Surgery and Healing in the Developing World - Dartmouth-Hitchcock

To My Son, the Urologist
Figure 3. A 650-pound surgical equipment/supply cargo stresses the bush plane and
pilot.
red wooden louvers. Shoes/sandals are deposited at the door. We sit on the cement
floor, women and children on the left, men on the right. Worship team leads with
3 varieties of drum and a harmonium (with imagination looks like an accordion
on its left side). Hymnody is national, without tune, tone or rhythm ... like a
chant ... sliding (gliding?) from note to note. NO air-conditioning, NO fans, NO
breeze, an aching back.
With obvious pride a hospital employee shows me his ‘clinic’ in the bazar ... a
shop with shelves and shelves of medicaments, where he works off-hours to supplement
his meager income from the hospital. To be sure, the potential for abuse
(self-referral, etc.) exists, but the matter is not an item of great concern, since the
hospital can handle only a portion of those who come for care each day anyway.
The sights, sounds and smells of the bazar assault the senses: children playing in
the filth of the sewage ditch; buses packed, inside and on the roof, beyond belief;
‘restaurants’ which redefine ‘dirty spoon’; labs and X-ray facilities tucked here and
there among the shops; an elderly woman homeopath cutting cocaine for eager consumers
(The ‘golden triangle’ is not far away.); the betel nut/lime mix; ranitidine for
4 cents a pill; the ‘bottled water’ recycled; the barber shops’ razors spreading HBV.
Heard of a 10 year-old girl raped by her uncle, admitted with torn vaginal
vault and acute abdomen. Child abuse is high here, but the figures are soft. Further,
it’s unlikely that any action would be taken against the uncle, since he is a relative
and any female within the extended family is fair game for any male urges.
The World Health Organization reports that of the professional blood donors
in Dhaka two-thirds are commercial sex workers and half are intravenous drug
abusers. Further, most hospitals in the country do not test blood prior to transfusion.
We generally obtain blood from a family member.
Two patients presented simultaneously to the receiving area ... one a young
man with blunt abdominal trauma, the other a young girl after undergoing a
‘stick abortion’. Both required urgent surgical intervention, but facility limitations
did not permit concurrent procedures. It seemed that a moral/ethical dimen-
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