Surgery and Healing in the Developing World Glenn W. Geelhoed, M.D., FACS Professor of Surgery Professor of International Medical Education Professor of Microbiology and Tropical Medicine George Washington University Medical Center Washington, D.C., U.S.A. L A N D E S B I O S C I E N C E GEORGETOWN, TEXAS U.S.A. Surgery and Healing in the Developing World LANDES BIOSCIENCE Georgetown, Texas U.S.A. 2005 Landes Bioscience Printed in the U.S.A. Please address all inquiries to the Publisher: Landes Bioscience, 810 S. Church Street, Georgetown, Texas, U.S.A. 78626 Phone: 512/ 863 7762; FAX: 512/ 863 0081 While the authors, editors, sponsor and publisher believe that drug selection and dosage and the specifications and usage of equipment and devices, as set forth in this book, are in accord with current recommendations and practice at the time of publication, they make no warranty, expressed or implied, with respect to material described in this book. In view of the ongoing research, equipment development, changes in governmental regulations and the rapid accumulation of information relating to the biomedical sciences, the reader is urged to carefully review and evaluate the information provided herein. Contents Foreword .......................................................................... ix Preface.............................................................................. xi 1. Preparation Time .............................................................. 1 Harvey Bratt 2. Surgery in Developing Countries ...................................... 6 John E. Woods 3. A Commitment to Voluntary Health Care Service .......... 13 Donald C. Mullen 4. International Surgical Education: The Perspective from Several Continents ........................ 18 Glenn W. Geelhoed 5. Medicine Writ Large in the Raw, without Power or Plumbing ............................................ 25 Glenn W. Geelhoed 6. To My Son, the Urologist ................................................ 33 Douglas Walter Soderdahl and Douglas Wayne Soderdahl 7. Medicine and Surgery in the Third World ...................... 53 Lawrence Levy 8. Lab in a Suitcase ............................................................. 59 Christine A. King and James Kerr 9. Lab-in-a-Suitcase: Saving Lives in Remote Corners of the Globe .................................................................... 68 Hollee D. Van der Veen and Milton B. Amanyun 10. Establishing Electrical Power in Remote Facilities for Health Care ............................................................... 71 Jeffrey A. Mazer 11. Tropical Nursing ............................................................. 87 Diana Downing 12. Communication in the Third World: A One-Way Street............................................................ 92 Jim Bascom 13. Anesthesia in the Third World ........................................ 98 John F. Williams 14. Outpatient Assessment of the Pregnant Patient: Dilatation and Curettage .............................................. 109 Kedrick D. Pickering 15. Basic Obstetrics and Obstetric Surgery in a Mission Setting ...................................................... 118 F. L. Dutton and Glenn W. Geelhoed 16. Pointers for American Surgeons Going to the Developing World ............................................... 144 Donald E. Meier and John L. Tarpley 17. Training to Serve the Unmet Surgical Needs Worldwide .......................................................... 153 Robert J. W. Blanchard, Ronald C. Merrell, Glenn W. Geelhoed, Olajide O. Ajayi, Donald R. Laub and Edgar Rodas 18. Guide to the Operating Theater on $25 a Patient ......... 167 Glenn P. Verbrugge 19. Orthopedic Surgery ...................................................... 177 Richard C. Fisher 20. Chronic Pyogenic Osteomyelitis in a Rural Area: The Aggravating Factor of Underdevelopment.............. 186 Ahuka Ona Longombe 21. Study of the Epidemiology and Treatment of Fractures in Rural North-East of Democratic Republic of Congo ....................................................................... 191 Ahuka Ona Longombe, M. Mbusa, K. Diyo, M. Kakule, K. Kasindi and M. Duani 22. The Prevention and Treatment of Landmine Injuries in the Developing World ............................................... 195 James C. Cobey 23. Cleft Lip and Palate Surgery in Developing Countries ............................................... 200 William P. Magee 24. Outreach Dentistry: A World of Wonder Awaits in the Golden Anniversary of General Dentistry ........... 218 Glenn W. Geelhoed 25. Dentistry ....................................................................... 233 David Foskett and Anthony M. Vandersteen 26. Reconstructive Surgery in the Tropics........................... 243 Harold P. Adolph 27. Factors Influencing Geographic Distribution and Incidence of Tropical Surgical Diseases .................. 277 Ricardo Cohen, Frederico Aun and Glenn W. Geelhoed 28. Population Dynamics of Surgical Tropical Diseases...... 285 Ricardo Cohen, Frederico Aun, Glenn W. Geelhoed and Eric L. Sarin 29. Metabolic Maladaptation .............................................. 288 Glenn W. Geelhoed 30. Nutrition and Development in Africa Risk: Factors on Either Side of the Fulcrum Balance ............. 321 Glenn W. Geelhoed 31. Uterine Ruptures in Rural Zaire ................................... 325 Ahuka Ona Longombe, K.M. Lusi and P. Nickson 32. Vesicovaginal Fistula of Obstetrical Origin in Northeast Democratic Republic of Congo (DRC): The Experience of the CME Nyankunde....................... 331 Ahuka Ona Longombe 33. Ophthalmology ............................................................. 335 James Kerr and Christine A. King 34. Accommodating Deficits in Material and Assistance ............................................................... 348 William L. Barrett, Laji Varghese and Malini Anand 35. Abscesses and Other Infections Treated by Surgery....... 358 Robert J. W. Blanchard 36. Surgical Training of Nurses for Rural Areas: Necessity or Aberration?................................................ 379 Ahuka Ona Longombe 37. Training of Medical Assitants in Mozambique for Surgery in a Rural Setting ....................................... 386 Ivo Paulo Garrido 38. Training Surgeons in the Developing World ................. 389 David C. Thompson 39. Mobile Surgery ............................................................. 404 Edgar Rodas and Edgar B. Rodas 40. Public Health Problems on Burma Frontiers: A Window into a Nation in Crisis ................................. 411 Myaing Nyunt 41. Medical Adventures in the Nigerian Bush ..................... 418 Glenn W. Geelhoed and Sally E. Geelhoed 42. Infectious Disease Mortality ......................................... 419 Glenn Geelhoed 43. World Health ................................................................ 438 Glenn W. Geelhoed ................................................................................. 44. Treating Others: Human Sciences in Theory and Practice ....................... 441 Glenn W. Geelhoed 45. The Impact of a Volunteer Medical Mission on the Attitudes, Knowledge Base, and Reported Humanitarian Motivations of a Group of Medical and Public Health Students .......................................... 447 Glenn W. Geelhoed 46. Field Notes on the Clinical, Public Health, Geographic, and Political Features of a Typical Day in a Himalayan Medical Mission .................................. 461 Glenn W. Geelhoed Editor Glenn W. Geelhoed, M.D., FACS Professor of Surgery Professor of International Medical Education Professor of Microbiology and Tropical Medicine George Washington University Medical Center Washington, D.C., U.S.A. Email: [email protected] Chapters Preface, 4, 5, 15, 17, 24, 27, 28-30, 41-46 Contributors Harold P. Adolph Diana Downing Chapter 26 Chapter 11 Olajide O. Ajayi M. Duani Chapter 17 Chapter 21 Milton B. Amanyun F. L. Dutton Chapter 9 Chapter 15 Malini Anand Richard C. Fisher Chapter 34 Chapter 19 Frederico Aun David Foskett Chapters 27, 28 Chapter 22 William L. Barrett Ivo Paulo Garrido Chapter 34 Chapter 37 Jim Bascom Glenn W. Geelhoed Chapter 12 Chapters Preface, 4, 5, 15, 17, 24, 27, 28-30, 41-44 Robert J. W. Blanchard Chapters 17, 35 Sally E. Geelhoed Chapter 41 Harvey Bratt Chapter 1 M. Kakule Chapter 21 James C. Cobey Chapter 22 K. Kasindi Chapter 21 Ricardo Cohen Chapters 27, 28 James Kerr Chapters 8, 33 K. Diyo Chapter 21 Christine A. King Chapters 8, 33 Donald R. Laub Edgar Rodas Chapter 17 Chapters 17, 39 Lawrence Levy Edgar B. Rodas Chapter 7 Chapter 39 Ahuka Ona Longombe Eric L. Sarin Chapters 20, 21, 31, 32, 35, 36 Chapter 28 K.M. Lusi Douglas Walter Soderdahl Chapter 31 Chapter 6 William P. Magee Douglas Wayne Soderdahl Chapter 21 Chapter 6 Jeffrey A. Mazer John L. Tarpley Chapter 10 Chapter 16 M. Mbusa David C. Thompson Chapter 21 Chapter 38 Donald E. Meier Hollee D. Vander Veen Chapter 16 Chapter 9 Ronald C. Merrell Anthony M. Vandersteen Chapter 17 Chapter 25 Donald C. Mullen Laji Varghese Chapter 3 Chapter 34 P. Nickson Glenn P. Verbrugge Chapter 31 Chapter 18 Myaing Nyunt John F. Williams Chapter 40 Chapter 13 Kedrick D. Pickering John E. Woods Chapter 14 Chapter 2 Foreword Surgery and Healing in the Developing World The major thrust of this book is to present a collection of “how I do it” from 50 authors. The whole book is a valuable traveling companion for those attempting their first medical mission, or veterans of many such trips eager to better perform this art. There is an occasional familiar