Honduras MD

The other day I did post operative followup on a patient who was the beneficiary of some life saving surgery performed by a US surgical team visiting Honduras. The approximate details aren’t pleasant for the squeamish, but they are essential to the points that follow.  The wound had become seriously infected. The lengthy plastic tube provided to drain the wound so it could heal, had been stuffed back into the body so the patient could get up and do things rather than lie there and recover. Pus, blood, and ooze was not only in the wound but probably also on the primitive floor and surroundings as well – though it wouldn’t have been noticed there. A raging fever showed the extent of the infection.

Prompt intervention to clean the wound and the patient with some strong antibiotics have stabilized things. The patient will recover; the children will continue to have at least the one parent they have now.

But none of that makes this story important. The importance lies in what the story illustrates. One is that as important as surgery is, it is often pointless unless there is a full time resident resource to follow up on post operative or post intervention care. That’s the hard part for this country, because it sometimes means going to the patients in their remote primitive circumstance, and intervening there to undo the mischief they deal themselves because they have no grasp that things they don’t see can harm them so much.

The other point is that this experience over a number of years begins to suggest that a new approach may be needed. It may be that every patient needs to see organisms through a microscope before they are treated so they begin to grasp that “what they can’t see” is always there waiting to invade their body, chew it up, and kill it – something that has a chance of changing their world view. Some sort of educational program, pre and post operative might help. The second solution that may be needed is a post operative, post trauma recovery center (not a hospital) – a clean place where patients can stay a short while while they get through the worst phase – a clean place where there is a chance to indoctrinate them on caring for themselves. It wouldn’t have to be too large or complex, nor equipped with sophisticated equipment. It wouldn’t have to be staffed on a permanent basis. Its use could be intermittent or transient. But it would have to accommodate some family members or friends that might live with them there for a few weeks. It would provide an opportunity to provide efficient care (vs. significant traveling time to walk up mountains to their primitive shacks). It would  a chance to influence them and any attendant caretakers to care for themselves. This will require a bit more thinking on my part. That’s one point of the story – something to think about for the future. Think along with me.