Surgery and Healing in the Developing World - Dartmouth-Hitchcock

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58 Surgery and Healing in the Developing World
and equipment and drugs of all sorts may be unavailable. “Appropriate technology”
is the term applied to innovative methods of producing adequately functional equipment
to do a task otherwise performed by expensive apparatus manufactured in the
northern hemisphere. In the neurosurgical field a variety of such have had to be
devised and include wire traction on the skull in place of tongs (originally devised by
Dr T L Hoen of Bellevue/NYU), the Harare Shunt for the treatment of hydrocephalus
and a simple stereotaxic device for intracranial needle placement.
In the orthopedic field the Association of Surgeons of East Africa sponsored its
own simple external fixator which was developed by Professor Kenneth Rankin. In
Uganda Mr. Peter Bewes designed skin graft knives using old safety razor blades and
an old kitchen knife. Numerous “peg legs” and crutches for the amputee, wheelchairs
of all sorts for the paralysed and many other devices of all sorts have been and
still need to be devised.
This is appropriate technology without which many things would be impossible
and much endeavour in the Third World would be unfruitful. To be successful in
this environment the ability to work hard, to improvise and to be able to work on
his/her own are essentials to a successful and satisfying practice.
To the highly trained and technically oriented surgeon or physician work in the
Third World may be very difficult and even prove too challenging. Many doctors
feel useless when faced with the absence of highly sophisticated equipment and
modern drugs while the sheer volume of work which presents itself, once the doctor
is known as a reliable and friendly practitioner, can in itself be daunting. Lack of
equipment and drugs can be intimidating and requires innovative methods for the
treatment of many diseases. Nonetheless the sick can and must be treated, and the
grateful smile of the departing patient, as everywhere, is a satisfying reward for all
the time and trouble lavished.