Emergency and Essential Surgery: simple actions to make a difference
Based on recent WHO country assessments, surgery is beginning to be seen as an integral part of primary health care, a preventive strategy and a cost-effective way of dealing with many health challenges specific to resource poor settings. Below are four examples of how simple interventions can avoid future complications:
Examples of surgery as primary health care
1) Washing and removing dead or damaged tissue from an open fracture:
Open fractures are characterized by a rupture of the bone sticking out through the skin. The condition is often complicated by deep wound and localized infection (osteomyelitis). A simple way to avoid the infection is to wash the injury with sterile, saline and distilled water, and early closure of the skin. When osteomyelitis develops, it becomes a chronic infection, which requires multiple complex surgeries to treat. Learning straightforward skills to treat an open fracture minimizes disability.
2) Treatment of a traumatic joint dislocation (shoulder, elbow, hip):
Neglected joint dislocations result in severe disability with partial to complete loss of joint function. In the majority of cases, a simple manual intervention by a trained health professional can put the joint back in position. The manoeuvre requires only sedation for most patients and can be performed in the emergency room.
3) Drainage of abscesses:
The pathological condition resulting from either bone, joint or muscle infections is a common source of morbidity in developing countries. Untreated infections may result in severe or permanent disability to the patient. The drainage of the wound, by collecting the pus through an incision over the affected area, is indicated to treat bacterial infections in muscles or bones. In case of a bone infection, a hole may need to be made in order to remove the pus. Joint illnesses require a more complex surgical procedure. However, the drainage can be easily performed at primary care level as long as safe anaesthesia is available.
4) Casting technique to prevent clubfoot (also known as Ponseti):
Clubfoot is an inborn deformity of the foot, usually marked by a curled shape or twisted position of the ankle, heel, and toes (also called talipe). The cause is most likely to be a genetic disorder. Aligning the child's foot in order to stretch the tight ligaments and tendons is a basic and effective clinical intervention. A cast that extends from the toes to the groins has to be applied afterwards, maintaining the correction obtained by the alignment of the foot and relaxing the tissues. Treatment should begin during the first week or two of life to take advantage of the favorable tissue elasticity.