Ethical considerations in targeted paediatric neurosurgery missions.

Within the context of global health development approaches, surgical missions to provide care for underserved populations remain the least studied interventions with regard to their methodology. Because of the unique logistical needs of delivering operative care, surgical missions are often described solely in terms of cases performed, with a paucity of discourse on medical ethics. Within surgery, subspecialties that serve patients on a non-elective basis should, it could be argued, create mission strategies that involve a didactic approach and the propagation of sustainable surgical care. The ethical considerations have yet to be described for paediatric neurosurgical outreach missions. We present here the perspectives of neurosurgeons who have participated in surgical outreach missions in Central America, South America, Eastern Europe and sub-Saharan Africa from the vantage point of both the visiting mission team and the host team that accommodates the mission efforts.

The science of shrinking human heads: tribal warfare and revenge among the South American Jivaro-Shuar.

THE PRACTICE OF "head-shrinking" has been the proper domain not of Africa but rather of the denizens of South America. Specifically, in the post-Columbian period, it has been most famously the practice of a tribe of indigenous people commonly called the Jivaro or Jivaro-Shuar. The evidence suggests that the Jivaro-Shuar are merely the last group to retain a custom widespread in northwestern South America. In both ceramic and textile art of the pre-Columbian residents of Peru, the motif of trophy heads smaller than normal life-size heads commonly recurs; the motif is seen even in surviving carvings in stone and shell. Moreover, although not true shrunken heads, trophy heads found in late pre-Columbian and even post-Columbian graves of the region demonstrate techniques of display very similar to those used by the Jivaro-Shuar, at least some of which are best understood in the context of head-shrinking. Regardless, the Jivaro-Shuar and their practices provide an illustrative counterexample to popular myth regarding the culture and science of the shrinking of human heads.