Wilderness and Environmental Medicine, 8,48-50 (1997)

Letter to the editors,

Reference texts for medical practice in remote andtropical settings

To the Editors:

Four fifths of the more than five billion people on our planetare living in the developing world [1]. Primary health carewill be increasingly important in these often tropical andremote areas. Physicians trained in the West will continue tobe in positions to provide medical care in developing coun­tries either while serving in local medical facilities or duringadventure travel.

Several years ago while working in a remote area ofNepal, I was called in the night to assist at a home deliverythat had become complicated. On my arrival, fortuitouslyalong with the local Lama, shaman, and midwife, I discov­ered a healthy newborn and a mother with retained placentaand postpartum hemorrhage. Having come prepared, I even­tually consulted the definitive and voluminous 1500-pageobstetrics text that I had noticed in the clinic and broughtalong on the one-mile hike to the house call. Reading on thedirt floor by dim candlelight, I was appreciative of the text'sclear and concise recommendation: "Proceed to the oper­ating room at once[!]" Since then, my pack carried to housecalls in remote villages is free of those weighty referencebooks that serve so well for medical practice in the UnitedStates.

Selection criteria

There is a growing medical literature suitable for clinicalreference by physicians who are practicing in a remote areaor developing country. These texts tend to be different fromthose physicians find useful in clinical settings in developedcountries. The scope of the presenting illness may be unfa­miliar. Clinical conditions often involve unreliable or non­existent lighting, heating, water and power sources, as wellas limited staff, supplies, equipment, pharmacy, laboratory,and diagnostic studies. Referral to larger centers or special­ists may not be available because of the remote location,inadequate transportation, lack of patient resources, and/orpatients' social standing or political status.

The texts listed in this article were selected primarily onutility and appropriateness for this setting and, where alter­natives were available, on considerations of weight andcost. All texts listed are soft cover or small-format hardcover, printed on thin Bible paper. Several are published inlow-cost editions for use in developing countries, producedby nonprofit organizations, and/or available in languages in

108D--6032 © 1997 Chapman & Hall

addition to English. The address from which to obtain thetitle and the languages available in addition to English fol­low each citation. During several years of working in re­mote and/or tropical areas, I have found these texts particu­larly helpful with daily clinical duties.

The surgical manuals are unique and essential to augmentthe skills and training of both primary-care physicians andsurgeons who are caring for patients in remote or tropicalsettings. In addition, the clinical manuals addressing themedical problems common to developing countries includ­ing tuberculosis, leprosy, AIDS, parasitic and other infec­tious disease, complicated obstetrics, comprehensive ortho­pedics, nutrition, and sanitation have often proved invalu­able. Training of health care workers is commonly animportant responsibility of physicians working in develop­ing countries; consequently a section listing appropriatemanuals is included.

Selected reference texts

Note: Brackets [ ] following each citation designate theaddress from which to obtain a copy of the text.

COMPREHENSIVE (INCLUDING INTERNALMEDICINE, PEDIATRICS, OBSTETRICS, ETC.)

Berkow, R., Fletcher, AJ., eds. The Merck Manual. 16th ed. Rah­way, NJ: Merck, 1992:2696. [Merck Sharp and Dohme Re­search Laboratories, West Point, PA 19486, USA]

Hope, R.A., Longmore, J.M., Hodgetts, TJ., Ramrakha, P.S. Ox­ford Handbook of Clinical Medicine. 3rd ed. Oxford: OxfordUniversity Press, 1995:837. [Oxford University Press, WaltonStreet, Oxford OX2 6DP UK]

ColIier, J.B., Longmore, J.M., Harvey, J.H. Oxford Handbook ofClinical Specialties. 3rd ed. Oxford: Oxford University Press,1995:811. [Oxford University Press]

DENTISTRY

,Dickson, M. Where There Is No Dentist. Palo Alto: HesperianFoundation, 1993:188. (Available in English and Portuguese.)[The Hesperian Foundation, P.O. Box 1692, Palo Alto, CA94302, USA]

King, M., Bewes, P., Cairns, J., Thornton, J., eds. Primary Sur­gery. Vol. I. Non-Trauma. (See "Surgery" below.)

DERMATOLOGY

Canizares, O. A Manual ofDermatology for Developing Countries.2nd ed. Oxford: Oxford University Press, 1993:370. [OxfordUniversity Press]

Letter to the editors

EMERGENCY MEDICINE/TRAUMA

King, M. ed. Primary Surgery. Vol. 2. Trauma. (See "Surgery"below).

Mengert, T.J., Eisenberg, M.S., Copass, M.K. Emergency MedicalTherapy. 4th ed. Philadelphia: Saunders, 1996:992. [W.B.Saunders Co., The Curtis Center, Independence Square West,Philadelphia, PA 19106, USA]

FAMILY PLANNING

King, M., King, F., and Martodipoero, S. Primary Child Care. AManualfor Health Workers. Oxford: Oxford University Press,1978:314. [TALC]

Klein, S. A Book for Midwives. A Manual for Traditional BirthAttendants and Community Midwives. Palo Alto: The Hesper­ian Foundation, 1995:519. [The Hesperian Foundation]

Kleinman, R.L., ed. Family Planning Handbook for Doctors. 6thed. London: International Planned Parenthood Federation(IPPF), 1988:361. (Available in English, French, and Span­ish.) [IPPF, P.O. Box, 759, Inner Circle, Regent's Park, Lon­don, NWl 4LQ, UK]

HEALTH WORKER TRAINING

Werner, D. Where There Is No Doctor. Palo Alto: Hesperian Foun­dation, 1994:565. (Available in English, English for Africa,Hindi, Portuguese, and Spanish.) [Hesperian Foundation]

Werner, D., Bower, B. Helping Health Workers Learn. Palo Alto:Hesperian Foundation, 1991:632. (Available in English andSpanish.) [Hesperian Foundation]

IMMUNIZAnON FOR TRAVEL

Center for Disease Control and Prevention (CDC). Health Infor­mation for International Travel. Atlanta, GA: CDC, 1990.[Superintendent of Documents, US Government Printing Of­fice, Washington, DC 20402, USA]

INFECTIOUS DISEASEffROPICAL MEDICINE

Bell, D.R., ed. The Lecture Notes on Tropical Medicine. 4th ed.Oxford: Blackwell Scientific Publications, 1995:368. [Black­well Mosby Book Distributors, 11830 Westline IndustrialDrive, St. Louis, MO 63141, USA]

Benenson, A.S., ed. Control ofCommunicable Diseases in Man. 16thed. Washington, DC: American Public Health Association(APHA), 1995:577. (Available in Arabic, English, Farci, French,Italian, Japanese, Portuguese, Spanish, and Turkish.) [APHA,1015 Fifteenth Street, NW, Washington, DC 20005, USA]

Crofton, J., Home, N., Miller, F. Clinical Tuberculosis. London:Macmillan, 1992:210. [TALC]

Gilles, H.M. Management of Severe and Complicated Malaria. APractical Handbook. Geneva: World Health Organization(WHO), 1991 :66. [Distribution and Sales, WHO, 1211Geneva 27, Switzerland]

Sanford, J.P., Gilbert, D.N., Gerberding, J.L., Sande, M.A. TheSanford Guide to Antimicrobial Therapy. Dallas: Antimicro­bial Therapy, Inc., 1996:125. [Antimicrobial Therapy, Inc.,5910 N. Central Expressway, Suite 1995, Dallas, TX 75206,USA]

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World Health Organization (WHO) A Guide to Leprosy Control.2nd ed. Geneva: WHO, 1988:121. [WHO]

World Health Organization (WHO). Guidelinesfor Clinical Man­agement ofHIV Infection in Adults. Geneva: WHO, 1991:86.(Available in English and French.) [WHO]

World Health Organization (WHO). Guidelinesfor Clinical Man­agement of HIV Infection in Children. Geneva: WHO, 1993:88. (Available in English and French.) [WHO]

World Health Organization (WHO). Treatment of Tuberculosis:Guidelines for National Programmes. Geneva: WHO, 1993:43. (Available in English, French, and Spanish.) [WHO]

LABORATORY

World Health Organization (WHO). Manual of Basic Techniquesfor a Health Laboratory. Geneva: WHO, 1980:478. (Avail­able in Chinese, English, French, and Spanish.) [WHO]

OBSTETRICS

Bergstrom, S., Hojer, B., Liljestrand, J., and Tunell, R. PerinatalHealth Care With Limited Resources. London: MacmillanEducation Ltd., 1994:186. [TALC]

Driessen, F. Obstetric Problems, A Parctical Manual. Nairobi,Kenya: African Medical and Research Foundation, 1991 :27S.[TALC]

King, M., Bewes, P., Cairns, J., Thornton, J., eds. Primary Sur­gery. Vol. 1. Non-Trauma. (See "Surgery" below.)

ORTHOPEDICS

King, M., ed. Primary Surgery. Vol. 2. Trauma. (See "Surgery"below.)

McRae, R. Practical Fracture Treatment. 2nd ed. New York:Churchill Livingstone, 1993:328. [Churchill Livingstone]

PEDIATRICS

Ebrahim, GJ. Paediatric Practice in Developing Countries. Lon­don: Macmillan, 1988:321. [TALC]

King, M., King, F., and Martodipoero, S. Primary Child Care. AManualfor Health Workers. Oxford: Oxford University Press,1978:314. [TALC]

Stanfield, P., Brueton, M., Chan, M., Parkin, M., and Waterson, T.,eds. Diseases of Children in the Subtropics and Tropics. 4thed. London: Edward Arnold and Educational Low-PricedBooks Scheme (ELBS), 1991:1076. [Tropical HealthTechnology\ELBS, 14 Bevills Close, Doddington, March,Cambridgeshire, PElS OTT, UK]

PHARMACOLOGY

Joint Formulary Committee. British National Formulary. London:British Medical Association, 1995:668. [British Medical As­sociation, Tavistock Square, London, WCIH 9JP, UK]

SURGERY

King, M., Bewes, P., Cairns, J., Thornton, J., eds. Primary Sur­gery. Vol. 1. Non-Trauma. Oxford: Oxford University Press,

50

1993:640. [Teaching-aids at Low Cost (TALC), P.O. Box 49,St. Albans, Herts, ALl 5TX, UK]

King, M., ed. Primary Surgery. Vol. 2. Trauma. Oxford: OxfordUniversity Press, 1987:400. [TALC]

King, M., ed. Primary Anaesthesia. Oxford: Oxford UniversityPress, 1986:169. [TALC]

VETERINARY MEDICINE

Aniello, S., Mays, A., Bergeron, J., eds. The Merck VeterinaryManual. 7th ed. Rahway, NJ: Merck, 1991:1832. [MerckSharp and Dohme Research Laboratories]

WATER AND SANITATION

Morgan, P. Rural Water Supplies and Sanitation. London: Mac­millan Publishers Ltd., 1990:358. [TALC]

WILDERNESS MEDICINE

Wilkerson, J.A., ed. Medicine for Mountaineering and Other Wil­derness Activities. 4th ed. Seattle: Mountaineers Books, 1992:416. [The Mountaineers, 300 Third Avenue W., Seattle, WA98119, USA]

Letter to the editors

Conclusion

Creative problem solving, adaptability, flexibility, and hu­mor serve well in remote settings. A good beginning beforeleaving home is to adjust the clinical reference library oneplans to bring along and rely on in the new and challengingpractice setting. This list is offered as a starting point.

Acknowledgments

I am indebted to the numerous colleagues in Alaska, En­gland, India, Nepal, and Tibet from whom so much has beengained.

Reference

1. United Nations. World Population Prospects: The 1994 Revi­sion. New York: United Nations, 1994.

JAMES A. LITCH, MD

Bozeman, Montana, USA, andHimachal Pradesh, India