Abstract
It falls to me to honour past Editors and contributors to the success of Tropical Doctor (TD) over the past 50 years. Initially produced as a rather tentative venture, needing private financial support, the journal has grown in volume, stature and scientific credibility over this period. In the early years, popular articles were the ‘how I do it’ variety, as there was a shortage of treatment manuals relevant to poor-resource situations. This was, to a large degree, altered by volumes on Tropical Medicine (1), Primary Surgery (2), and Primary Anesthesia (3), as well as numerous manuals on Obstetric care, and a myriad of other subjects.
Access to information is easier now than ever through the Internet, even though coverage in many places on the globe remains sub-optimal. So, the content of TD has changed from ‘advice from experts’ to a more scientific analysis of clinical problems. Despite these changes, the aim of the journal remains the same: to provide useful, up-to-date, practically relevant, appropriate information to the practitioner in low- and middle-income countries, working with limited (or very limited) resources. Although medical schools now exist in almost all countries, their graduates still migrate to the major cities, leaving the rural districts bereft and the massive shanty towns unserved.
Inevitably, over a period which has seen the advent of flexible gastro-intestinal endoscopy, mobile high-resolution ultrasound, computerised tomography and nuclear magnetic resonance imagery, endoscopic surgical techniques and a whole host of investigative laboratory tests hitherto quite undreamt of, articles in TD reflect these developments. Yet, as Professor Sharma, one of our co-editors eloquently writes below, appropriate technology is needed, and with it appropriate research. Screening programmes, for example, are of no benefit unless the data gathered is reliable, properly analysed and acted upon. Even then, the results of any proposed treatment need to be shown to be beneficial in the environment concerned. What may be good for Tokyo may not work in Togo! This lesson, as described in a previous editorial (4) was sadly not learnt in Sierra Leone during the Ebola outbreak; disastrously, it has not been heeded with COVID-19. This pandemic has been surrounded by rash political decisions resulting from sins of omission (not reporting the disease in the first place) and commission (instituting treatments and restrictions which have no proven benefit). It remains to be seen what will happen when the ravages of ZIKA (5), plague (6) or NIPAH virus (7) reach global proportions.
Related to these technical advances, it is evident that less surgery is now performed in District Hospitals than in the 1970s, despite the fact that much can reasonably be achieved with little sophistication, and emergency care must still be available locally, particularly where transport to city centres is difficult, expensive or dangerous. The relative paucity of surgical articles in TD reflects this trend, both of which should be reversed. We appeal therefore for those practicing surgery, who may not be fully fledged surgeons, to write of their travails, their hurdles and their findings!
TD has been in the forefront of informing on these threats and other challenges. Indeed over the past 50 years, a number of seminal articles have been published. I have selected 50 to congratulate these authors, and to remind potential contributors to rise to the challenge and write the things that need to be written! These articles will now become available by free access thanks to the generosity of Sage Publishing.
Tempest MN. Cancrum oris. TD 1971; 1: 164–169. Monath TP. Lassa Fever. TD 1973; 3: 155–161. Board AJ, Henry RAN. Ketamine. The economics of anaesthesia in developing countries. TD 1974; 4: 22–25. Gebbie DAM. Symphysiotomy. TD 1974; 4: 69–75. Barss P. Diagnosis and Management of Onyalai. TD 1976; 6: 50–52. Finlayson R. Kawasaki disease. TD 1979; 9: 152. Elamin AM, Kawasaki disease in two African siblings. TD 1979; 9: 153–154. Leguay G, Varzalle A. Sickle cell trait and aviation. TD 1980; 10: 51–55. Sarara RA, Fontoura ACF, Pereira E, Vieira ZEG. Cardiovascular response to anaesthesia in Chagas’ disease. TD 1980; 10: 62–65. Stanley SL, Kell O. Ascending paralysis associated with diethyl carbamazine treatment of Loa Loa infection. TD 1982; 12: 16–19. Jeyarajah R, Jayatissa SK, Senivaratne N, Dharmasena BD. Intermittent peritoneal dialysis. TD 1986; 16: 13–17. Zanoni P, de Lalla F. Value of diagnostic laparoscopy. TD 1986; 16: 148–149. Ederisinghe JA. Scarabiasis. TD 1988; 18: 47–48. De Boer CN, Thornton JG. Cranial surgery in a rural Kenyan hospital. TD 1988; 18: 64–66. Carswell JW. Clinical Manifestations of AIDS in tropical countries. TD 1988; 18: 147–150. Van den Bosch CA. Diagnosis of Burkitt’s Lymphoma. TD 1990; 20: 11–14. Carswell JW. HIV: Implications for blood transfusion and banking in Africa. TD 1990; 20: 42–43. Adogu AA. Typhoid psychosis. TD 1990; 20: 92. Ketcham DW. Where there is no anaestheologist: the many uses of ketamine. TD 1990; 20: 163–166. Mlingi N, Kimatta S, Rosling H. Konzo; a paralytic disease observed in southern Tanzania. TD 1991: 21: 24–25. Veeken H, Verbeek J, Houwelling H, Cobelens F. Occupational HIV infection and health care workers in the tropics. TD 1991; 21: 28–31. Parkes G. Pig-bel in Nepal. TD 1991; 21: 180–181. Dobson MB. Oxygen concentrators for the smaller hospital. TD 1992; 22: 56–58. Longombe AO, Ralaimiarison A, Lusi KM. The use of fishing nylon for surgery in rural areas in North East Zaire. TD 1993; 23: 178–179. Rennie JA. The poor cousin of medicine. TD 1994; 24: 5–6. Bergman NJ, Jürisoo LA. The ‘kangaroo-method’ for treating low birth weight babies in a developing country. TD 1994; 24: 57–60. Bergman NJ. Reduction of posterior dislocation of the hip. TD 1994; 24: 134–135. Holmgren G, Sjoholm L. The Misgav Ladach method of Caesarean section: evolved by Joel-Cohen and Michael Stark in Jerusalem.TD 1996; 26: 150–157. Warrell DA. Prazosin: scorpion envenoming and the cardiovascular system. TD 1997; 27: 1. Bell MSG, Duncan MJ. Need a pizza meshed skin? A simple expansion device. TD 1997; 27: 229. Puri M, Rathee U, Rathee S. Conjoined twins in a septate uterus. TD 1997; 27: 244–245. Aaskov J. Where are the Will Pickles of Lautoka, Pegu, Ibadan or Belem? TD 1998; 28: 65–66. Thistle PJ, Watt JA. Abdominal pregnancy in Zimbabwe: guidelines in management in rural districts of developing countries. TD 2000; 30: 180–181. Bitekyerezo M, Kyobutungi C, Kizza R. The outbreak and control of Ebola viral haemorrhagic fever in a Ugandan medical school. TD 2002; 32: 10–15. Danbauchi SS. Echocardiographic features of peripartum cardiac failure: the Zaria syndrome. TD 2002; 32: 24–27. Olasoji O, Arotiba T, Dogo D. Experience with unoperated cleft lip and palate patients in a Nigerian teaching hospital TD 2002; 32: 33–36. Shuftan C. Aid and reform in Africa: lessons from 10 case studies: final report. TD 2002; 32: 108–110. Pao PS, Dhawan R, Shivananda PG. Burkholderia pseudomallei infections. TD 2002; 32: 174–175. Rahman M. The Bangladesh arsenic catastrophe: clinical manifestations. TD 2003; 33: 42–44. Olasode BJ, Ironside JW. The brain smear, a rapid affordable intraoperative diagnostic technique for brain tumours appropriate for Africa. TD 2004; 34: 223–225. Gnanaraj J. Minimally invasive appendicectomy using the cystoscope. TD 2008; 38: 14–15. Jain M, Rai s, Chakravarti A. Chikungunya: a review. TD 2008; 38: 70–72. King M. Foreskins: leave them alone. TD 2014; 44: 19–20. Molyneux M. Global warming and altitude malaria. TD 2014; 44: 125–127. Brown C, Arkell P, Rokadiya S. Ebola virus disease: the ‘Black Swan” in West Africa TD 2015; 45: 2–5. Armon P. Symphysiotomy. TD 2015; 45: 60–67. Ibembe IN, Wiggin TR. An alternative to India ink stain. TD 2015; 45: 206–207. 50Elneil S. Female sexual dysfunction in female genital mutilation. TD 2016; 46: 2–11. Porrino P. Zika virus infection and once again the risk from other neglected diseases. TD 2016; 46: 159–165. Ahmed QA, Memish ZA. Yellow fever from Angola and Congo: a storm gathers. TD 2017; 47: 92–96. Dos Santos Grácio AJ, Grácio MAA. Plague in Madagascar. TD 2018; 48: 159–165. Wilson A, Warrier A, Rathish B. Contact tracing: a lesson from the Nipah virus in the time of COVID-19. TD 2020; 50: 174–175.
Perhaps it is worthwhile for readers not already au fait, the special supplementary edition of January 1991 on Disasters is still very much a worthwhile read. Many other articles are quite fascinating: it does not always require rigorous scientific method to produce a valuable piece! Many a personal account may deliver a powerful message. I recommend these:
Yudkin JS, Mchomey FJ. The mysterious deaths at Mtoni. TD 1977; 7: 148–151. Lennox CE, Pust RF. Surgical experience of tribal warfare in Papua New Guinea. TD 1979; 9: 184–188. Adeheye EO, Kwanini F, Ord RA. Uvulectomy: serious complications. TD 1984; 14: 160–161. Tahzib F. Camel injuries. TD 1984; 14: 187–188. Fegan D, Glennon M. Garfish injury. TD 1990; 20: 91. MacBride-Stewart G. Fishing for a foreign body. TD 1992; 22: 45. Senapati MK, Subramaniam MS. Rapunzel syndrome. TD 1997; 27: 53–54. Puri M, Rathee U, Rathee S. Conjoined twins in a septate uterus. TD 1997; 27: 244–245. Moissinac K, Chong Se To B, Gul YA, Liew NC. Appendicitis despite previous appendicectomy. TD 2001; 31: 217. Bem C. Voice. TD 2014; 44: 3–5. Ugboma HAA, Oputa VOA, Ugboma EW. Ruptured ectopic pregnancy: the long and tortuous journey to the theatre. TD 2014; 44: 173–175.
However, for potential contributors, I can do no better, though, than recommending they read our chairman’s valuable advice, just as valid after 30 years, before submitting their work to TD:
Molyneux, M. Writing for Tropical Doctor. TD 1990; 20: 2–3.
This, as well as pertinent advice from another previous editor, still holds (TD 2010;40.193): ‘We would be keen to publish papers that provide: (1) Evidence on the epidemiology, treatment and outcome of conditions that are common in the tropics; (2) Reports that would affect practice in rural tropical hospitals; (3) Data that help maximise the use of scarce resources; (4) Things that may improve the practice of non-specialist health-care workers.
In contrast, we are unlikely to publish: (1) Specialist papers that are irrelevant to most tropical clinicians; (2) Articles that use “high tech” investigations or involve “high tech” treatment; (3) Articles that concentrate on rare pathologies; (4) Data that are only of relevance to one specific geographical location’.
It is notable that certain subjects tend to recur, but articles rarely refer to previous wisdom published in TD, preferring to use Pubmed and other sources. This is a pity, as the thrust of TD differs significantly from other journals, and its alternative philosophy must be respected. Grading of articles is difficult: obviously, if we were to publish a totally outrageous paper, it may well be cited 100 times by those wishing to deride it! So much for the much vaunted ‘Impact Factor’! But clearly some papers are more read, more influential, or more relevant than others. We try to encourage these. Indeed, it may be the case that our comment,
Mahmoud O. The brutality of the Sudanese government against doctors is determined by policy rather than isolated events. TD 2019; 49: 157–158.
was in fact influential in the revolutionary about-turn in that country. We believe that the word is stronger than the sword, and that is why we speak out against doctors involved in torture, or dirty war practices, for example. We urge our contributors to be similarly outspoken about things that matter. Correcting medical imbalances globally is, after all, the raison d’être of Tropical Doctor. Happy Jubilee!