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| Photo courtesy of Michelle Murrey, Mercy Ships |
Those of us who talk about global surgery a lot (which I promise I do,
even though I haven't updated this blog in a few months) often talk
about how surgery differs from other global health interventions in a
really fundamental way.
Improving surgery, we claim, actually improves entire health systems. Unlike delivering a vaccine, you can't do good surgery without the physical plant, nursing, sterilizing, infection control, anaesthesiology, electricity, water, and suction required to do it--to say nothing of the surgeons themselves. So, we figure, for a ministry of health that is interested in improving its country's healthcare, writ large, surgery is an appropriate place to focus. Positive externalities, and all.
It's a dry argument, as anything which requires you to write the phrase "positive externalities" will be, but this week, in a small, 28-pound child, it became incarnate.
On Monday, in Pointe Noire, Congo, where I've been for the last two weeks with Mercy Ships, I met a two-year-old boy who was first diagnosed with malaria a year ago. After antimalarials did nothing, his parents took him to Kinshasa, where they were told that, malaria or not, he had a tumor in his mouth. Nothing could be done, and he would gradually suffocate. Over the last four months, his breathing slowly worsened, until he began to lose consciousness three times a day. His mother initially brought him to the hospital every time; eventually, she stopped.
His dad, though, works in the port here in Pointe Noire and saw the Africa Mercy sail in. The rumor was, this clunky, white, metal box actually contained a hospital. He and his wife bought a calendar, ticking off the days until our patient selection day last Wednesday. When they got to the front of the line of over 7,300 people, their son couldn't breathe.
Two days ago, he went to surgery, where we took out a mass the size of my fist--ridiculously large for a two-year-old.
The reason I tell this story, though, is not to talk about the operation.
See, as he was wheeled into the operating room, a small, multinational army welcomed this child and his compromised airway: two anaesthesiologists, one intensive care physician, one anaesthetic assistant, two nurse anaesthetists, three surgeons, and three OR nurses. We were from the US, the UK, the Netherlands, Switzerland, and Congo, and we were flanked by an entire difficult airway setup, with video laryngoscopy, flexible fiberoptic laryngoscopes, and an open tracheotomy tray.
Taking care of this small boy was not just a matter of a couple of hours of struggling against an obstructing tumor and reconstituting a destroyed palate. It was management of the patient from the time he was carried onto our ship, through his intubation, his surgery, his middle-of-the-night re-intubation for pulmonary edema, his round-the-clock, one-on-one ICU care by dedicated pediatric ICU nurses, his eventual extubation, and his quiet return to his mother, a toddler finally able to sleep.
This is surgery. It's not just scalpels and suction; it's an infrastructure. And while it's hard to build, it can be built, and platforms like this might play a role in building it. And help a few patients along the way.
Improving surgery, we claim, actually improves entire health systems. Unlike delivering a vaccine, you can't do good surgery without the physical plant, nursing, sterilizing, infection control, anaesthesiology, electricity, water, and suction required to do it--to say nothing of the surgeons themselves. So, we figure, for a ministry of health that is interested in improving its country's healthcare, writ large, surgery is an appropriate place to focus. Positive externalities, and all.
It's a dry argument, as anything which requires you to write the phrase "positive externalities" will be, but this week, in a small, 28-pound child, it became incarnate.
On Monday, in Pointe Noire, Congo, where I've been for the last two weeks with Mercy Ships, I met a two-year-old boy who was first diagnosed with malaria a year ago. After antimalarials did nothing, his parents took him to Kinshasa, where they were told that, malaria or not, he had a tumor in his mouth. Nothing could be done, and he would gradually suffocate. Over the last four months, his breathing slowly worsened, until he began to lose consciousness three times a day. His mother initially brought him to the hospital every time; eventually, she stopped.
His dad, though, works in the port here in Pointe Noire and saw the Africa Mercy sail in. The rumor was, this clunky, white, metal box actually contained a hospital. He and his wife bought a calendar, ticking off the days until our patient selection day last Wednesday. When they got to the front of the line of over 7,300 people, their son couldn't breathe.
Two days ago, he went to surgery, where we took out a mass the size of my fist--ridiculously large for a two-year-old.
The reason I tell this story, though, is not to talk about the operation.
See, as he was wheeled into the operating room, a small, multinational army welcomed this child and his compromised airway: two anaesthesiologists, one intensive care physician, one anaesthetic assistant, two nurse anaesthetists, three surgeons, and three OR nurses. We were from the US, the UK, the Netherlands, Switzerland, and Congo, and we were flanked by an entire difficult airway setup, with video laryngoscopy, flexible fiberoptic laryngoscopes, and an open tracheotomy tray.
Taking care of this small boy was not just a matter of a couple of hours of struggling against an obstructing tumor and reconstituting a destroyed palate. It was management of the patient from the time he was carried onto our ship, through his intubation, his surgery, his middle-of-the-night re-intubation for pulmonary edema, his round-the-clock, one-on-one ICU care by dedicated pediatric ICU nurses, his eventual extubation, and his quiet return to his mother, a toddler finally able to sleep.
This is surgery. It's not just scalpels and suction; it's an infrastructure. And while it's hard to build, it can be built, and platforms like this might play a role in building it. And help a few patients along the way.
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