Surgery in the tropics

The practice of surgery in the tropics provides experience in the management of a broad range of conditions without many of the aids now regarded as essential in developed countries. Clinical judgement must play a greater role but the often advanced stage of disease at presentation may lessen the need for investigations and limit the treatment options. Subspecialisation is well advanced in many countries but most of the surgery performed in the world is by people not long out of medical school, much less by general surgeons. Western trained surgeons need to take into account local cultural attitudes to disease and disease management. Busy practical surgeons in tropical areas have made notable contributions to knowledge and practice. Burkitt and Huckstep, both in Kampala, and Brand in Vellore are outstanding examples. Each of these men was heavily dependent on a great many comparatively untrained but skilled paramedical workers.