GUEST POST: How to Improve Medical Services in Third World Countries

The world has become a much smaller place, thanks to technology and globalization. But no matter how connected we are, there still exist huge disparities between the rich and the poor. The gap gets wider with each passing year, for individuals and nations. In the eyes of the developed world, third world countries are perceived as places where the standard of living is poor and where the things they take for granted are considered luxuries. In reality however, third world countries have their share of both the obscenely rich and the dirt poor. And the main reason for their backwardness is not just the paucity of money, but also the lack of awareness and education among the poorer and downtrodden sections of society.

When we consider the state of medical services in these countries, we see that the rich are able to afford any kind of treatment for all kinds of diseases. But for the poor and the middle class, medication is prohibitively expensive simply because quality medical services are only offered by the private sector. The government does offer services for the poor and those who are not able to afford private medical treatment, but the quality of treatment is poor at times. Also, the facilities are often overcrowded and not hygienic, and this makes the middle class hesitant to seek medical treatment at these places.

Improving medical services in third world countries is an uphill climb, but it can be done if:

• Tax money is put to better use – to build cleaner and more spacious medical facilities and to pay qualified doctors and other healthcare personnel so that they don’t move away to set up their own private practice or join a private care provider.
• Politicians don’t get greedy and swindle public funds that are meant for the improvement of society and the common man.
• Bribery is abolished and doctors and healthcare personnel are encouraged to offer better services through various incentives.
• People are made more aware of the need for cleanliness and personal hygiene.
• Education is made compulsory for children so that they have opportunities to leave behind the squalor and poverty they grew up in.
• Smaller towns and villages are better linked by road to cities and larger towns where there are better medical facilities.
• Mobile medical services are introduced in remote villages so that diseases are diagnosed in the early stages and the need for emergency care and hospitalization is minimized.
• More emphasis is placed on preventive rather than curative care. When this happens and people are more aware of the need for preventive care through the right diet and regular exercise, healthcare begins to look up in any nation, developed or developing.

By-line:

This guest article is written by Teresa Jackson, she writes on the subject of online NP schools . She invites your questions, comments at her email address : teresa.jackson19@gmail.com.

GUEST POST: How to Ensure Healthy Babies For HIV Mothers

It’s a problem that still plagues most third world countries because the level of awareness is pretty low, because the people are not educated enough, and because HIV/AIDS is still rampant. The most important thing on an HIV positive pregnant woman’s mind is the fear that she will pass on the dreaded disease to her unborn child, and most women opt for an abortion rather than put their child through the same torment that they undergo every day. But the truth is, if you follow the right precautions, babies with HIV mothers are unaffected by this virus.

Combination antiretroviral therapy must be provided to the mother during pregnancy and during labor, and to the child after birth.

Breastfeeding must be avoided as much as possible, and if the mother insists on it or if the child is allergic to other forms of sustenance, they can try the preventive method suggested by a study conducted by the University of North Caroline at Chapel Hill. According to this study, providing the infant with antiretroviral syrup every day or treating the mother with highly active antiretroviral drugs helps prevent mother-to-child HIV transmission.

• Mothers must be encouraged to follow hygienic procedures and drink water that is potable or filtered.
• Mothers must work closely with their clinicians to monitor the baby and ensure maximum protection for their child.
• Doctors must ensure that the mother’s blood does not enter the baby’s bloodstream at the time of birth
• A natural birth is a definite no-no in such situations. The mother must be prepared for a C section.
• The mother must undergo regular prenatal checks and follow her doctor’s instructions to the letter.
• The babies will be monitored closely for up to six weeks after birth.

It’s up to the mother to see that her baby does not suffer from this dreaded disease. As long as she is confident and careful, there’s no reason why her baby cannot be born healthy. Doctors allow a 98 percent chance that HIV mothers will deliver healthy babies.

This guest article was written by Adrienne Carlson, who regularly writes on the topic of nurse practitioner schools . Adrienne welcomes your comments and questions at her email address: adrienne.carlson1@gmail.com

GUEST POST: 7 Excellent Open Courseware Collections To Learn About The Human Body

The human body is a fascinating and intricate construction, and there are many reasons to learn more about it. You may want to know how it works so that you can better understand your own, and thereby make the best decisions possible in regards to good health and maintenance. You may want to understand how it works so that you can move into a profession that works to restore it to health. You may just be curious. Whatever the reason, these 7 excellent open courseware collections to learn about the human body are a great place to begin or to continue your study of the human body.

General Human Anatomy

General Human Anatomy takes a general look at the structure of the body and all its systems. This is a cursory examination of the human body as a structure provided by UC Bekeley and is the perfect start to any study of the human body.

Human Anatomy

Human Anatomy, provided by Emory University, takes the investigation a step farther examining the systems of the human body. It takes a look at the organization of the nervous system and the physical anatomy of each portion of the body. Focuses include the upper and lower extremity, the vertebrae and spinal cord, the head, the neck, the abdomen, and the thorax.

Human Growth And Development

Tufts University's Human Growth and Development takes a look at the human body throughout the lifespan. The development of bodily and cognitive skills during the lifespan can be better understood when you are aware of the progression of physical growth that happens concurrently.

Cell-Matrix Mechanics

Cell-Matrix Mechanics, courtesy of the Massachusetts Institute of Technology (MIT), will teach you about the physical processes of the development of cells and tissues. This will include a look at the growth process both as it occurs naturally with aging and as it occurs with healing after damage to certain tissues.

A Clinical Approach To The Human Brain

A Clinical Approach to the Human Brain, also from MIT, is a collection that will explain how the human brain works both when it is healthy and when it is not. The resources talk about the actual anatomy of the brain and all of its workings. Neurons, synapses, and neurotransmitters are all covered.

Sensation And Perception

MIT's Sensation and Perception is an essential courseware collection. The human body functions in response to its environment, and the senses provide the information that allows the body to avoid danger and to make choices. These resources will cover how signals are received and then transformed into usable information in the body.

Cellular Neurobiology

Cellular Neurobiology, a final contribution from the Mass Institute, will focus on the functioning of the nervous system. It will cover the physical processes at work in synaptic transmission, neurodevelopment, and the way that information is filtered and processed.

The human body is a wonderfully complex construct. These courses will teach you much about its overall functioning while still leaving so much more to learn as you get into specific systems. Everyone should take some time to learn about the human body because everyone has one. If you know about its functioning then you will learn more about how you can keep it working at peak efficiency, and make the best, most informed decisions for the only body you will ever have in this life.

About the Author:
Mary Ward is a freelance author and writes about medical career topics, such as how to select among ultrasound technician schools, tips for job advancement, and more.

GUEST POST: Trusting your Doctor – Is it the Right Treatment?

Welcome to All Scrubbed Up's 4th guest blogger... Sarah Scrafford! Enjoy her views on the patient-doctor relationships. We think this one may draw some comments...

There are some people who treat their doctors like Gods – they think they can do no wrong, that they can cure any malaise, and that they have their best interests at heart. And then there are others who are extremely reluctant to trust anyone connected to the medical field, who move from doctor to doctor in search of the perfect one they can trust but never find one at all, and who generally prefer to treat themselves unless it’s a life-threatening situation. In my opinion, neither extreme is advisable – while you must trust your doctor to do the best for you, it’s also prudent to exercise caution and do a bit of research before you throw yourself at the complete mercy of a total stranger.

We hear horror stories of medical malpractices that occur because of both negligence and/or incompetency; the victims of these tragedies escape with no lasting damage if they’re lucky, but if they’re not, they could end up with chronic conditions, or worse, die. Medical lawsuits are extremely complicated affairs that end up becoming costly and difficult to prove, which is why it’s best to be prepared and do your homework before going to a doctor to seek treatment:

* Talk to other patients: Before you commit yourself to going under the knife of a particular surgeon, talk to his or her other patients so that you get proper feedback from the right sources. Long time patients are your best bet – they’re the ones who know exactly how competent and how trustworthy your soon-to-be physician is.

* Check the Internet: Some doctors have a web presence, but then again, you can’t believe their own publicity. Run a search to see if people have blogged about their efficiencies or inefficiencies – this being the age of free and available information, most people are not hesitant to air their views from a public soapbox, especially when the medium is as vast and diverse as the World Wide Web.

* Talk to your doctor itself: Some doctors are open to honest communication, and if you’re a good judge of character, you’ll know if you’re in good hands or not.

* Use relatives or close friends in the medical community: People who have close connections to the medical industry are usually in the inner loop regarding doctors and their methods of treatment. If you know someone in the medical community, don’t hesitate to pick their brains and seek their opinion.

* Bedside manner is not everything: Don’t be fooled by the bedside manner of doctors – that’s all there is to some of them. Style over substance never works, more so when it’s a question of your life. So take what doctors say with a pinch of salt, and double check your facts if you want to life a long and healthy life.

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This article is contributed by Sarah Scrafford, who regularly writes on the topic of Radiology Technician Schools. She invites your questions, comments and freelancing job inquiries at her email address: sarah.scrafford25@gmail.com.

GUEST POST: Lenshopper.com - Amazing Emergency Room Stories

Welcome to All Scrubbed Up's 3rd guest blogger... Lenshopper.com! Enjoy their fine fare of humorous anecdotes...

Amazing Emergency Room Stories
Every day hundreds of thousands of people all over the world are rushed to different hospitals emergency rooms. All of them with real injuries and physical complaints but with different reasons as to why they had to be hospitalized. Here are some funny emergency room stories. Whether or not they’re true events is up to you to decide but stranger things have happened. Or?

Tricky Contacts
On a regular Tuesday evening a local emergency room in Pennsylvania gets a visit by a man that can’t remove his contact lenses. Under the obvious influence of alcohol the man complains of his head aching and abnormal pains in his eyes. Explaining to the nurse that he has been trying to remove his without any luck. The contacts will only come out halfway before popping back in. The nurse then uses a suction pump to get the lenses out but with no result.

When the doctor finally examines the man he quickly realizes that the man has in fact not contact lenses but has being trying to remove the membrane of the cornea. Hence the pain in the eyes.

Don’t Ride An Ambulance in San Francisco
After answering a 911 call from an elderly woman paramedics are rushing back to the local San Francisco ER. While driving up an incline ambulance personnel witness how the back doors of the ambulance suddenly fling open. The stretcher with the resting woman flies out the back and rolls down the hills at a horrifying speed. Rolling through a crossing missing ongoing cars by mere inches the stretcher finally comes to a stop and tips over. The woman is found to be without any physical injuries but clearly chocked.

Bungee Jumping With A Foot Loose
Arriving to the emergency room of Tacoma, Washington, Kerry Bingham had spent the night drinking with his friends. After about the 5th pitcher somebody told the story of a friend of a friend of a friend who had bungee jumped from a nearby bridge during rush hour.

Inspired by the story Kerry and his friends decided to follow this dared devil’s example and too bungee jump from the very same bridge. Well there they realize they have no bungee jump cord, a minor detail according to Kerry who is drunk as a skunk by now.

Several minutes later Kerry’s left foot is strapped and secured to a coil of lineman’s cable and he makes the jump only to fall 40 feet before the cable stretches, feel his left foot being torn of his leg and tumble into the cold river beneath.

Miraculously Kerry survives the fall and is picked up by two fishermen and rushed to the local ER. He later thanks god for keeping an eye out for him and swears never to drink again.

GUEST POST: Lobotomy Revisited (by Brian Carty)

The second guest post from Brian Carty of Hot Medical News, covering the... well, less-covered side of medicine! Enjoy "the history of the lobotomoy"! There's a great video that goes along with this post. Watch it here.

By Brian Carty, MD, MSPH
March 25, 2008

Do you remember Rosemary Kennedy, John F. Kennedy's sister? Maybe not, since she spent most of her life hidden away in an institution in the Midwest. She had a lobotomy, a brain operation for mental illness, in 1941 when she was 23. Her father, Joseph Kennedy, arranged the operation. The procedure left her mentally incapacitated. Whether she was mentally ill, mentally retarded, or both, is unclear, but her disruptive behavior led to the operation and its unfortunate outcome. She died of natural causes on January 7, 2005 at the age of 86.

The lobotomy, also called leucotomy, was devised in 1935 by the Portuguese neurologist Egas Moniz for the treatment of various psychiatric disorders. In this procedure, holes were drilled in the skull and a blade was used to cut nerve fibers from the frontal lobes (the front of the brain, just behind the forehead) to the rest of the brain. The term lobotomy came to include a variety of surgical procedures on the frontal lobes which were performed for psychiatric disorders.


An estimated 50,000 lobotomies were performed in the US in the 1930s and 40s. Although electroconvulsive therapy was introduced in the 1930s, it is useful mainly for the treatment of depression. Otherwise, before effective psychiatric drugs were available in the 1950s, the only other treatments for the severely mentally ill were incarceration and physical restraint.

By today’s standards, conditions in the mental hospitals of the time were unimaginable. Many patients were severely agitated, extremely violent, and incontinent. The hospitals were dirty, overcrowded, and understaffed.

Many severely ill patients benefited from lobotomy with decreases in violence and agitation. However, lobotomy often caused serious adverse effects, including disturbances of mood and personality, euphoria, poor judgment, impulsivity, loss of initiative, intellectual deficits, and seizures.

For many patients, however, a decrease in agitation and violence, even when accompanied by neurologic injury from frontal lobe surgery, was understandably considered an improvement. When the first effective antipsychotic drug, Thorazine (chlorpromazine), was introduced in the US in 1954, the number of lobotomies performed plummeted.

Surgery for psychiatric disorders is still performed rarely today. The procedures have become more selective and less extensive and now include deep brain stimulation with implanted electrodes. Similar surgical procedures and deep brain stimulation are sometimes done for movement disorders and chronic pain. Surgery for psychiatric disorders is still controversial and, when performed, is most often used for treatment-refractory obsessive-compulsive disorder (OCD). OCD is a disorder characterized by obsessive thoughts and compulsive behaviors such as repeated hand washing or checking to see if doors are locked. OCD can severely affect functioning and quality of life.

It is worth noting again that surgery for psychiatric disorders must be judged with reference to conditions which existed at the time the procedures were introduced. Although lobotomy is viewed by many as barbaric, the operation gave many patients a limited improvement which was otherwise unobtainable. The wisdom of hindsight should be applied sparingly; newly introduced medical treatments often cause unintended harm. The history of lobotomy should remind us that future generations will inevitably view our current best treatments as primitive.

GUEST POST: Are Ya Juicin' It? Anabolic-Androgenic Steroid Abuse

Welcome to our second guest poster on All Scrubbed Up... Brian Carty of HotMedicalNews.com. Here's an indepth look at the effect of steroids in body builders. Chilling stuff.

By Brian Carty, MD, MSPH
March 14, 2008

Irritable, angry, aggressive, but feeling strong and invincible, Mr. A, 32, a bodybuilder and prison guard, stopped at a convenience store to call his boss. Car trouble on the way to work.. He would be late.

Bodybuilder and enhanced performance


[With permission of Steve Michalik. Mr. Michalik, a former Mr. America and Mr. Universe, once used steroids and suffered as a result. He is now an energetic and outspoken opponent of steroid abuse.]


Mr. A was taking his fifth cycle of anabolic-androgenic steroids (abbreviated in this article as "steroids"), and he was "stacking," combining high doses of several different steroids, sometimes referred to by the slang term "juice." The woman working at the convenience store noted his uniform and joked, "You officers use my phone so much, I ought to start charging for it." Mr. A was strangely disturbed by this remark. He felt that the woman had criticized and demeaned him, and he was obsessed by the remark that afternoon and throughout the night. He slept poorly. His wife could not reassure him.

'Roid Rage
Later, he said that he wanted to "scare the lady in return for that remark she made to me." In the morning Mr. A drove back to the convenience store and forced the woman into his car. She fought back, biting his hand and grabbing his revolver which fired through the windshield. Although he subdued her and drove away, when the car stopped she bolted from the car. He shot her in the back as she fled, leaving her permanently paralyzed. Mr. A was later arrested, tried, and sentenced to twenty years in prison. After his arrest and withdrawal from steroids, he developed major depression which resolved in a month.

This case and several other cases of homicide or near-homicide by anabolic steroid abusers are presented in an article by Dr. Harrison Pope, Jr., and Dr. David Katz in the January 1990 Journal of Clinical Psychiatry.

Read more on this subject at Brian's site here (continuation of article)...

GUEST POST: Superhero Surgeons - It ain't all Sex, Drugs & Rock 'n Roll (by Bongi)

Welcome to the third, in an initial series of 3 guest posts by our Mpumalanga HeavyWeight... Bongi. He's witty, he's irreverant - he's a little whack.

But it's all in the name of demystifying the doctor. Or not.

Enjoy SUPERHERO SURGEONS - It ain't all Sex, Drugs & Rock 'n Roll!

If you like Bongi's work - visit him here! Wear a glove. Spread the love.

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yes i have an alter ego. yes, i dress in funny clothes with a cap covering my head and a mask covering my face. and yes, dressed as such i try to fight the powers of evil (mainly sepsis and bleeding and cancer and the like). i am ... a superhero.


but there is often little understanding for what goes on under the paper thin masks and baggy gowns we wear. certain …um…occurrences, well, occur with us just as much as with other people.

a common cold behind a theatre mask is no small thing. remember you can’t blow your nose. sniffing loudly only works for a while and attracts all sorts of strange stares. just leaving it is really the only option. the positive side of this is you suffer less from the mild dehydration that accompanies massive loss of …mucus. there is, after all, fluid replacement (it is a very short trip from your nostrils to your mouth over your upper lip). ‘nuf sed. somehow this never appealed to me though. so, for all you budding surgeons out there, when you have a cold, plug your nostrils with tissue before scrubbing up. once you’re scrubbed, it is too late. The side effects are only a slight change in voice which is a small price to pay to avoid the constant lip licking and salty taste throughout the operation.

then there is a running stomach. this may be one reason to excuse yourself, handle the situation and rescrub. however, there is the real problem of dehydration, confounded by long hours of standing and concentration. here may i suggest a drip. the gas monkey (anaesthetist) can quite easily give a quick bolus or change the vaculiter when needed. (quick note, i’m not pulling this out of my thumb. i have actually seen this). stay at home, i hear you say? somehow that just doesn’t work with us doctors. i’m not sure why, but it is very rare that a doctor will stay at home merely because he is sick. what sort of a superhero would that be.

the last problem that can be encountered is best explained by thinking back to my registrarship. i was assisting the prof with some or other laparotomy. my stomach had been giving me trouble for some time. up until just before scrubbing up with the prof i had found it necessary to quietly leave polite conversation to allow the release of colonic gas quite a number of times. but once scrubbed up, this avenue was no longer open to me. what could i do? i simply puckered up and held it all in. this worked well, but became progressively difficult. we were approaching the end of the operation, but i could pucker no more. finally i reached a point where i had no choice. i needed release. i decided to quietly let one slip as to not attract too much attention with loud noises. so, as the professor started to close the sheath, i did just that. i was just inwardly congratulating myself for the stealth with which the…um…operation had been executed when the professor stopped closing and dived back into the abdomen. in a dry voice he quietly says, “someone cut the colon.” as he started carefully moving bowel out of the way to better examine the colon. now imagine my embarrassment when i was forced to say’...

“colon? yes. cut? no”

GUEST POST: Tough Surgeon (by Bongi)

Second post (in an initial public offering - har har - of 3) by our man with the plan - BONGI!

Enjoy... I didn't. This one was particularly gross for us "mere mortals". Read more of Bongi's stuff here.

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A story that i thought quite funny at the time, illustrating us macho surgeons...

sigmoid volvulus. a wonderful condition which is very common in africa. not the type the textbooks talk about found in institutionalised old folk, but the type found in young black adult males. prevalence highest in uganda, decreasing as one moves south, but still pretty common in south africa. so in my registrarship, i became quite good at detorting the volvulus which is the emergency treatment in casualties. if this doesn't work or on sigmoidoscopy (siggy as we called it) if you see any questionable bowel, immediate laparotomy is performed.

anyway the patient came in and had a clear sigmoid volvulus on examination and x-rays. i got the siggy ready to detort and place a flatus tube. now, for the lay person, in this area of blocked colon, the feces has been rotting. yes rotten feces, the only thing to top regular or garden variety feces. the feces is also under extreme pressure, so as you insert the siggy, it deflates with vigor (explosively). many of my friends got showered with this rotten projectile fecal matter and often in their face when they detorted sigmoid volvulus on more than one occasion. i had evolved a way of doing it that decreased my chances of being the proverbial fan that was just about to get hit. yes, i think i was pretty good at it. in fact the picture above is me with my trusty siggy ready to detort a volvulus.

so, getting back to the story; i called the students to see the procedure, because this could be their only chance to see it. i set everything up and started the siggy, with an enterage of students, a house doctor and a rotating medical officer standing to observe. i got to the twist, observed to make sure there was no necrosis and started gently inserting the flatus tube. it slipped easily in. and as usual there was a sudden and massive release through the tube of rotten feces and particularly rancid flatus. i stood there trying to control my gag reflex. it would be considered an acute loss of cool if the tough surgeon was seen to be gaging at anything by his awe struck juniors (tongue in cheek for those who wonder). i just couldn't. i gagged over and over again. now i was struggeling to prevent myself from vomiting. despite this, my prominent thought was that the students would think i was a wimp.

then i looked up. every last one of them had bolted. not one had mannaged to overcome the stench to stay and watch. i laughed. all my ego driven worries about what they would think of me were in vain. obviously if a surgeon nearly gagged then mere mortals (tongue in cheek, flamers) like medical students and doctors would obviously not be able to be in the near vicinity of such a thing.

the patient did well, got his elective colectomy the next week and went on his merry way.

GUEST POST: Fashion Statements (by Bongi)

Ladies and Germs ... Please give a hearty, clinically clean, surgically scrubbed welcome to our first guest poster - Bongi from Other Things Amanzi! Welcome my man...

This is part of a drive to get more contributions to All Scrubbed Up. We're about a year old now and readership is growing rapidly. More content for you, our medically minded audience.

This is part 1 of a 3 post series. If you like Bongi's work - TELL US! It's a fascinating insight into Mpumalanga medicine (and this time, what they wear!)

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Fashion Statements

sometimes we as surgeons are restricted by the most mundane of things. back in my kalafong days, more often than my first world visitors could imagine, entire theater lists would get canceled because of lack of theater attire (scrubs). this gave rise to a funny story and, indirectly to a more recent and somewhat more serious story.

story one.

i arrived in theater one morning in kalafong, ready and eager to operate. there were no theater pants, only tops. i quickly found out there were none available and the matron was on the verge of canceling my list. i checked my gas monkey (anaesthetist). he got one of the last pairs and was dressed for action. the sister was also appropriately attired. it was just me that couldn't enter the theater complex.

not to be blocked by such a minor thing, which was anyway an administrative error and therefore, i reasoned, should not disrupt theater lists, i made a plan. i took a sterile drape and wrapped it around my waist like a sarong and strutted out into theater.

my fashion statement it would seem was too much for the matron, because before i had made even 5 meters, she came rushing up to me with a clean pair of theater pants (she had apparently just created them from subatomic particles using a process of fusion) and insisted i go back to the change room to make myself decent. no fashion sense it seems.

the second story was more recently.

i was called to the theater at the local provincial hospital in the early hours of the morning. it seems they started a laparotomy for a gunshot abdomen and were now in deep water. i dived into my car (i reasoned i would soon be diving into their deep water with them and i wanted to get my eye in) and raced to the hospital, trying to fully wake myself up as i went. i parked and charged to theater.

there i encountered obstacle number one. the change room door was locked. no problem, i would just go in through the main door.

obstacle number two was the main theater doors had been locked using a piece of wood wedged through the door handles. i shouted into theater, but there was no reply. i reflected that, although they had called me in at some ungodly (but not unsurgical) hour, they had not allowed easy access. the telephone call had lead me to believe that the situation was critical. i could not let a mere locked door get in my way. i broke it down. inside i found one of the sisters sound asleep. my supplications to open the door as well as my violent attack on said door had, luckily, not disturbed her no doubt well deserved rest.

obstacle number three awaited me in the change room. there were no shirts. at this stage i was feeling slightly less than my usual cheery self. i was in no mood to waist more time. i dressed in theater pants and entered theater with a naked torso.

there was stunned silence. the medical officer was speechless. he started explaining his operative dilemma, but as he looked up and saw me he went quiet. if i wasn't in such a bad mood i'm sure i would have laughed. i started scrubbing. (i suppose i should say something like my godlike torso faintly illuminated by the one light in the scrub room, but that is implied, of course).


soon i was donned with the operating gown and got to work. no longer blinded with jealousy, no doubt, the medical officer found his voice again and could explain to me the situation. my mood also improved and soon the normal intraoperative banter was being exchanged as if it wasn't 3o'clock in the morning and as if the consultant hadn't just turned up half naked after breaking down the theater door and of course as if there wasn't someone whose life hung in the balance.