On-line version ISSN 2078-5135
SAMJ, S. Afr. med. j. vol.103 n.3 Cape Town Mar. 2013
Common Medical Problems in the Tropics
By C R Schull. 3rd ed., revised and updated. Oxford: Macmillan. 2009. ISBN 978-0-23003-104-3.
This book should be viewed in the context of its aims, i.e. as a reference for paramedical health workers in isolated rural areas with limited access to senior advice and even simple investigations. However, it would also be a valuable reference for doctors, particularly those who trained in high-resource settings or who are working outside their area of expertise. This edition is a major re-write by Dr Schull and his wife, who have generously agreed to forego royalties from sales. The book is available through Teaching Aids at Low Cost (TALC), thanks to a grant from the Australian Medical Association of Queensland Foundation.
The first chapter, 'On being an effective health worker', is a highlight that should not be skipped. Experience is often worth more than knowledge in medicine but is harder to obtain, and Dr Schull summarises his wealth of experience on difficult topics such as interactions with traditional healers and how to work together with other community leaders.
Most of the book is a comprehensive reference text, with chapters devoted to the major tropical diseases and a systematic approach by organ system. There are many practical points with helpful diagrams such as how to make a malaria film and a skin smear. Extensive photographs and diagrams illustrate the anatomy, examination techniques and pathology.
A possible flaw is the detail given to areas that commonly depend on national policies. For example, there is a detailed section on HIV with multiple regimens, indications and follow-up strategies. Most countries where antiretrovirals are available have extensive and slightly different guidelines, and it is the responsibility of the healthcare worker to become familiar with them. Also problematic is that some information is out of date owing to rapid changes as new data emerge.
This is a valuable reference text for the practising of healthcare in the tropics, and its scope extends well beyond the paramedical workers at whom it is principally aimed. The generosity of author and sponsors makes this important information available at low cost to those who most need it.