A new updated version of this seminal textbook is now available FREE online at global-help.org.
The preface reads:
The first edition of this work by Maurice King appeared in 1990 and has established itself as the gold standard of do-it-yourself guides to surgery in the up-country hospital. Some 50000 hours of work went into compiling the mass of expert contributions from many varied and far-flung individuals, all enthusiasts with a first hand indigenous experience of surgery in poor-resource environments. The need for such a book has been amply justified, and 25 years on, its usefulness is in no way diminished. Indeed, there is even greater urgency for such appropriate basic surgical guidelines to be disseminated in parts of the world where people's access to surgery has been difficult or well-nigh impossible. To this end, it is envisaged that these manuals will be translated into French, Spanish, Portuguese, Russian and Chinese, and also produced electronically as Compact Discs. Publication on a freely accessible web-site will allow more readers access throughout the world.
Also, more is included on pathologies seen in different parts of the world, viz. Chagas’ disease in South America, Hydatid disease in Asia, Schistosomiasis in Egypt, and so on. There will remain gaps, as different hospital environments will always differ hugely: suggestions for alterations and inclusions will always be gratefully received, and incorporated in future editions, which can now be updated electronically much more easily than heretofore.
The single most dramatic change in the practice of surgery in much of the developing world, and in Africa in particular, has been the rampant inexorable spread of HIV disease since the early 1980's; this has seen the appearance of new pathologies, and the requirement that new strategies are developed not only to combat its spread, but to deal with its effects. By the new Millennium, antiretroviral medication was still seriously beyond the scope of most Government Health systems, but this is changing. Whilst the advent of therapies to combat HIV effectively may still remain out of reach for very many, it will offer hope to the young and those yet unborn that this scourge may be controlled, if only by encouraging victims of the disease to be tested. Until recently, so much obfuscation around the disease, and slavish following of individualistic ideologies, has prevented much community openness concerning this epidemic; it is fervently hoped that with cheaper and successful antiretroviral treatment, the exceptionalization of HIV may disappear.
Much therefore of the changes since the First Edition have concentrated on the impact of HIV disease; however, other changes are noted: for example, the inclusion of ultrasound and flexible endoscopy, which, though the equipment is expensive (it might be sourced through donor agencies), it is highly cost-effective in diagnostic yield. Further, thyroid surgery is no longer excluded, as its performance is considered no more complex than much else described. The inclusion of grading of difficulty of operations, as mooted in the First Edition, has been carried out: this scale is inevitably idiosyncratic and is offered simply as a guideline, especially for surgical technicians. Furthermore various procedures, which are in danger of being lost to the experience of Western style practitioners and their trainees but are eminently useful in poor-resource settings, have been described in some detail.
It is rare that a book tells its reader what not to do, and what to do when things go wrong! This is such a book, whose aim, essentially, is to encourage surgery in the districts and remote areas, if necessary by non-specialist, even non-medical, practitioners. The realization that surgery is not an expensive luxury but a cost-effective intervention is slowly dawning on Health planners; however, to remain viable, such surgery must remain relevant and relatively low-cost. It is estimated that 80% of surgery necessary can be covered by 15 essential procedures. If even only these are mastered, the surgical contribution offered will be substantial.
The editors’ view is that laparoscopic surgery is not at this stage a generally viable adjunct, and is therefore not described. Where special arrangements have been made, and a surgeon with appropriate skills is available, the benefits should not of course be denied patients in rural environments. Nonetheless, the greater danger is that surgery is not done simply because of the unavailability of highly trained individuals or of high-technology equipment, presumed essential, and this must on all counts be avoided. Appropriate technology has been described, and inventions made known through the practical insights of many in poor-resource settings has also been included. This must be further encouraged; indeed the principles thus discovered should be exported to the so-called knowledgeable rich world, which groans under the ever-increasing cost and bureaucratic complexity of delivering high-technology medicine.
It is the fervent hope that this second edition will bring relief and benefit through surgery to millions to whom it might otherwise be denied. The fact that some 2 billion people in the world do not have access to any surgery must be seen as a scandal, and this book will do its part in correcting this tragedy.