I always enjoy week two of the Developing Health Course. By now we have got to know one another, shared some laughs and got used to the strange coffee. We are all ages and stages, from a fourth year medical student from Leeds, to a nurse who’s spent 26 years in Ghana. Participants are, or will be, working in a total of 18 countries, ranging from Papua New Guinea to Mongolia and including nine countries in Africa.
The other reason that the second week is fun is that we have practical skills afternoons that make a change from lectures and seminars – fascinating as these are, they can’t compete with pulling teeth out of pigs’ heads and putting each other in plaster. Monday was surgery day and there was a chance to practise spinals and sutures, as well as sessions on dentistry and wound care. Amanda Stephens, from Christian Dental Fellowship, had brought two pigs’ heads for us to learn how to take out a tooth. They proved to be very stubborn but three people managed to extract whole teeth – and were awarded prizes later. The kitchen staff were a bit surprised when I asked them to dispose of the remains – we declined their offer of cooking them for our supper.
Yesterday was trauma and orthopaedics so we practised plastering, traction, physio on each other, and skin grafts on oranges, which smelled a lot better than the pigs’ heads
Our first talk today was from Hilary Edgcombe, who started with photos of an elephant and a boa constrictor under anaesthetic, which was cool.
11% of world’s disability-adjusted life years are lost due to conditions amenable to surgery. Safe anaesthesia is necessary for surgical care. This is not available worldwide:
In the UK, anaesthesia related mortality is 1 per 185,000
Malawi central hospital: 1 per 504
Togo teaching hospital 1 per 133
South Africa: 1 in 4 maternal deaths are anaesthesia related: 90% avoidable
Surgery for the non-surgeon
John Rennie and Colin Binks gave the next talks on surgical matters. They both apologised for the dwindling capacities of their ageing neurones, but assured us that with enough onhealthy celexa prompting they would be able to recall the more important arteries, etc.
‘You must take your bible, your toothbrush, your anti-malarials and the Textbook of Primary Surgery. It’s brilliant, full of pictures, and perfect for those of you who are far more comfortable cutting sausages than cranial burr holes.’
‘You can do good surgery without electricity, although it is rather nice to have a lightbulb…’
Driving round the North Circular via the world’s most awful roundabout meant that I nearly didn’t make it to the course this morning. Happily though, I avoiding the lorry that tried to crush me by changing lanes without indicating, and I arrived ready for a day of trauma…
Chris Lavy spoke about the low numbers of surgeons in Low Income Countries
‘Where I work in Oxford, I don’t even recognise all the other surgical consultants in my hospital. When we lived in Malawi I knew the names, birthdays and spouses of every surgeon in the country.’
16% of the global burden of disease is injuries, so we need to take it seriously. The Primary Trauma Care course is basically a very low cost of the ATLS course.
Alan Norrish performed 2,000 operations in his four years in Zambia, Afghanistan, Malawi and UAE. Lots of orthopaedic pathology in developing countries is treatable, but some is not. He said;
‘Some people spend all their money trying to find a resolution to a long term problem, and sometimes the best you can do is tell them there is no cure, and then they can spend the money on useful things for their life.’
Sarah Tucker spoke about her work on burns in Nepal; ‘We did an audit that showed that in six years, no one had survived 40% burns on our burn unit. Painful as it is to say, this means that it was unlikely to be worth the heavy investment in resources treating people with this level of fatal wound. Sadly we had to make the decision to treat anyone with more than 40% burns palliatively.’
Right now we’re just starting women’s health day, with a team of five facilitators gathering from all over the country – one just got off the night train from Scotland – another busy day.