Surgical techniques and priorities

Abstract

This paper compares contemporary western surgical needs (e. g. the surgery of physical decay) with the surgical needs of less developed countries and shows that these are a function of expectations, real and unreal. An outline of the needs of poor societies follows, with examples from practical experience in the Zulu country: e. g. surgery of trauma, including burns; obstruction; childbirth; congenital defect; vision, especially cataract. Also the incidence of cancer is briefly mentioned, stressing the differences between the developed and less developed countries. The priorities are surgery at the periphery. Its extent is discussed along with its surprising range and the concept of the ‘appropriate’ in surgery. Surgery at the central institution is also discussed. The tech­niques available are: ( a ) Anaesthesia, regional and local (e. g. for Caesarean section). ( b ) Fluid replacement; blood and electrolytes. ( c ) Transport: the itinerant surgeon or the mobile patient?; the use of the visiting expert at the periphery; the teaching of surgical techniques to partially trained personnel. ( d ) Anti-microbials: the need for a policy is stressed along with the value of long-acting agents, and the problem of resistant organisms. ( e ) Surgical prophylaxis (e. g. vesico-vaginal fistula, poliomyelitis, epilepsy and burns).