Surgery and Healing in the Developing World - Dartmouth-Hitchcock

To My Son, the Urologist
for the needs back home. Of course, the solution lies in local and regional efforts
like those of the PACCS.
CMDS provides another avenue of service through its Commission of International
Medical Educational Affairs (COIMEA), in which teams of specialists journey
as invited guests to serve in medical schools and training institutions overseas
for the purpose of education and relationship building. My terms in Mongolia and
the People’s Republic of China came about under COIMEA’s aegis. Finally, an increasing
number of American medical students and residents seek exposure to frontier
medical practice, such that I envision serving as preceptor to these trainees on
future missions.
Doug: Can you flesh out a ‘typical’ mission for me?
Dad:
During particularly interesting and fruitful times of growth, I journal. In answer
to your query I share a small portion of my journal from Bangladesh in 1997.
‘KIDNEY OF THE HIMALAYAS’ ... A JOURNAL
6/15: Arrived in Dhaka at midday; heat and humidity oppressive, people
everywhere. The crush of the crowd, the filth, the beggars, the admix of odors
make progress a bit arduous. Being Sunday in a Muslim country, it is a regular
work day. I am thankful to be provided a driver to negotiate the congestion of
vehicles, pedestrians and animals, where the largest vehicle has the right-of-way
and the horn is as essential as the steering column.
6/16: It’s off to Memorial Christian Hospital, 65 miles to the south of
Chittagong, into arguably the most impoverished area of all of Bangladesh. I am
impressed by an extremely labor-intensive effort to build, and repair, the road.
Because little rock is available, workers manufacture bricks, which are then shivered
by hand (hammered) at the roadside, to be used to support the overlying
macadam. Indeed, labor IS cheap. No light or toilet paper in the unisex bathroom
at the only gas station along the way. Reeking urine and feces guide me to
the hole in the ground. Would have preferred the great outdoors, but then, in
Bangladesh one is never not being watched.
The mission compound, located on the old Burma Road of World War II
fame, perches atop a rise overlooking an alluvial plain extending out a bit over 10
miles into the Bay of Bengal. Quarters are comfortable and very affordable, but
do note that if one wishes air conditioning in addition to the ceiling fan there is a
small extra charge. Our bearer tends solicitously to our daily needs. Curiously,
Bengali (local) cuisine is not normally prepared in the common dining area.
Emphasis is upon fruit, vegetables, rice and a potpourri of beef, mutton, chicken
and fish. Quickly I notice that the fare reappears at the table until either it is
eaten or it spoils. The grounds are lush and carefully landscaped. Moss-covered
paved-brick pathways can be a bit treacherous, especially now in the monsoon
season, when it rains steadily from June to September.
The hospital, just inside the gate, has 55 beds, but since it serves a population
of nearly 12 million, in actuality it functions much like a 150-bed MASH unit.
Its career expatriate staff, 2 physicians and 5 nurses, aided by wonderful national
workers, each day treat hundreds who make it past the triage medic at the gate.
The facility, in an advanced state of disrepair, has open male and female wards,
two operating rooms, a labor/delivery/postpartum area and a bustling outpatient
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