Preface: How the Book Is Organized
This book is divided into several sections, beginning with introductory
chapters that describe resource-poor situations that may require medical
improvisation. Subsequent sections discuss: Basic Needs, Patient
Assessment/Stabilization, Surgical Interventions, and Non-Surgical
Interventions. The Appendices provide useful information about preparing a
hospital disaster plan and assembling medical kits for different activities.
The Basic Needs section begins with communication
alternatives, since difficult communication is the most frequently cited
problem in resource-poor situations. Improvised methods for preventive
medicine/public health come next, since supplying clean drinking water and
suitable waste facilities saves more lives (in a non-dramatic way) than all
the interventional medical treatments combined. Finally, I discuss
improvised basic equipment for health care and methods for cleaning and
reusing medical equipment under resource-poor conditions.
Not all improvised equipment is discussed in this section,
since most equipment improvisations are described in the chapter appropriate
for their use. Reusing medical equipment is, rightfully, a controversial
subject, since inadequate cleaning, disinfection, and sterilization lead to
passing diseases from one patient to another. The best available information
has been used to provide guidance for when supplies and cleaning methods are
suboptimal.
The Patient Assessment/Stabilization
section describes methods and improvised equipment to assess vital signs,
and to manage airways, breathing, circulation, and dehydration/rehydration
(vital to saving children's lives). Also included are improvisations and
alternatives for medications and medication delivery, imaging, laboratory
testing, and patient movement/evacuation. Four chapters describe
improvisations for analgesia, local and regional anesthesia, and general
anesthesia. The Sedation and General Anesthesia chapter includes techniques
for both non-anesthesiologists and anesthesiologists. The
Ketamine, Ether
and Halothane chapter describes the most common anesthetics used in
developing countries, including unique administration methods. Younger
anesthesiologists, as well as other practitioners who may be called upon to
give
ketamine or ether, may be unfamiliar with these medications or
alternative administration techniques.
While not
everything in the Surgical Interventions section is strictly surgical (e.g.,
there is a chapter on neurology/neurosurgery), dividing the chapters in this
way provides a convenient method of locating information. The two Dental and
the Orthopedics chapters occupy significant space, since health care
professionals often need to apply these skills in resource-poor environments
even if they have little training in these areas. All chapters in the
Surgical Intervention section describe improvised equipment and techniques
that can save lives. For instance, the Otolaryngology chapter describes the
old, very basic, technique of placing posterior nasal packs, while the
Obstetrics/Gynecology chapter describes balloon tamponade for peripartum and
other vaginal bleeding.
The Non-Surgical
Interventions chapters include improvisations that can be used both in
traditional medical areas (e.g., gastroenterology, infectious diseases,
pediatrics/neonatal, and psychiatry), as well as other areas in which health
care professionals may need to be involved when resources are limited:
recognizing and treating malnutrition, assisting with rehabilitation, and
doing death notification, forensic investigation, and body management.
The Appendices provide a disaster plan for hospitals that
includes transparent markers and clear actions for each progressive disaster
level, and also suggest what to include in medical kits for several
resource-poor situations.
Hopefully,
Improvised
Medicine's contents will help you provide excellent medical care to your
patients in resource-poor settings. This information has already proven
valuable when I had to provide care in such settings. My experience has
convinced me that medical improvisation is both possible and highly useful.