a Third World context, it’s ‘adjustment to lack’,
virtually any lack one can imagine. Lack of an adequate operating room, functioning
equipment, pharmaceuticals and supplies, physician personnel, trained support
staff, physical safety, a reliable power supply, potable water, laboratory/X-ray support,
translators, anesthesia capability, diligent postoperative care, facility organization
and management typify to varying degrees my experience. Poverty, malnutrition,
high prevalence of HIV infection (exceeding 50% in some areas), whimsical government
bureaucracies and late presentation of patients (often for economic reasons)
can frustrate even the most heroic attempts to deliver quality care. Obstetric complications
and trauma account for most surgical emergencies. For the urologist prostatic
obstruction, urethral strictures, stones and vesicovaginal fistulae comprise the
bulk of problems encountered. The emigration of trained national surgeons and
collapse of national healthcare systems stress to a critical level some countries’ health
and well-being. In some instances a shocking greed, corruption and callousness at
all levels of government sap the tenuous attempts to deliver medical care to individuals
ravaged by socioeconomic chaos and physical disease.
Unquestionably, the medical mission scene is changing. With political independence
many Third World governments aspired to some form of Western style of
healthcare delivery. Under national pressure, missions handed over hospitals and
clinics to national leaders, who shortly discovered that operating these institutions
was beyond their resources. Presently in place in many instances is an ‘on-again,
off-again’ relationship between government, missions and non-governmental organizations.
Indefinite funding, “the West reaching out to the rest”, however, is problematic.
Moreover, money and other resources can be a source of tension. A Westerner
suggesting a low tech or low cost solution may sometimes be accused of seeking to
deprive Third World people of the best, which they surely are entitled to receive. A
“cargo cult” mentality fluorishes in this setting.
Doug: How did your interest in short-term volunteer medical missions evolve?
Dad:
In 1965 Mom, a Registered Nurse, and I received a Smith Kline & French scholarship
to serve three months in Swaziland, Africa. Even though assigned to anesthesia
and dental duties on that mission, breaking free to scrub in surgery as often as
possible, our eyes were opened and hearts burdened to minister to the medically
desperate overseas. We devoted six months in 1969 to work in Papua-New Guinea,
I functioning as sole general surgeon in a 400-bed acute care facility. For over a
decade with the U.S. Army medical corps in Honolulu, as a urologist I led many
humanitarian missions with residents and ancillary personnel throughout Micronesia.
Then, in civilian practice in Honolulu, Mom, now a urology nurse, and I performed
occasional missions overseas. But, the time to which we had looked forward (i.e.,
family launched, ‘empty nest’, ‘mid-life crisis’ — call it what you wish.) came in
early 1995, when I retired from active Stateside practice to pursue medical missions
in developing nations much of the time. In view of our experience in Swaziland over
thirty years ago, we encourage and support as we are able those early in their medical
careers to work overseas. Lives may be changed, as ours were.
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