We Have Changed

In Atul Gawande's book Better, the author places current surgical treatment of the wounded in Iraq in the context of military history. He notes how military medical teams in the current war have drastically reduced mortality from trauma- compared to the Vietnam war, or even the more recent Gulf War- without any new technologies. He also notes how this has been done without an increase in medical personnel. The vast improvements have been achieved with a better system. Forward Surgical Teams (FSTs) that literally follow troops on missions, can assemble surgical care units at the scene of injury- ultimate M*A*S*H units. Such units temporize and stabilize the wounded. These are then linked to Combat Support Hospitals (CSHs; like much about the military, acronyms abound). More advanced hospitals, primarily in Germany, can then perform technically involved, and time-consuming, surgeries. The FSTs are thus part of a network of support.
Better systems may also be a key to health in the developing world. A recent article in The Lancet (Vol 370, Sept 29, pg 1115) shows how a health program in the Democratic Republic of Congo has effectively addressed the problem of river blindness. The African Programme for Oncocerciasis Control (APOC; public health is not without its acronyms, either) enlists volunteers in villages to deliver and monitor treatment for this nasty parasite. These volunteers are linked to local health workers, thus creating a network of health care. The system, dubbed community-directed treatment has reduced the prevalence of onchocerciasis infection by 73% before implementation of the program- this all in a war-torn country. This network system of voluntary workers are now extending their care to Vitamin A distribution and other types of deworming. Better.