Editorial Tropical Doctor 2014, Vol. 44(2) 61 ! The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0049475514528430 tdo.sagepub.com
Editorial
There are many dedicated doctors working in isolated spots in the world. They rely on their own training and the support of the medical, nursing and administrative staff around them. Some are in situations where they crave support, recognition and advice. Not all are isolated, but many have difficulty accessing information, especially practical information. Advice from colleagues may not be appropriate or obtainable. Practical help does not always relate to the complex situations at hand in remote practice. Such assistance is not always readily available via the Internet, and is of course even more problematic to obtain if Internet access is intermittent, slow or even totally absent. Tropical Doctor exists to fill this gap. We are particularly pleased to hear from practitioners who have succeeded in overcoming hurdles in the practice by innovative solutions. Advances are often made through the imposition of lateral thinking, and responding to a crisis decisively. So it was extremely gratifying to receive this account from Impfondo, Congo: ‘She’s not responding to us anymore, doctor,’ my nurse said. ‘I’ll meet you in the Operation Room,’ I replied, trying to muster up all the confidence I had. This was my first day on call. We had already performed a number of difficult operative procedures, and now, a 5-year-old girl had just arrived after having been run over by a motorcycle, while trying to cross the street. We could tell she had a shattered depressed skull fracture on a brief examination. Clearly she was at risk of having had serious cerebral injury. As we headed to the OT, my colleague leant over and said, ‘I’ve only ever seen one of these before, so I’ll be assisting you.’ At this point, all I could respond was, ‘Sure!’ knowing I hadn’t operated on any more than he had seen. When the child arrived at the OT, she was totally unresponsive. We quickly administered a small dose of ketamine, opened her scalp, elevated her fractured skull, and removed the blood which pressed on her brain. When we finished, she was still alive and stable but was still was not responding. We were worried. The next day as I entered her room, there was no one in the little girl’s bed. Here, this is usually a terrible sign. It usually meant that the patient had died during the night. Feeling terrible, I saw her mother in the corner of the room and as tactfully as I could asked her, ‘What happened?’ Looking rather confused, she just pointed to the floor. Rather dejected I looked
down to see the little girl, not dead, but sitting up, smiling and eating breakfast. Over the next few days, we watched her recover miraculously and start running around playing with other children. Her smile was an encouragement to everyone at the hospital. When she left the hospital, she was able to function normally.1
We welcome your contributions. Reference 1. Tenpenny E. See http://wordpress.us5.list-manage1.com/ track/click?u¼20afebebbed4bf6704efa2b39&id¼f11dba 83a4&e¼335741ad15.
Michael H Cotton FRCS, FACS, FCS (ECSA), FMH Editor
Downloaded from tdo.sagepub.com at Karolinska Institutets Universitetsbibliotek on May 24, 2015
Editorial
There are many dedicated doctors working in isolated spots in the world. They rely on their own training and the support of the medical, nursing and administrative staff around them. Some are in situations where they crave support, recognition and advice. Not all are isolated, but many have difficulty accessing information, especially practical information. Advice from colleagues may not be appropriate or obtainable. Practical help does not always relate to the complex situations at hand in remote practice. Such assistance is not always readily available via the Internet, and is of course even more problematic to obtain if Internet access is intermittent, slow or even totally absent. Tropical Doctor exists to fill this gap. We are particularly pleased to hear from practitioners who have succeeded in overcoming hurdles in the practice by innovative solutions. Advances are often made through the imposition of lateral thinking, and responding to a crisis decisively. So it was extremely gratifying to receive this account from Impfondo, Congo: ‘She’s not responding to us anymore, doctor,’ my nurse said. ‘I’ll meet you in the Operation Room,’ I replied, trying to muster up all the confidence I had. This was my first day on call. We had already performed a number of difficult operative procedures, and now, a 5-year-old girl had just arrived after having been run over by a motorcycle, while trying to cross the street. We could tell she had a shattered depressed skull fracture on a brief examination. Clearly she was at risk of having had serious cerebral injury. As we headed to the OT, my colleague leant over and said, ‘I’ve only ever seen one of these before, so I’ll be assisting you.’ At this point, all I could respond was, ‘Sure!’ knowing I hadn’t operated on any more than he had seen. When the child arrived at the OT, she was totally unresponsive. We quickly administered a small dose of ketamine, opened her scalp, elevated her fractured skull, and removed the blood which pressed on her brain. When we finished, she was still alive and stable but was still was not responding. We were worried. The next day as I entered her room, there was no one in the little girl’s bed. Here, this is usually a terrible sign. It usually meant that the patient had died during the night. Feeling terrible, I saw her mother in the corner of the room and as tactfully as I could asked her, ‘What happened?’ Looking rather confused, she just pointed to the floor. Rather dejected I looked
down to see the little girl, not dead, but sitting up, smiling and eating breakfast. Over the next few days, we watched her recover miraculously and start running around playing with other children. Her smile was an encouragement to everyone at the hospital. When she left the hospital, she was able to function normally.1
We welcome your contributions. Reference 1. Tenpenny E. See http://wordpress.us5.list-manage1.com/ track/click?u¼20afebebbed4bf6704efa2b39&id¼f11dba 83a4&e¼335741ad15.
Michael H Cotton FRCS, FACS, FCS (ECSA), FMH Editor
Downloaded from tdo.sagepub.com at Karolinska Institutets Universitetsbibliotek on May 24, 2015
