reference texts for medical practice in remote and tropical settings
TRANSCRIPT
Wilderness and Environmental Medicine, 8,48-50 (1997)
Letter to the editors,
Reference texts for medical practice in remote andtropical settings
To the Editors:
Four fifths of the more than five billion people on our planetare living in the developing world [1]. Primary health carewill be increasingly important in these often tropical andremote areas. Physicians trained in the West will continue tobe in positions to provide medical care in developing countries either while serving in local medical facilities or duringadventure travel.
Several years ago while working in a remote area ofNepal, I was called in the night to assist at a home deliverythat had become complicated. On my arrival, fortuitouslyalong with the local Lama, shaman, and midwife, I discovered a healthy newborn and a mother with retained placentaand postpartum hemorrhage. Having come prepared, I eventually consulted the definitive and voluminous 1500-pageobstetrics text that I had noticed in the clinic and broughtalong on the one-mile hike to the house call. Reading on thedirt floor by dim candlelight, I was appreciative of the text'sclear and concise recommendation: "Proceed to the operating room at once[!]" Since then, my pack carried to housecalls in remote villages is free of those weighty referencebooks that serve so well for medical practice in the UnitedStates.
Selection criteria
There is a growing medical literature suitable for clinicalreference by physicians who are practicing in a remote areaor developing country. These texts tend to be different fromthose physicians find useful in clinical settings in developedcountries. The scope of the presenting illness may be unfamiliar. Clinical conditions often involve unreliable or nonexistent lighting, heating, water and power sources, as wellas limited staff, supplies, equipment, pharmacy, laboratory,and diagnostic studies. Referral to larger centers or specialists may not be available because of the remote location,inadequate transportation, lack of patient resources, and/orpatients' social standing or political status.
The texts listed in this article were selected primarily onutility and appropriateness for this setting and, where alternatives were available, on considerations of weight andcost. All texts listed are soft cover or small-format hardcover, printed on thin Bible paper. Several are published inlow-cost editions for use in developing countries, producedby nonprofit organizations, and/or available in languages in
108D--6032 © 1997 Chapman & Hall
addition to English. The address from which to obtain thetitle and the languages available in addition to English follow each citation. During several years of working in remote and/or tropical areas, I have found these texts particularly helpful with daily clinical duties.
The surgical manuals are unique and essential to augmentthe skills and training of both primary-care physicians andsurgeons who are caring for patients in remote or tropicalsettings. In addition, the clinical manuals addressing themedical problems common to developing countries including tuberculosis, leprosy, AIDS, parasitic and other infectious disease, complicated obstetrics, comprehensive orthopedics, nutrition, and sanitation have often proved invaluable. Training of health care workers is commonly animportant responsibility of physicians working in developing countries; consequently a section listing appropriatemanuals is included.
Selected reference texts
Note: Brackets [ ] following each citation designate theaddress from which to obtain a copy of the text.
COMPREHENSIVE (INCLUDING INTERNALMEDICINE, PEDIATRICS, OBSTETRICS, ETC.)
Berkow, R., Fletcher, AJ., eds. The Merck Manual. 16th ed. Rahway, NJ: Merck, 1992:2696. [Merck Sharp and Dohme Research Laboratories, West Point, PA 19486, USA]
Hope, R.A., Longmore, J.M., Hodgetts, TJ., Ramrakha, P.S. Oxford Handbook of Clinical Medicine. 3rd ed. Oxford: OxfordUniversity Press, 1995:837. [Oxford University Press, WaltonStreet, Oxford OX2 6DP UK]
ColIier, J.B., Longmore, J.M., Harvey, J.H. Oxford Handbook ofClinical Specialties. 3rd ed. Oxford: Oxford University Press,1995:811. [Oxford University Press]
DENTISTRY
,Dickson, M. Where There Is No Dentist. Palo Alto: HesperianFoundation, 1993:188. (Available in English and Portuguese.)[The Hesperian Foundation, P.O. Box 1692, Palo Alto, CA94302, USA]
King, M., Bewes, P., Cairns, J., Thornton, J., eds. Primary Surgery. Vol. I. Non-Trauma. (See "Surgery" below.)
DERMATOLOGY
Canizares, O. A Manual ofDermatology for Developing Countries.2nd ed. Oxford: Oxford University Press, 1993:370. [OxfordUniversity Press]
Letter to the editors
EMERGENCY MEDICINE/TRAUMA
King, M. ed. Primary Surgery. Vol. 2. Trauma. (See "Surgery"below).
Mengert, T.J., Eisenberg, M.S., Copass, M.K. Emergency MedicalTherapy. 4th ed. Philadelphia: Saunders, 1996:992. [W.B.Saunders Co., The Curtis Center, Independence Square West,Philadelphia, PA 19106, USA]
FAMILY PLANNING
King, M., King, F., and Martodipoero, S. Primary Child Care. AManualfor Health Workers. Oxford: Oxford University Press,1978:314. [TALC]
Klein, S. A Book for Midwives. A Manual for Traditional BirthAttendants and Community Midwives. Palo Alto: The Hesperian Foundation, 1995:519. [The Hesperian Foundation]
Kleinman, R.L., ed. Family Planning Handbook for Doctors. 6thed. London: International Planned Parenthood Federation(IPPF), 1988:361. (Available in English, French, and Spanish.) [IPPF, P.O. Box, 759, Inner Circle, Regent's Park, London, NWl 4LQ, UK]
HEALTH WORKER TRAINING
Werner, D. Where There Is No Doctor. Palo Alto: Hesperian Foundation, 1994:565. (Available in English, English for Africa,Hindi, Portuguese, and Spanish.) [Hesperian Foundation]
Werner, D., Bower, B. Helping Health Workers Learn. Palo Alto:Hesperian Foundation, 1991:632. (Available in English andSpanish.) [Hesperian Foundation]
IMMUNIZAnON FOR TRAVEL
Center for Disease Control and Prevention (CDC). Health Information for International Travel. Atlanta, GA: CDC, 1990.[Superintendent of Documents, US Government Printing Office, Washington, DC 20402, USA]
INFECTIOUS DISEASEffROPICAL MEDICINE
Bell, D.R., ed. The Lecture Notes on Tropical Medicine. 4th ed.Oxford: Blackwell Scientific Publications, 1995:368. [Blackwell Mosby Book Distributors, 11830 Westline IndustrialDrive, St. Louis, MO 63141, USA]
Benenson, A.S., ed. Control ofCommunicable Diseases in Man. 16thed. Washington, DC: American Public Health Association(APHA), 1995:577. (Available in Arabic, English, Farci, French,Italian, Japanese, Portuguese, Spanish, and Turkish.) [APHA,1015 Fifteenth Street, NW, Washington, DC 20005, USA]
Crofton, J., Home, N., Miller, F. Clinical Tuberculosis. London:Macmillan, 1992:210. [TALC]
Gilles, H.M. Management of Severe and Complicated Malaria. APractical Handbook. Geneva: World Health Organization(WHO), 1991 :66. [Distribution and Sales, WHO, 1211Geneva 27, Switzerland]
Sanford, J.P., Gilbert, D.N., Gerberding, J.L., Sande, M.A. TheSanford Guide to Antimicrobial Therapy. Dallas: Antimicrobial Therapy, Inc., 1996:125. [Antimicrobial Therapy, Inc.,5910 N. Central Expressway, Suite 1995, Dallas, TX 75206,USA]
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World Health Organization (WHO) A Guide to Leprosy Control.2nd ed. Geneva: WHO, 1988:121. [WHO]
World Health Organization (WHO). Guidelinesfor Clinical Management ofHIV Infection in Adults. Geneva: WHO, 1991:86.(Available in English and French.) [WHO]
World Health Organization (WHO). Guidelinesfor Clinical Management of HIV Infection in Children. Geneva: WHO, 1993:88. (Available in English and French.) [WHO]
World Health Organization (WHO). Treatment of Tuberculosis:Guidelines for National Programmes. Geneva: WHO, 1993:43. (Available in English, French, and Spanish.) [WHO]
LABORATORY
World Health Organization (WHO). Manual of Basic Techniquesfor a Health Laboratory. Geneva: WHO, 1980:478. (Available in Chinese, English, French, and Spanish.) [WHO]
OBSTETRICS
Bergstrom, S., Hojer, B., Liljestrand, J., and Tunell, R. PerinatalHealth Care With Limited Resources. London: MacmillanEducation Ltd., 1994:186. [TALC]
Driessen, F. Obstetric Problems, A Parctical Manual. Nairobi,Kenya: African Medical and Research Foundation, 1991 :27S.[TALC]
King, M., Bewes, P., Cairns, J., Thornton, J., eds. Primary Surgery. Vol. 1. Non-Trauma. (See "Surgery" below.)
ORTHOPEDICS
King, M., ed. Primary Surgery. Vol. 2. Trauma. (See "Surgery"below.)
McRae, R. Practical Fracture Treatment. 2nd ed. New York:Churchill Livingstone, 1993:328. [Churchill Livingstone]
PEDIATRICS
Ebrahim, GJ. Paediatric Practice in Developing Countries. London: Macmillan, 1988:321. [TALC]
King, M., King, F., and Martodipoero, S. Primary Child Care. AManualfor Health Workers. Oxford: Oxford University Press,1978:314. [TALC]
Stanfield, P., Brueton, M., Chan, M., Parkin, M., and Waterson, T.,eds. Diseases of Children in the Subtropics and Tropics. 4thed. London: Edward Arnold and Educational Low-PricedBooks Scheme (ELBS), 1991:1076. [Tropical HealthTechnology\ELBS, 14 Bevills Close, Doddington, March,Cambridgeshire, PElS OTT, UK]
PHARMACOLOGY
Joint Formulary Committee. British National Formulary. London:British Medical Association, 1995:668. [British Medical Association, Tavistock Square, London, WCIH 9JP, UK]
SURGERY
King, M., Bewes, P., Cairns, J., Thornton, J., eds. Primary Surgery. Vol. 1. Non-Trauma. Oxford: Oxford University Press,
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1993:640. [Teaching-aids at Low Cost (TALC), P.O. Box 49,St. Albans, Herts, ALl 5TX, UK]
King, M., ed. Primary Surgery. Vol. 2. Trauma. Oxford: OxfordUniversity Press, 1987:400. [TALC]
King, M., ed. Primary Anaesthesia. Oxford: Oxford UniversityPress, 1986:169. [TALC]
VETERINARY MEDICINE
Aniello, S., Mays, A., Bergeron, J., eds. The Merck VeterinaryManual. 7th ed. Rahway, NJ: Merck, 1991:1832. [MerckSharp and Dohme Research Laboratories]
WATER AND SANITATION
Morgan, P. Rural Water Supplies and Sanitation. London: Macmillan Publishers Ltd., 1990:358. [TALC]
WILDERNESS MEDICINE
Wilkerson, J.A., ed. Medicine for Mountaineering and Other Wilderness Activities. 4th ed. Seattle: Mountaineers Books, 1992:416. [The Mountaineers, 300 Third Avenue W., Seattle, WA98119, USA]
Letter to the editors
Conclusion
Creative problem solving, adaptability, flexibility, and humor serve well in remote settings. A good beginning beforeleaving home is to adjust the clinical reference library oneplans to bring along and rely on in the new and challengingpractice setting. This list is offered as a starting point.
Acknowledgments
I am indebted to the numerous colleagues in Alaska, England, India, Nepal, and Tibet from whom so much has beengained.
Reference
1. United Nations. World Population Prospects: The 1994 Revision. New York: United Nations, 1994.
JAMES A. LITCH, MD
Bozeman, Montana, USA, andHimachal Pradesh, India