The Invention of Surgery by David Schneider

Author:David Schneider
Language: eng
Format: epub
Publisher: Pegasus Books
Published: 2020-01-12T16:00:00+00:00

The mosquito nets that hang down from the ceiling in the open-air hospital ward are like spinnaker sails over an armada of hospital beds. In Rwanda, like most African countries, the hospital wards have limited walls and windows, which facilitate the free flow of air across the dozens of patients whose cots are lined up in neat rows. Tuberculosis is thwarted with the exchange of air, but open windows permit mosquito entry. Each cot has a mosquito net anchored overhead to a rafter; the netting itself is opaque and dense enough to block the tiny mosquitos that transmit the parasites that causes malaria. The nocturnal routine is always the same, where every inhabitant unfurls the twisted-up netting to cover all four corners of their sleeping area. In the morning, the process is reversed, and the white nets are wound up with a dozen twists and moored to a corner of a bed.

I arrived late last night from another outpost hospital in the western provinces of Rwanda with our team of American doctors and nurses and Rwandan surgical residents. I have traveled to Central Africa to mentor the young physicians, always heeding the advice of a veteran surgeon before my first trip overseas years ago: when you prepare to teach in a third-world country, throw your modern textbooks out the window. They are outdated in two respects: the proposed treatments are based on current technology and newfangled gadgets (which are not available in developing countries) and the diseases are distinctive (namely, TB is still a major problem around the globe, much less so in America). A much better approach is to find a fifty-year-old textbook, where TB of the bone is addressed and simple tools are used to solve everyday problems.

Waking early, I join the local medical staff in the outdoor atrium for morning rounds. Men, women, and children are all housed in the main ward, which is surrounded by massive trees, heavy vines, and exotic-sounding birds. My team and I (joined by a Rwandan orthopedic resident, Paul) enter the main ward, where I witness most of the patients twirling up their mosquito nets. Some patients are listless, and I’m told that there has been a gastrointestinal illness that has been rampant through the region in the last few weeks. Along one edge of the building are the malaria sufferers, obvious to the trained eye, owing to their utter catatonic state and complete lifelessness. In medical school, I had learned about the flu-like symptoms, including headache, fever, joint pain, and even convulsions, but seeing malaria patients up close, suffering so severely, has given me a profound respect for the little plasmodium that causes malaria and a new fear of mosquitos.

Paul and I walk along one aisle of patients, flanked by little cots in neat rows. Most Westerners want a private hospital room; here there are sixty cots in this high-ceilinged, open-air ward. As we come to the end of the row I spot a young man, probably twelve years old, who is lying on his back, propped up on his elbows, with a few blankets under his back and head.

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