В 1980-е годы знакомый хирург гордо показывал мне, как ловко он подготавливает кембрик для использования в качестве катетера
Последние годы создают иллюзию того, что наша медицинская практика далеко ушла от тех ужасных времен и мы будем впредь использовать только современное оборудование и изделия, соответствующие лучшим стандартам.
В. Аксенов обратил мое внимание на статью в BMJ, приведенную ниже. Она поучительна. Тем, что показывает, куда ведет бедность здравоохранения.
Василй Власов
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Using bicycle pumps during mass sterilisations in India is common, says doctor
BMJ 2014; 349 doi: http://dx.doi.org/10.1136/bmj.g7561 (Published 09 December 2014) Cite this as: BMJ 2014;349:g7561
- Sanjeet Bagcchi
A doctor in the Angul district of the Indian state of Odisha has said that it is normal practice in some areas to use bicycle pumps to inflate the abdomens of women while carrying out laparoscopic sterilisations at mass sterilisation camps.
Retired surgeon Mahesh Chandra Rout was found to have used a bicycle pump to inflate the abdomens of 56 women during laparoscopic sterilisations and is being investigated by the local health ministry. In early November the deaths of 13 women following laparoscopic sterilisations at two mass sterilisation camps in Chhattisgarh triggered outrage across India.1
Rout told the Hindustan Times that using bicycle pumps during laparoscopic sterilisation was a regular activity in rural areas that lacked sophisticated surgical equipment.2 He said that over the past 10 years he had carried out more than 60 000 procedures using bicycle pumps.2
Rout’s activity has sparked a backlash in Angul, with attacks on the hospital where the sterilisations took place. However, the Odisha government has assured the public that it will look into the matter. Arti Ahuja, Odisha’s health secretary, has said that the chief district medical officer of the area has been asked to submit a report on the sterilisation camp in a week.2 Ahuja told the BBC, “Doctors will be required to adhere to internationally accepted safety norms to prevent any possible infection.”3
Ahsan Ahmed, consultant intensivist at Medica Institute of Critical Care in Kolkata, told The BMJ that using a bicycle pump to inflate the abdomen is potentially dangerous because of the inability to monitor intra-abdominal pressure. Moreover, atmospheric air is rich in nitrogen, which does not get absorbed rapidly in the body. This increases the risk of complications, such as embolism, if the air enters the systemic circulation, he said.
Ideally, carbon dioxide, which is rapidly absorbed, should be introduced into the abdomen through an insufflator, and the pressure of the gas inside the abdomen should be monitored and controlled. Reports indicate that the government hospital in Angul has a carbon dioxide insufflator that has not yet been used.3
“It is important to consider poor people as human beings, irrespective of their financial status, and [one should not] experiment on them just because they are poor,” said Ahmed. He called for the implementation of a strict government policy to monitor and maintain the established protocol for surgical procedures in health camps in India.
Notes
Cite this as: BMJ 2014;349:g7561
