Haiti

With moderate supplies, we can try to practice low-resource medicine. Without supplies, doctors and nurses don't matter. No real medicine takes place, and a hospital becomes a mere gathering of medical personnel. Or a morgue.

* Outdoor amputation with local anesthesia (video).

* Underequipped field hospital whose physicians are doing what little they can (video).

* Logistical nightmare for Doctors Without Borders (article).

No one could have prevented the earthquake, but Haiti was especially vulnerable because of shoddy infrastructure and lack of health services. The historic reasons for this are many and wretched. Tracy Kidder points out that there are 10,000 aid organizations established in Haiti, yet it remains obscenely poor. Educate yourself about Haiti and about Partners in Health's medical efforts there in his unforgettable book Mountains Beyond Mountains.

OF NOTE: Going to Haiti? Need some Creole? As of 1/15/10, Transparent Language is offering their "Byki Haitian Creole" software for free on iTunes, as their way of helping. And Pimsleur offers its first ten lessons of Haitian Creole free as well.

First-person accounts from MSF docs in India and Zimbabwe

I'd like to call your attention to three blog entries at the British Medical Journal's website, in which three physicians write about their work in low-resource settings with Médecins Sans Frontières (MSF, a.k.a. Doctors Without Borders).

Joseph Jacob discusses working in Kashmir and Chhattisgarh, India, where he and his colleagues are treating malnutrition, scabies, leprosy, TB, mental health disorders, malaria, and obstetric conditions. They also responded after Cyclone Aila hit India and Bangladesh in July '09.

Caroline Forwood writes about Bihar, where kala azar is endemic. This vicious disease, also known as visceral leishmaniasis, is transmitted by the sandfly, a creature 3 millimeters long that bites. Treatment options for this disease are few, though two new drugs were approved for use in India in the last decade. The MSF docs are using amphotericin B, which is expensive and carries serious side effects but is highly effective and readily available.

Philipp Du Cros gives the reader a look at his job improving or starting tuberculosis treatment programs, and focuses on MSF's efforts in Zimbabwe. What's striking about this and so many other accounts of work in low-resource areas are the descriptions of the distances patients must travel to obtain the most basic care. Add transportation to the list of problems (it includes sanitation, electricity, security, and many more) that are integral to the practice of low-resource medicine.