Surgery and Healing in the Developing World - Dartmouth-Hitchcock

6
40 Surgery and Healing in the Developing World
highly skilled and experienced, solicitously guide me as I steady my ‘sea legs’. What
a pleasure to assist a wonderful ‘surgical assistant’ with a 10th-grade education in
the performance of complicated cleft lip/palate repairs and other remarkable reconstructive
operations. He learned over a couple decades by watching career and
short-term surgeons, as myself. Truly, we teach each other.
I cystoscope, using the laparoscope’s camera/monitor for all to watch attentively,
an elderly man with advanced bladder malignancy. Sadly, we have nothing appropriate
to offer. How frustrating it is that patients present only as a last resort, having
already tried home remedies, spiritual exercises, the village chemist’s recommendations,
the local medico’s (sometimes even self-designated as ‘quack doctors’!) prescriptions,
etc. And, since women in this culture cannot consent to medical care, even for
themselves, a family council often must be convened before approval is granted to
present to the hospital. As a result, we walk in a ‘valley of death’, not in a ‘valley of
the shadow of death’. And so much suffering preventable and/or treatable!
I lunch with a man from Dhaka, who provides some shocking statistics: population
of Bangladesh 120 million; annual growth rate over 2%; life expectancy
52 years; 1 doctor for each 6,000 people; 21 urologists in the entire country;
12,000 individuals for each hospital bed; 60% of the population homeless; 33%
living in abject poverty; average caloric intake 1,250 cal/day.
6/23: Three deaths last night—a young lad who aspirated, a young woman
with uterine rupture and a dead baby (4 days’ labor, transverse lie) delivered by
C-section. My surgical assistant tells me of his arranged marriage, the norm, and of
how his wife ‘does a good job’, as though marriage is a business. He wishes for one of
his 2 children, the boy of course, to attend medical school, but fees are beyond reach
for all but the privileged few. Girls quit school after 6th grade, get married, bear
children, toil at home, die. In the marketplace one sees only an occasional female,
usually a widow without someone to shop on her behalf, or a prepubertal girl.
6/24: I perform my first spinal anesthetic in over 3 decades ... successfully! A
lad with pseudovaginal perineal hypospadias appears in the clinic, and the medic
tells me he knows of two others from the same village! Even though Bangladesh’s
life may be defined by waters tumbling from the ‘rooftop of the world’, the
Himalayas, earning it the moniker ‘kidney of the Himalayas’, urinary stone disease
is common. Lacking state-of-the art equipment, I train the general surgeon
and assistants to ‘cut for stone’.
6/25: I am invited out for dinner to the home of a wealthy man in a nearby
village to celebrate the first birthday of his granddaughter. A wonderful feast for
the stomach, as well as for the eyes. We eat with the right hand without any
utensils whatsover, a hand cleansed intermittently in a basin delivered by the
bearer of the home. A proper host never eats with his guests, but stands by to
ensure that all is well for the honorees. Owing to a staggeringly high infant mortality,
in some places babies are not even given an official name until age 1 or 2
years. Bengali men wear the punjabi shirt and lungi (like a lava lava) and women
the sari (pronounced ‘sharee’ in Bangladesh).
6/26: Worship at the Bengali church, a 2-mile walk across the road. En route
pass through a Christian development, settled mostly by Christian staff at the
hospital. Muslims and Christians in the same village mingle to a significant degree
only at the bazar or market. We also pass a blue and white mosque, adjacent
to a murky pool of water, where the faithful bathe for ceremonial cleansing, often
5 or more times each day! Church is a cinderblock building with bright green or