64 Books for Clinical Care at the LDC District Hospital - Pust 12Nov2012

7/26/2019 64 Books for Clinical Care at the LDC District Hospital - Pust 12Nov2012

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Books for Clinical Care at the

LDC District HospitalRonald E. Pust MD

University of Arizona College of Medicine

2009

Prepared as part of an education project of the

Global Health Education Consortium

and collaborating partners


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Learning objectives: Books for Clinical

Care at the LDC District Hospital

1. Define the ideal roles of the District Hospital [DH] in a Less-

Developed Country [LDC]

2. List 8-10 skill areas needed by clinicians at a DH.

3. Debate the utility of books vs. other information sources in daily

clinical care in these skill areas.

4. Cite evidence-based care protocols and books arising from

research and practice in LDC conditions.5. Discuss the egalitarian learning legacies left by collaborative use

of such books and protocols.

6. Purchase such resources for collaborative care.


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A District Hospital in a L.D.C.


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Why focus on the District Hospital [DH] ?

The District Hospital: Where the rubber meets the road

WHO, echoing experienced clinicians, asserts that the DH isthe level in any LDC health system at which physicians can

make the largest differences in health.

The DH is the bridge from the village care system to healthcarein both clinical and public health care.

One example, among many, is Safe Motherhood: Prenatal

care and birthing at a health center relies on midwives aspart of the District Health team, which sends birthingemergencies to physicians at the DH


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Childrens ward in a different, but also typical, LDC District Hospital


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Why Books? Why W.H.O. E-BM* protocols? Handbooks work when/where e-media failor never were

available--and those are the crucial places of care.

EBM protocols, identical for allclinicians, promote

collaborative learning and egalitarian [vs.expert] care. National protocols, linked to the nations WHO Essential

Drug list, lead to more cost-effective care for more citizens.

Still, this stance encourages each individual clinicians

learning and advancement via all media available. Inputfrom them leads to constant reassessment of protocols andthe supporting national Essential Drug list.

*Evidence-based medicine


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What is an ideal District Hospital [DH] ?

The DH serves the governments administrative district,

usually 100,000500,000 citizens in a defined area.

Some governments designate some NGO-sponsored

hospitals as District Hospitals.

The DH is the linchpin between the specialized

provincial and/or national hospital[s] and each of these

serves 100,000500,000 people.

The DH is staffed by several broadly-skilled generalist

physicians, nurses, and technicians [e.g., lab, radiology,

operating theatre, IV fluid manufacture, etc].

The DH is the hub for local clinical & public health

outreach/supervision for allthe Districts citizens.


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CORE SKILL AREAS AT THE DISTRICT HOSPITAL

Generalist in primary and secondary care, including

community public health, under resource constraints

Maternal Care: Safe Motherhood and obstetric care.

Sick Children: Integrated Management [IMCI] Nutrition in Maternal-Child Health

Adults who are Sick: Acute and Chronic Care

Trauma and Surgical Care

Mental & Spiritual Health

Hospital & Community Health Team Leadership

We will follow this sequence in this module.


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CLINICIANS ROLES IN LDC HEALTH CARE:

Generalist in primary and secondary care

Schull CR. Common Medical Problems in the Tropics.

2nd ed. Macmillan; 1999.

Eddleston M, et al. Oxford Handbook of Tropical

Medicine. Oxford University Press; 2008.

Cook GC, Zumla A, eds. Mansons Tropical Diseases.

23rd ed. Saunders;2003See next slide for above 3

See also standard management handbooks for your

nation, often adapted from WHO protocols


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Schull CR. Common Medical Problems in the Tropics. 2nd ed. Macmillan; 1999.

Eddleston M, et al. Oxford Handbook of Tropical Medicine. Oxford Press, 2008.

Cook GC, Zumla A, eds. Mansons Tropical Diseases. 23rd ed. Saunders;2003


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PERTINENT PRACTICAL RESOURCES:NATION OR REGION-SPECIFIC

On arrival [or before] contact the Ministry of Health orthe WHO or NGO office in the nation where you will

work to ask for locally-approved clinical guidebooks.

These are typically adapted from international sources

depicted in later slides in this module.


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Clinical Guidelinesglobal [MSF], national [Kenya]

and local [Chogoria district Hospital]


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Guidelines must be up-to-date ! and evidence-based !


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GENERALIST SKILLS IN GLOBAL PUBLIC HEALTH:

Some overviews

Markle W, Fisher M, Smego R. Understanding Global

Health. Lange Medical Book by McGraw Hill; 2007. Merson MH, Black RE, Mills AJ. International Public

Health: Diseases, Programs, Systems and Policies. 2nd

ed. Gaithersburg, MD: Aspen Publishers, Inc; 2006.

Osborn G, Ohmans P. Finding Work in Global Health.Health Advocate Press; 1999.

See next slide


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Merkle, Merson, and Osborne references in Global Public Health


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Hesperians Manuals in many languages for para-medical training


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MATERNAL CARE AND SAFE MOTHERHOOD: 2ndSkill Area at DH


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MATERNAL CARE AND SAFE MOTHERHOOD

[I.M.P.A.C.] Integrated Management of Pregnancy and Childbirth

[IMPAC]. Managing Complications in Pregnancy and

Childbirth: A guide for midwives and doctors. WHO; 2003

King M, Mola G. Safe Motherhood in Developing

Countries. Marie Stopes International, 2006.

Mola G. Manual of Standard Managements in Ob-Gyn for

Doctors, HEOs and Nurses in Papua New Guinea. PNG

National Health Dept, 4thed.,2000 [a good example of ahandbook for all clinicians in a nation]

See next slide for these manuals


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IMPAC [WHO}, Safe Motherhood [Marie Stopes UK], and Mola [PNG] books


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IMPACs spiral manual forneonatal care, Managing

Newborn Problems. WHO/

UNICEF/UNFPA/World Bank

2003

Of the 9+million child

deaths under 5 years,

neonates [< 1 month old]

now account for ~40 %.


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Primary Care OB handbooks from East Africa, UK, and USA


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Technique handbooks for specific problems in Ob-Gyn


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Practical Obstetrics and Midwifery manuals from the U.K.


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Hesperians books for midwives and womens health in many languages


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Womens health handbooks from a variety of sources: WHO, TALC, CDC


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SICK CHILDREN: 3rdSkill Area

Integrated Management of Childhood Illness[ I.M.C.I. ]


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IMCI [summary of research in Bu llet in of WHO,1997] led to Pocketbook by 2005:

WHO. Pocketbook of Hosp ital Care for Chi ldren: Guid el ines for the Management

of Common I l lnesses with Lim i ted Resources, 2005 [378pp] Also CD [above]

Full text free at http://whqlibdoc.who.int/publications/2005/9241546700.pdf
http://whqlibdoc.who.int/publications/2005/9241546700.pdfhttp://whqlibdoc.who.int/publications/2005/9241546700.pdf


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National sick child care

manuals usually are based onIMCI research.

Some [as these in Papua NewGuinea] were published earlier

than WHOs Handbo ok of

Hosp ita l Care for Chi ldren.


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NUTRITION IN MATERNAL-

CHILD HEALTH: 4th

Skill Area

Jelliffe DB, Jelliffe EFP. Growth

Moni tor ing and Promot ion in

Youn g Chi ldren. Oxford University

Press; 1990.

Ashworth A, Burgess A. Caring fo r

Severely Malnou r ished Chi ldren.

Macmillan 2003.

See next slide


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Nutrition guide books from MSF and Teaching Aids at Low Cost [TALC]


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Nutrition manuals MUST adapt to each nations specific foods:

One good example of an international / British Commonwealth book

adapted by Papua New Guinea, a Commonwealth member nation

King FS, Burgess A.

Nutr i t ion for

Developing

Countr ies.2nded.

Oxford Press; 1992.[English Language Book

Society; the ELBS low-

priced series is

sponsored by the British

Government]

Clark D, Korte R,

Wright M. Nutr i t ion

for Papua New

Guinea. Dept of

Public Health,

Konedobu,PNG,1975.


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Further focus

on topics inNutrition

Cogill B. Anthropometric Indicators Measurement Guide. Washington DC:Academy for Educational Development; 2001. [research & clinical methods]

Tratamiento de la Malnutricion Grave. WHO; 1999. [also in English]

Topley E. Anaemia in Rural Africa. Cambridge: FSG MediMedia; 1998 [U.K.-

sponsored by D.F.I.D.]


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ADULTS WHO ARE SICK: 5th

Skill Area Until the AIDS epidemic, adult illnesses, especially those which are

chronic, had little emphasis in global health guidelines [although a fewLDCs have long had adult illness protocols, often for acute diseases]

Integrated Management of [Adolescent and] Adult Illness [IMAI], newprotocols patterned after IMCI, are now developing under WHO at URL:http://www/who/int/hiv/pub/imai/en/

First titles in IMAI cover adult AIDS-related illnesses, e.g.:

Chronic HIV care with ARV therapy

General principles of good chronic care

Palliative care: symptom management and end-of-life care

Tuberculosis Care with TB-HIV Co-Management
http://www/who/omt/hiv/pub/imai/en/http://www/who/omt/hiv/pub/imai/en/


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ADULTS WHO ARE SICK WITH SPECIFIC INFECTIOUS

DISEASES: 3 Global Fund diseases Heymann DL, ed. Control of Communicable Diseases Manual.

19th ed. APHA; 2008.

Rabkin M, El-Sadr W, Abrams E. The Columbia Clinical Manual.Care and Treatment of HIV/AIDS in Resource-Limited Settings.

Columbia University; 2005. Crofton J, Horne N, Miller F. Clinical Tuberculosis. 2nd ed.

Macmillan; 1999.

Rich ML, ed. The PIH Guide to the Medical Management ofMultidrug-Resistant Tuberculosis. International Edition. Partners

in Health; 2003. WHO. Management of Severe Malaria. 2nd ed. WHO; 2000.

See following 3 slides


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The Columbia HIV manual, African and Kenyan national HIV/AIDS manuals


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Tuberculosis Manuals from [left to right]: WHO, UK [Crofton/TALC], Kenya

[Ministry of Health], and USA [CDC and Partners in Health]


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Malaria handbooks:

Warrell&Gilles. Essen-

t ia l Malar iolog y, 4thed,

2002, ELBS/UK

WHO: Management of

Severe [falciparum ]

Malaria: A Practic al

Handbook, 2000

Kenya. Min. of Health:

Nat ional Guidel ines

forMalaria, 2003


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Skin Diseases are common all over the world,

sometimes baffling in tropical LDCs


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Regional Manuals [Africa] of Skin Diseases; Leprosy is among them


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ADULTS WHO ARE SICK:

Chronic Disease

.a neglected and burgeoning need in all

LDCs, especially in the growing cities.

Here is the first textbook on

Diabetes in A fr ica,ed. by Gill,Mbanya

&

Alberti: London: FSG [sponsored by

DFID of the UK


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TRAUMA AND SURGICAL CARE: 6thSkill Area


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TRAUMA AND SURGICAL CARE: 6thSkill Area

King M, ed. Primary Surgery, Vol 1: Non-Trauma. Oxford Press; 1990.

[640 pp]

King M, ed. Primary Surgery, Vol. 2: Trauma; Oxford Press; 1987. [387

pp.]

King M, ed. Primary Anaesthesia; Oxford Press; 1986. [169 pp]

These 3 books [A4 size=20.5 x29.5 cm], along with an anatomy atlas, can

be placed on a second Mayo stand in the O.R., giving enough detail to

complete any surgery. Written by multi-national surgeons working in

Africa, they are all you need.

See next slide

[see also Maternal Care: 2ndSkill Areafor operative obstetrics]


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The Oxford/GTZ Primary Surgery books on operative procedures


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Despite Grants

Anatomy Atlas in

the O.R., some

surgeons still

manage to cut the

palmar arch

note the arterial

blood on theAtlas page

On right: Baileys Emergency Sugery; an edition about 20 years old may be

better than the newest, since you likely will not have the latest surgical gear.


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Sir Zachary Copes invaluable classicfrom 1921 to the present


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Much of the surgery in LDCs is trauma and orthopedics, usually treated by closed

reduction when possible, followed if necessary by skeletal traction [see next slide]


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Trauma, infection or birth defects often lead to disability. Hesperians

manuals teach how to help at the District Hospital and village levels.


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Dental conditions are the most prevalent disease in the world.

Hesperians Dental Manual by dentist Dr. Murray Dickson


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Eye care is a most

useful skill. Visiting

eye surgeons make

major differences in

Individual patients.

Here are British and

American manuals.

Schwab L. Eye Care in Developing Nations. San Francisco, CA:

American Academy of Ophthalmology, 1999

Sanford-Smith J. Eye Diseases in Hot Climates. Butterworths/ELBS,1997 [3rded.]


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MENTAL HEALTH

Patel V. When There is No

Psychiatrist. Gaskell (Royal College

of Psychiatrists), 2003.


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Hospital & Community Health Team: 8thSkill Area

Making it runadministration and epidemiology

Pearson CA. Medical Administration for Front-Line Doctors.

2nd ed. Cambridge: FSG Communications, Ltd; 1995.

Amonoo-Lartson R, et al. District Health Care: Challengesfor Planning, Organization and Evaluation in Developing

Countries. Macmillan; 1996.

McCusker J. Epidemiology in Community Health. Kenya:

AMREF; 1985.

See next slide


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Hospital & Community Health Team: 8th Skill Area

Making it runadministration and epidemiology


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Equipping and running a hospital, its operating room, lab, radiology and


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interpreting radiographs.

WHO: Manual of Radiographic

Interp retation fo r General

Pract i t ioners. WHO; 1985.

[same title in Spanish]

Daley CL, Gotway MB, Jasmer

RM. Radiographic Manifestat ions

of Tuberculosis. 2nded. San

Francisco,CA: Francis J Curry

National Tuberculosis Center;2006. [free from that source]


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Strengthening your

hospitals Community

Health Program is a keyRole in leading the

District Health team.

Stockman D. Community Assessment: Guidelines for developing Countries.Intermediate Technology Publications [U.K.]; 1994.

Lankester T. Setting Up Community Health Programmes.Macmillan [U.K.];

2001.

TEAM LEADERSHIP

8THSkill Area..concludes

the 8 Skill Areas in this

GHEC Module:


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YOU will carry forward a 40-50 year old struggle:Clinical & community care with limited resources

King M.

Medical Care

in Developing

Countr ies.

Nairobi:Oxford; 1966.

Morley D.

Paediatric

Prior i t ies in the

Developing

World.Butterworth;

1973.

Two of the books that started the Global Health movement, clinically


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National clinical guidebooks in use by staff at District Hospital


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PUBLISHERS AND SOURCES OF SOME OF THE

RESOURCES CITED IN THIS MODULE

World Health Organization. (WHO). http://www.who.int

Blue Trunk Libraries: selected books for District Hospitals,etc

http://www.who.int/ghl/mobile_libraries/bluetrunk/en/print.html TALC and AMREF [see below] also sell books sets for district

hospitals. These sets include many cited in this module.

Pan American Health Organization. (PAHO)

http://www.paho.orgMany WHO and PAHO titles in Spanish.

continued
http://www.who.int/ghl/mobile_libraries/bluetrunk/en/print.htmlhttp://www.paho.org/http://www.paho.org/http://www.who.int/ghl/mobile_libraries/bluetrunk/en/print.html


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Teaching Aids at Low Cost [T.A.L.C.] U.K.

Teaching Aids at Low Cost. (TALC). PO Box 49, St.Albans, Herts, AL15TX, UK. http://[email protected]

TALC selects the most practical books from variouspublishers and distributes them in LDCs at subsidizedprices; TALC offers many more titles in its online catalog.Electronic Teaching-Aids at Low Cost (e-TALC) is acollaborative project to distribute free up-to-date healthand development information on CD-Rom. E-Talc, Unit13, Standingford House, Cave St., Oxford OX4 1BA, UKhttp://www.e-talc.org [email protected]

Continues
http://www.e-talc.org/http://www.e-talc.org/http://www.e-talc.org/http://www.e-talc.org/


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African Medical and Research Foundation. (AMREF). PO

Box 30125, Nairobi, Kenya or 19 West 44th St, Suite 1708,

New York, NY 10036. http://www.amref.org

[AMREF also sells low-priced book sets in Africa]

The Hesperian Foundation: Palo Alta. PO Box 11577,

Berkeley CA 94704 http://www.hesperian.org [Hesperian

produces books for LDC paramedicals]

American Public Health Association. (APHA). 1015 Fifteenth St,

SW. Washington DC 2005. http://www.apha.org Most useful

APHA title is Control of Communicable Disease Manual. [first ed.

In 1905!]

Centers for Disease Control and Prevention. (CDC). Atlanta GA

30333 http://www.cdc.gov[source for jobs, travel med]

Continues
http://www.amref.org/http://www.hesperian.org/http://www.apha.org/http://www.cdc.gov/http://www.cdc.gov/http://www.apha.org/http://www.hesperian.org/http://www.amref.org/


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Medecins Sans Frontieres/Hattier. 8 Rue Saint-Sabin,

75011 Paris, France, or Doctors without Borders, USA,Inc., 6 E 39th St, 8th Floor, New York, NY 10016.

http://www.msf.org [treatment manuals for disasters]

Global Health Council. 1701 K Street, NW, Suite 600.

Washington DC 20006. [largest US global health org.]http://www.globalhealthcouncil.org[some publications]

Global Health Education Consortium (GHEC):

http://www.globalhealth-ec.org[sponsor of this module!]

FURTHER INFORMATION ON THESE RESOURCES?

Contact Ronald Pust, MD at [email protected]
http://www.msf.org/http://www.globalhealthcouncil.org/http://www.globalhealth-ec.org/mailto:[email protected]:[email protected]://www.globalhealth-ec.org/http://www.globalhealth-ec.org/http://www.globalhealth-ec.org/http://www.globalhealthcouncil.org/http://www.msf.org/


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COMPREHENSIVE CLINICALLY-ORIENTEDCOURSES/CURRICULA

American Society of Tropical Medicine and Hygiene.

Diploma Courses in Clinical Tropical Medicine andTravelers Health.

http://www.astmh.org/certification/certificate.cfm

University of Arizona. Global Health.

http://www.globalhealth.arizona.edu/


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Putting all this together in Arizona

Global Health: Clinical and Community CareThe Arizona July Course

http://www.globalhealth.arizona.edu

Course Description: The University of Arizona summer course, revisedannually since 1982, is a small group, problem-solving course preparingfourth year [North American] medical students, primary care residents andother clinicians for health care experiences in LDCs. In a 3-week,full-time[70 contact hours], intensive, interactive course, multi-disciplinary facultywith LDC clinical experience guide clinicians in adapting clinical and WHOpublic health skills in resource-poor nations. Visiting learners receive threeweeks/one months elective credit at their home institute [which must alsoarrange the actual overseas preceptorship]. Tuition free to North American

LCME medical students.

Not surprisingly, this course relies on international [non-USA] backgroundsourceslike those in this modulethat are evidence-based and tested inresource-poor regions of LDCs.
http://www.globalhealth.arizona.edu/http://www.globalhealth.arizona.edu/


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The 3 handbooks used as required texts in the Arizona July Course

all are featured earlier in this GHEC Module and in use worldwide


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Summary of Module: Books for Clinical Care at

the LDC District Hospital

You have viewed and considered:

The role of the District Hospital in Less-Developed Countries

The skill areas needed by clinicians at DHs in LDCs The pros and cons of LDC-derived books for these skills

Numerous examples of such handbooks in each skill area

Sources from which to purchase these resource materials for

yourself or to provide at LDC sites where you work

One shameless commercial slide for a free Arizona course

A brief quiz on this content Sorry, no CME credityet


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CreditsThe author of this Module, Ron Pust, MD, of College of

Medicine, University or Arizona in Tucson, thanks all of the

Summer Course participants, including visiting faculty, forvolunteering a part of their lives to pass on their LDC-

derived skills.

He gives special thanks to Course Co-Directors, Tracy Carroll,

MPH, Susan M. Berryman, CHES, to Course Administrator

Arleen Heimann, and the Dept. Chairs who have permittedthis course since 1982and to the 500+ co-learners who

have endured it, then gone to the far corners of the planet.


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The Global Health Education Consortium and the Consortium of Universities

for Global Health gratefully acknowledge the support provided

for developing teaching modules from the:

Margaret K endr ick B lodget t Found ation

The Jos iah Macy, Jr. Foundat ion

Arn old P. Gold Found at ion

This work is licensed under aCreative Commons Attribution-Noncommercial-No Derivative Works 3.0

United States License.
http://creativecommons.org/licenses/by-nc-nd/3.0/us/http://creativecommons.org/licenses/by-nc-nd/3.0/us/http://creativecommons.org/licenses/by-nc-nd/3.0/us/http://creativecommons.org/licenses/by-nc-nd/3.0/us/http://creativecommons.org/licenses/by-nc-nd/3.0/us/http://creativecommons.org/licenses/by-nc-nd/3.0/us/http://creativecommons.org/licenses/by-nc-nd/3.0/us/http://creativecommons.org/licenses/by-nc-nd/3.0/us/http://creativecommons.org/licenses/by-nc-nd/3.0/us/

64 Books for Clinical Care at the LDC District Hospital - Pust 12Nov2012

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