Surgery and Healing in the Developing World - Dartmouth-Hitchcock

Medicine and Surgery in the Third World
essential task, fetching water, hoeing the ground, or finding firewood and then the
whole family suffers.
On the medical side there is the problem of expensive drugs for cancer and other
treatments let alone the need for haematological and biochemical examinations.
Even diabetes, cheaper though medications for this condition have become, presents
a problem in stabilisation. Where currencies deteriorate in value, ordinary
drugs become unaffordable. The steadily increasing work load which is being imposed
upon the hospitals by the AIDS pandemic has created daily intakes to some
hospitals which have become unmanageable. Patients for whom prolonged admission
would appear proper are having to be discharged the following morning to
make room for the next intake which will appear that day. Paediatrically the same
situation holds good because of the number of children born to HIV positive mothers
while obstetrics and gynaecology is similarly inundated.
Recently the health services have started to experience a new problem. There has
always been a steady brain drain of doctors from the underdeveloped world to the
First World; now there is a drain of nursing personnel as well. It is clear that in many
parts of the First World there have not been sufficient incentives to attract local
young people into those fields, yet from the standpoint of a person in the Third
World the salaries offered represent a glittering reward. A large number of young
people, both trained and untrained, are leaving their homes and families to go there
to work. Whereas this is of little consequence as far as the untrained person is concerned,
because in most Third World countries there are more applicants for training
than places available, it is of great consequence to a country when the trained
people disappear.
The Third World feels that immense kudos arises from the fact that locally based
training is considered good enough to allow their people to go to the First World to
work, and we are very gratified about that. However to produce trained people
ostensibly for the Third World who then go and live and work in the First World is
of no value to the country that trained them. The moment one produces staff who
are of an acceptable calibre and training to the countries of the northern hemisphere
then one is fishing in the same pond as the Americans, British and others. Clearly in
those circumstances, the bigger the bait the bigger and more fishes it will catch and
national loyalty inevitably plays second fiddle to finance, or even to working conditions,
in those circumstances. The Third World has to face the fact that if it is to
keep its staff it either has to pay them at commensurate rates (which few countries
can afford to do or they would not be Third World countries) or it has to produce
staff whose qualifications are oriented specifically towards their needs and not the
needs of the First World. This is something yet to be appreciated by many Third
World countries struggling for First World status. Nursing, medical and paramedical
training has understandably been modelled on the pattern of the western world
and its acceptance by the authorities of that part of the world has been considered
the yardstick of success by developing countries. However the training which equips
a young person to work in a sophisticated centre may be entirely inappropriate to
the requirements for running a rural health facility. For that an entirely different
education and training may well be required. By training its medical and nursing
staff along those lines, the countries of the Third World would not only have appropriately
oriented staff which would be much better for themselves, but would also
have staff who were not leaning towards the western world.
The question of instrumentation has been touched upon already. In all countries
where the currency has been debased, imported materials become very expensive
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