 The tropics, plant and animal life thrive, not only the engulfing organic life of the land itself, but also microscopic organic life, warmth and moisture combined to speed life processes. Vegetation is luxurious. In this excess of warmth and moisture, disease-producing organisms of all sorts become more prevalent and more virulent. And sources of contagion and infection are everywhere at hand. Human feces is often left exposed to animals and insects. But all too many native peoples live out their short lives under conditions of extreme poverty, ignorance and filth. Frequently diseased laden human fecal matter is spread over vegetable gardens for fertilizers. Carriers or pathogenic organisms recognize no boundary lines. And military installations in the tropics cannot be completely isolated. An army hospital or any hospital in a country like this can be adequately staffed one day and shorthanded the next. In an emergency, we just never seem to have enough nurses go around. The length of the stag line at our Friday night parties is a good point of illustration. But seriously, we have been rather tightly staffed while we've been awaiting your arrival, so we're very glad to have you here. Living and working in the tropics is going to be something very new for most of you, just as it was for us. So when new personnel arrive, we make it a point to get together and talk over a few things that are have to be a bit different. The type of cases we get, the procedures that we have to be a little extra careful about. After all, we don't want to be patients ourselves. First, there's the problem of drinking water. Untreated water is almost certain to be dangerously polluted. Dysentery, typhoid, and just about the whole list of gastrointestinal diseases. Native markets are common sources of dysentery. Washing fruit is not an effective precaution. Merely handling any food offered under these conditions is a health hazard. As a matter of good common sense, it's a good idea not to eat anything except what's served right here at the hospital. So much for food and drink. Now about the fungus infections of the skin. You're all familiar with athlete's foot. In temperate climates, it's a common, very infectious, but rarely dangerous condition. Here in the tropics, such fungus infections are extremely common and they may become very serious. Fungus infections that begin on the feet spread to the hands and face. Breaks in the skin are open doors to other disease organisms and the healing process can be exceedingly slow. So take care of your feet. It'll be on them all day long. Sometimes the days really are long. The weather isn't always as comfortable as it is right now. This is one part of the world where a cold shower can really feel good. When you take those showers, watch your step. Don't take careless chances by going without bath clogs. Just as important, be sure to dry your feet very carefully. Use foot powder regularly. If you notice any signs of fungus infections, you'll have to wear stockings that can be boiled until the infection is completely disappeared. No nylons? That's what it'll mean. That's right, but it's not just a personal problem. You'll find that many patients who are hospitalized for other reasons are likely to have fungus infections as well. While we have these patients here, such infections should be cleared up and taken care of. Infected feet during the day should not be kept under covers or sheets where perspiration might indeed recover. An electric fan helps the drying process. Taking care of epidermal pitosis calls for sensible nursing attention. And since patients with infected feet are likely to be up and about to some extent, at least a good many of them are, it's important to caution them against infecting others in the ward or reinfecting themselves for that matter as a part of the general routine of ward supervision, there's the matter of insect control. Here in the tropics, the importance of this matter is one that can hardly be exaggerated. With the cooperation of hospital technicians, there are many responsibilities around the hospital these men handled very competently. The insect problem can be and always is kept well in hand. Walls, screens, they all get a residual spray of five percent DDT. Eaves, crevices, all such exposed surfaces need insecticide. Still, in spite of precaution, some insects sometimes do get into hospital buildings. And crawling insects in particular can bring serious medical problems. That's the reason for the cups under the bed legs. The cups should always be kept filled with oil. Neglect to keep these cups filled and the results could be shocking. Pants. Don't ask how they'll find out or where they'll come from. It's happened in native civilian hospitals and it could happen here. Throughout the tropics, rodents are plentiful and they can play a vital role in the spread of murine typhus, bubonic plague, and other serious diseases. Rat-proofing is of course a first line of defense. But doors to hospital wards can accidentally be left open and a broken screen may not always be discovered immediately. Wards may be rat-proof, but a prompt report. Men already sick enough to be hospitalized must not be exposed to further disease immediately and with a minimum of disturbance to patients. Every effort must be made to destroy the animal. Sometimes even the nurses get into action. Now you'll find out it's going to be hot here during the day. Going to be? That's right. Going to be. Keeping our wards cool is important. We have a... Ah, the punka. The punka. This is the punka. It's a fan that works like this. You'll see them in native hospitals. And this ambitious little gentleman on the business end of the rope is a punka wallop. Yes, this is the punka. And it's not as punk of ventilating contraption as you might think. It's crude. Yes, of course it's crude. But it gives a broad, gentle circulation of air. After all, that's the idea. I think it would be a good idea to install one of them right here. But it isn't always so hot. Towards sundown, it rains. But really, it rains. Lately, it's been five o'clock on the dock. You can practically set your watch quiet. Then, right after the rain, things dry right up. And then after a little while, it begins to cool off. Our air conditioning isn't quite as primitive as the punka. But whether it's an electric fan or for a punka wallop, it does the work. It's best to stop such draft shortly after sundown. Lying in bed, it frequently gets cool enough so even a blanket feels good. The use of adhesive tape against the skin is not good practice in the tropics. During the heat of the day, the skin becomes so moist that tape doesn't hold too well. But more important, adhesive tape can become very irritating and result in complicating infection. Fluid loss is naturally greater in the tropics. And fever, of course, further increases the patient's need for liquids. Alcohol rubs, keeping patients scrupulously clean and dry, their sheets free of wrinkles, gently moving the bed position of seriously injured patients. In the tropics, such attentions take on added importance. Because of the heat, the moisture, and sometimes unavoidable shortages of hospital personnel, decubitus ulcers are a serious threat. But which nurses and doctors must be constantly on the alert, particularly in the tropics. Once decubitus ulcers are allowed to get started, they develop rapidly. Pressure areas may also become infected with fungi, and the dermatological characteristics of the primary disease can be obscured. Nurses must watch out for any type of skin irritation. Skin eruptions are always easier to prevent than they are to treat, especially here in the tropics. That's a good point. Now a little more about the different types of cases we come up against. We get a good number of gastrointestinal diseases here with quite severe diarrhea. There's basillary dysentery, amoebic dysentery, and sometimes even cholera, although that's not too common. Modified isolation is routine with the preliminary admission diagnosis of dysentery. And the isolation ward is almost always admitting a patient. With dysentery, the microorganisms of the disease attack the lining membranes of the intestinal tract. How is anyone in the tropics likely to contract this fairly common but serious disease? Well, the usual sources of dysentery are unpurified water, uncooked fruit and vegetables, and the contaminated fingers of food handlers who happen to be disease carriers. The patient's comfort is the first consideration. Of course, the routine of obtaining an accurate temperature, pulse, and respiration record is performed with minimum disturbance to the patient. Vomiting as well as severe diarrhea is characteristic in the acute stage of dysentery. An estimate of the amount of vomitus will be entered as fluid output. Techniques of disinfection and disposal are most important. There's an approved disinfectant in the covered waste can. No contaminated material is emptied directly into the sewage disposal system. Rinse water is disposed of in the same way as body waste. The used basin is also disinfected. Anything you want to add? Well, just some things you already know, but since they are so very important in a hospital of this sort, they can stand repetition. Aseptic techniques are the greatest importance in dealing with contagion. Within a contagious ward, a gown is hung inside in. Only the already contaminated exterior of the gown is exposed to further contamination. Even though the hands have only just been washed, as soon as anyone leaves the contaminated area, they're washed for a second time. In the isolation utility room, a medical technician obtains a stool specimen. A preliminary diagnosis of dysentery must be confirmed by laboratory analysis, and it's imperative that a stool specimen be sent to the laboratory for examination while it's still fresh and warm. The first prescription may be tentative. Details of medication will be determined after the laboratory examination. The immediate objectives are to relieve pain, control, dehydration, and provide symptomatic nursing care. Dysentery with its frequent liquid stools is a very unpleasant way to be critically ill. Patients need constant care. They're encouraged to drink liquids. It's an important factor in the general effort to try to control and prevent dehydration. The disease can be extremely serious. Little personal attentions of good nursing care can have a great deal to deal with patient morale, and the state of a patient's morale is likely to be a prime factor influencing the rate of his recovery. There will be bathing. This matter of thorough cleanliness will be most important, and there may be applications of soothing lanolin or petrolatum to ease the burden of anal irritation, and so leave just that much more of the patient's strength to combat the disease. If all intake is not sufficient to control dehydration, as is so frequently the case, intravenous fluids are administered. Prevention of dehydration is of major concern in treating gastrointestinal disorders. Complete nursing notes and records are especially important. The record of fluid output includes not only the amount of urine, liquid stool, and vomitus, but also descriptive nursing notes, additional determining factors which may indicate whether further intravenous solutions are needed. With the passing of time, as a patient suffering from dysentery gradually grows stronger, medications usually start to gain the upper hand. But still, a nurse must provide for the patient's every need. With cases of hiccups, sucking a piece of ice may help. A doctor will be informed immediately. An occurrence of hiccups can have quite serious implications. Of course, there's constant concern with the serious complications that may result from a continuation of frequent liquid stools. There can never be any relaxation of sanitary discipline in the utility room. Because of the virulence of dysentery organisms, those handling body waste must take every precaution to protect their health. Disinfectant added, and the excrement is always thoroughly mixed with the disinfectant before it's disposed of. Finally, the bedpan itself is thoroughly disinfected. The way a nurse goes about her duties on the ward, her attitude, her skill, her little acts of thoughtfulness. The total of all of these little things can have a big influence on a patient's improvement. A good nurse is always concerned with that mysterious reserve source of human strength, which all who work with a seriously ill recognize, or want of a better word, call it the will to live. Bland, low residual foods are customary, and an increase in caloric protein and vitamin intake is important because of the loss of nutrients in the feces. Barriers against infection can never be lowered for a moment. Anything that a patient has touched must be considered to be contaminated. Even when dysentery organisms are dry, they will actually live on for a number of days. Given a little moisture, unless these hearty and dangerous organisms were destroyed, they would be likely to live on for a very considerable time. All burnable waste will be incinerated. There's no special medical mystery about diseases of the tropics, tropical diseases. I'm just a little tired of hearing people whisper those words as if bacteria were like King Cobra's or Carl's snakes that never wiggle on frosty mornings. Most of the so-called tropical diseases can be found in various degrees in almost all kinds of climates. Naturally, no one would want to underestimate the virulence of these organisms. But on the other hand, it would be just as ridiculous to let our rational judgment give sway to old wives' tales that grew up before the age of modern medicine. When hospital personnel use reasonable precautions, such a disease as leprosy, for example, is not hazardous to treat, not nearly as hazardous as many of the more common illnesses whose names arouse no hysteria. There is no reason at all why words like leprosy, plague, or cholera should ever become scare words. Not cholera, yes, it's serious. And it's a disease that calls for medical and nursing care even more exacting than that required of other dysentery. The aim of treatment is to prevent a circulatory collapse. And with cholera and its attendant tremendous loss of body fluid, the threat of dehydration and collapse demands the most constant nursing attention and medical care. Temperature records are paramount. And rectal thermometers are never used because they may stimulate a bowel movement. In caring for cholera patients, rigid protective measures are imperative. But if all precautionary procedures are observed, it's actually safer inside a hospital during a cholera epidemic than it is outside. The pulse rate is taken frequently. Constant blood pressure readings are indicated. Whenever changes in pulse blood pressure or blood specific gravity suggest a worsening condition, the doctor is, of course, called immediately. One of the illnesses that's most common in the tropics is malaria. An attack of severe chills and fever calls for the presence of a doctor. A blood smear is taken when the fever is at its height. The smear will help the doctor to identify the particular type of malaria that a patient has been stricken with. Malaria may mimic any number of other diseases. Nursing care will be important. Warm blankets and hot water bottles for the attack of chills. Alcohol rubs to bring down fever. And patients may suffer severe headaches, joint pains, and other disturbing conditions that call for symptomatic medications such as salicylates. The patient's graphic temperature chart will also be an aid in determining the particular type of the malaria. Specific identification is usually withheld until the diagnosis has been substantiated in the laboratory. It's not only patients suffering from malaria who take malaria suppressive drugs. Generally speaking, all patients must be given such suppressive medication. In the tropics, everyone is a suspected case of latent malaria. Though a patient may not have any known history of malaria, there's always a chance he may have the disease in a latent state. Neglect to take suppressive drugs and the lowered physical resistance resulting from other illnesses might bring the latent malaria out into an active attack. If any patient, no matter what he's hospitalized for, should fail to take his malaria suppressive, the attack that might result could seriously complicate an otherwise favorable prognosis. Malaria prevention concerns you too, all of us on the hospital staff. Since it's the female anopheles that causes all the trouble, I think that any talk about malaria prevention should be the woman's responsibility. Well, it takes a female to fight a female. But seriously, this is a problem we all have to face. After dark in the tropics can be a particularly dangerous time. I mean, as far as exposure to malaria bearing mosquitoes is concerned, of course. How do people who are safely inside of screened buildings get bitten by insects that are disease vectors? Well, sometimes maybe they just leave doors open and turn their entrance hallways into fine big insect traps. An effective defense against malaria calls for protective clothing, insect repellents, and insect sprays. And even though you're inside a screened building, you still need to sleep under a mosquito net. Same general precautionary measures necessary against malaria also apply to the other insect-borne diseases. Folloriasis and, for that matter, dengue fever. In the case of dengue, the trouble-making mosquito is female. Operates during the daylight. Dengue fever is a disease some of you may not be too familiar with, but it's not uncommon wherever you find the ADs of Egypta and Mosquito, both in and out of the tropics. Patients usually have severe symptoms of aching joints. It's often called break bone fever because the patients feel like the bones in their bodies are being broken. Dengue is one of those illnesses for which the art of nursing is more important than any medical science. There's no specific medication for the treatment of the disease. It's only the symptoms of dengue that can be treated. And for these, the doctor may prescribe pain-relieving drugs. There may be treatment to reduce temperature. And mild sedatives may be prescribed. During convalescence from dengue fever, periods of marked mental depression are not uncommon, and the will to live may be at a low F. Nursing care is the prime factor in patient treatment. And the painfulness of the disease taxes all of a nurse's professional skills. Sulfur compounds and antibiotics are constantly improving the prognosis for patients who contract some of the most serious of the so-called tropical diseases. Here in the tropics, perhaps more than anywhere else, the successful hospital program is the result of an effective medical team. It's especially true in the tropics, that good nursing care can greatly improve the prognosis for every patient. Well, to sum up, the basic nursing skills called for in the tropics are no different from those called for anywhere else. The big difference here is the environment. Patients get sicker and are harder to care for, and precautionary measures against infection take on added importance. That's the story.