ABSTRACT
This paper describes a model humanitarian mission to Guyana; it illustrates the value of excellent ongoing care in collaboration with local physicians and surgeons, cooperation with local government and medical officials, and frequent periodic follow-up missions (always to the same hospital, working with the same staff). This effort has largely avoided the so-called "Seven Sins of Humanitarian Medicine".
Subject(s)
Altruism , Medical Missions , Developing Countries , Guyana , Humans , Kidney Failure, Chronic/therapy , Kidney Transplantation , Renal Dialysis/economicsSubject(s)
Male , Female , Humans , General Surgery , Radiology , Vascular Diseases , Wounds and InjuriesABSTRACT
An 18-year-old soldier had a gunshot wound to his left thigh during the Mexican Civil War (1910-1917). He presented with persistent bright red bleeding. His wound was treated by compression. A few years after the injury, he noticed a thrill, large varicose veins, limb swelling, and skin changes. A plain film showed an 8 x 10-cm midthigh mass. After a bullfighting incident, the pseudoaneurysm ruptured. Because of increased bulk and discomfort, the patient agreed 3 years later to be treated. Angiography showed a chronically obstructed femoral artery and vein. A 3000-mL hematoma was evacuated. This case illustrates the long-term sequelae of an arteriovenous fistula. This report describes a 51-year delay of treatment for causes unrelated to diagnosis. To our knowledge, this case is the longest delay in treatment of an arteriovenous fistula and its complications reported in the literature.
Subject(s)
Arteriovenous Fistula/etiology , Warfare , Wounds, Gunshot/complications , Adolescent , Arteriovenous Fistula/diagnosis , Arteriovenous Fistula/surgery , Humans , Male , Mexico , Time Factors , Treatment RefusalABSTRACT
It is a historical fact that warfare and surgery have been linked together as far back as military history has been recorded. In the 18th century, the tendency of most armies to dismiss their medical services at the end of every major conflict resulted in higher mortality at the beginning of the next war. This became evident in the French and British Armies during the Battle of Waterloo. These countries went to great efforts to mobilize their civilian reserve physicians, only to discover that more than half of the medical personnel declined to serve. The scarcity of physicians and the inexperience of those caring for the wounded resulted in a high casualty rate. The current armed conflicts throughout the world with their high number of victims are living evidence of the need for preparedness of the military medical personnel. In this article, we review the systems of military medical education in several countries, and offer the example of the Escuela Medico Militar (Military Medical School) of Mexico, a prestigious source of military medical physicians for the Mexican armed forces.