Case Scenario
You are the mission director for a short-term medical mission to a less developed country with a need for otolaryngology. The country, which is poor, has few physicians, with otolaryngologists located only in the larger cities. After locating the sleeping quarters and stowing the team’s equipment, you and your team are given a tour of the clinic and regional hospital and find them to be quite basic—that is, the resources provided to care for patients are minimal. You see that the diagnostic equipment, operating room, and recovery room facilities are far less adequate than you had been led to believe. It becomes apparent that the scope of the surgical procedures you and your team came prepared to perform may need to be reconsidered.
Explore this issue:
July 2016
Svetlana Lukienko/shutterstock.com
Your otolaryngologist host has mobilized a number of nurses and translators to assist the team in obtaining histories and performing physicals on the patients, many of whom have walked for several days to be seen. The translators seem to have a serious lack of medical knowledge, however, and it is difficult to determine just how well your questions and comments are being translated to the patients.
In spite of the agreement with your hosts that you and your team would only be addressing otolaryngologic clinical issues, quite a few of the patients are requesting care for medical issues outside of the scope of otolaryngology—such as diabetes, skin sores, burns on the extremities, hernias, and deformities of the fingers and toes. One family has carried in a grandmother in a makeshift gurney to see your team, when in fact she has suffered a severe stroke from hypertension.
There are, however, plenty of patients with otolaryngologic disorders. The team diagnoses facial paralyses, facial skin cancers, head and neck tumors, cleft lips and palates, severe nasal deformities, malunions of mandibular fractures and mandibular tumors, vocal fold paralyses, chronic ear disease, and chronic sinus disease. You also are asked to see a number of prospective patients the host otolaryngologist introduces to you and the team as “requiring” facial plastic surgery procedures. These individuals are dressed much more affluently than the rest of the patients and are waiting in a side room where tea and sweet biscuits are being served.
You and your team are given a tour of the clinic and regional hospital and find them to be quite basic. You see that the diagnostic equipment, operating room, and recovery room facilities are far less adequate than you had been led to believe. It becomes apparent that the scope of the surgical procedures you and your team came prepared to perform may need to be reconsidered.
The remainder of the patients, who seem genuinely in need of medical and surgical care, are dressed in clean but poor clothing and, in some cases, beg you for help. Many others seem quite shy, perhaps because they have never seen or been around Americans before.