From the introduction to Chapter 7 in Operation Health: Surgical care in the developing world.
At first her father refused to give permission to operate. “You can’t do that type of operation here” was his rationale. There were only a few minutes available to convince him otherwise. His daughter, only 3 years old had fallen from a balcony an hour before. She now lay in a hospital bed paralyzed on one side and seizing on the other. Her right pupil was dilated. Clinically she had an epidural hematoma – a blood clot was rapidly expanding around her brain; within the hour, without an operation, she would be dead.
Technically, the father was correct. At the hospital there was no CT scanner and no neurosurgeons. His daughter needed holes drilled into her skull and the blood clot removed. In a high income country, this would have been a medical emergency with a full team of specialized experts. Such specialists were not available in the entire country; however, without an operation his daughter would certainly die. There was not much of a choice; ultimately he consented to an operation.
Twenty minutes later the little girl was asleep in the operating room and the procedure began. A few moment later holes were drilled in her skull, blood clots removed, and the nurse anesthetist reported that her vital signs had stabilized – she was improving.
After the operation she was transferred to the small intensive care unit. The next morning she was awake and alert, and the following day she was transferred to a general ward. She recovered fully.
Although this story illustrates a classic “numerator” issue – treating a single patient, not a population, it began to spark my interest to try to understand why surgical care was not receiving greater support from donors and aid groups. Even Ministries of Health seemed to ignore the massive need for surgical care for their populations.
As traumatic injuries and especially road traffic injuries increase throughout the world, improving surgical services for trauma care can play a preventive and therapeutic role. Fractures and lacerations, which can easily be treated, even without the specialized knowledge of a surgeon or even a doctor, can prevent severe disabilities and even death. Major operations for conditions such as epidural hematomas or ruptured spleens can be lifesaving.
We need to look at traumatic injuries and surgical care from the standpoint of the population: millions are dying and hundreds of millions are permanently disabled from conditions that are preventable or treatable with surgical care. We need to examine the role that public health can play in improving surgical care for victims of trauma.
To read more see Chapter 7 “Implementation of Trauma Registries in Resource Limited Settings: A case study from Tanzania” in Operation Health: Surgical care in the developing world.
Operation Health: A series of books on surgery and global health from Johns Hopkins University Press 