Surgery and Healing in the Developing World - Dartmouth-Hitchcock

6
42 Surgery and Healing in the Developing World
sion should tip the decision in favor of the man. An attempt had been made to
take an innocent life. The man’s bowel perforation was quickly repaired. Then,
when we returned to the surgical prep area, on the gurney beside the woman was
a robust baby girl, and beside her a green stick with a string wound around for
easy retrieval after the attempted abortion! Turned out, too, that the young lady
had been married only 7 months with a full-term pregnancy, and further, there
was a question of paternity.
Because modern drugs are too expensive, irregular and uncertain in supply,
and possibly ineffective owing to microbial resistance, many patients favor traditional
remedies. Indeed, different levels of ability to pay lead to different levels of
quality of care. Traditional medical practices no doubt can be effective. Cultural
relativism maintains that notions of healing should be interpreted within the
particular world-view of the patient and his or her cultural group. Like their
patients, traditional healers do not necessarily distinguish between subjective and
objective symptoms, curing and caring, or measurable and immeasurable clinical
data. They seem to focus upon relieving suffering, controlling symptoms, and restoring
physical function as well as social and psychological well-being. My experience
supports the idea that it is possible to combine the best of biomedical and
traditional health practices so that a genuinely sustainable pattern of healthcare
can develop, something unanticipated by health planners even a decade ago.
6/29: Noticed today that none of the patients, including babies, wears an ID
bracelet. One incubator contained two unrelated female newborns. Has there
ever been a mix-up? Who would ever know and/or care? An adoption would be
no problem here, since one could simply walk out of the hospital with a baby of his
or her choice (a male, of course). In OPD had patients named ‘Muhammad Ali’
and ‘Taj Mahal’! A young man with a longstanding indwelling suprapubic tube
for traumatic prostatomembranous urethral disruption declined definitive repair.
Another man, 60 years of age, with dramatic rectal prolapse and BPH postponed
surgical correction, preferring to suffer a while longer.
7/1: I’m on first call tonight. Received a call from an experienced Bengali
nurse, who asked what I would recommend for a 3 year-old male (9 Kg) with
acute onset of dyspnea without fever, cough or any other symptom. Having focused
only on Urology for 3 decades, I volleyed back, ‘What would you customarily
do in such a case?’ She replied with a number of suggestions. Of course, I
eagerly endorsed her advice. A bit humorous, what with the formality and redundancy
involving me in part of the care loop, but then I AM a full-fledged member
of the team, a bit stretched out of my comfort zone, but exhilarated, too.
7/4: Independence Day in America, 3 days ago for Canada. Have been thinking
about what changes Bangladesh really needs. The liberals wish to change the
structure, but in my view will not succeed in what appears for all the world to be
a fixed, closed system. The atomic approach, that is, one by one, seems much
more reasonable and effective, although undoubtedly slower. Ironic that her critics
had been critical of the late Mother Teresa for her avoiding the massive, the
impressive, the monumental, while tending to the hurting one by one. Surely
something good, I think.
7/6: As I returned from an early morning jog, I noted not only the milling of
hundreds of hopeful patients awaiting the triage medic at the gate, but also a
Muslim cleric conducting a prayer chant. In an area of incredible spiritual admix
invisible battles abound.