Resource conservation, another way of saying, save money. Case in point. Tillie comes in for a Pap smear and the provider can't see the IUD strings, which extend from the IUD's stem inside the uterine cavity, about three-quarters or an inch beyond the cervical opening. So an ultrasound is ordered: perhaps the IUD was expelled-gone. Or maybe it perforated the uterine wall, migrated beyond the uterus into the abdominal cavity. Or the most likely explanation: the strings may have curled up inside the uterus.
Long and skinny "alligator" forceps can reach inside the uterus grasp the strings to retrieve and IUD (after which a new IUD can be inserted, leaving longer strings).
So why wasn't this attempted, saving the cost of the ultrasound? Probably because ultrasound are seen as relatively cheap (compared to a CT xray, for example) and very safe, and some less experienced providers may be uncomfortable blindly inserting the forceps into the uterine cavity. All true enough, but that's one reason why medical care is so expensive.
All told, over five days in Cambodia I saw 27 patients with 11 going to major surgery and 3 having small epidural inclusion cysts removed (superficial cysts arising from blocked skin ducts, leading to accumulation of the secreted material--skin oils) as marble-size cysts. Nothing dangerous--these are not infections or malignancies), but can be annoying and unsightly, so I'm fine removing them.
Many difficulties with poorly trained or simply insufficient staff (often no scrub techs or experienced assistants, so I managed my instruments myself and did the best I could do with inadequate assisting. And problems with instruments. And as I mentioned no fellow abdominal surgeons.
All puts a downer on future trips, but I'll let a few more months pass then re-decide.
So why wasn't this attempted, saving the cost of the ultrasound? Probably because ultrasound are seen as relatively cheap (compared to a CT xray, for example) and very safe, and some less experienced providers may be uncomfortable blindly inserting the forceps into the uterine cavity. All true enough, but that's one reason why medical care is so expensive.
