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Thinking out of the box

Year: 1982
Setting: Ouesso hospital, Northern Congo
Position: Medical expert on a timber consortium mission

It has been quite an adventure riding for three days on dirt roads from Pointe Noire to Brazzaville though the Mayombe Mountains and from Brazaville to Ouesso in the jungle forest. The 4x4 I am driving got stuck of few times and we had to winch our way out of the watery ditches. I even ate porcupine at a small restaurant of a hotel where we spent the night in the middle of nowhere on the plateau. Finally, we reach destination tired but happy.

I have to assess the different medical facilities in town. As I walk through the lobby of the city hospital, I reflect upon how to address the growing gap between what used to be called the first and the third worlds. Through the window, I can see a surgeon meticulously removing the gallbladder of a pygmy woman in the main operating room. While I discuss the procedure with a colleague, all the lights suddenly go off. A few torch lights emerge from the dark and I expect the generator to take over momentarily. But there has been a disruption in the erratic delivery of oil and the generator cannot be started.

As this unfolds, I witness the nurses in the O.R. lifting the curtain on a window that faces outside. Some staff members run outside. This activity puzzles me for a moment. What is happening here? Next, I hear the roar of car engines in the parking lot. All the vehicles converge in front of the O.R.'s outside window and the drivers turn on their high-beam headlights. With the brightness thus created, the operation resumes and is concluded without any other problem. The patient is then transferred to the ward. The next day, I come back to visit her. We have a quick chat and she is in good spirits.

Lesson for the doctor: Necessity is the mother of invention and creativity is a crucial skill when resources are scarce, particularly in challenging environments.

Yann Meunier, MD, is the health promotion manager for the Stanford Prevention Research Center. He formerly practiced medicine in developed and developing countries throughout Europe, Africa and Asia. Each week, he will share some of his experiences with patients in remote corners of the world.

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