I leave with a strange feeling inside; this is something totally exceptional for me, to see a human body in this state [bones splintered, muscle crushed]. To understand the challenges faced by the surgeons and medical team with each case, to admire their skill, calmness and dedication to doing the best they possibly can for each and every patient. I take my hat off to them.
I take a couple of deeps breaths. I tell myself ‘everything will be okay’. What on Earth am I doing? And then I remember. Twice whilst I was in Uganda, the distinctive MSF Toyota land-cruiser, adorned with MSF flag and stickers and no weapons logos and giant radio antenna zoomed past me and I got butterflies in my tummy.
Our patient from the other day first presented to an outside clinic, where there is no surgeon, when he still felt too weak to stand several days after being beaten with fists and sticks. He was admitted to the clinic with a swollen, distended abdomen and increasing pain, given intravenous fluids, evaluated with an X-ray and a blood count, suggesting blood loss, followed by a phone call to our project chief and a discussion with me about transfer. At home this patient would have had a CT scan to identify whether he had an injury to the spleen and/or liver, plus checked for signs of other injuries that would suggest he needed surgery. With a stable liver or spleen injury, he would be placed at bed rest to minimize the chance of recurrent bleeding. Here in the Central African Republic the choice was to risk leaving him at a facility that had no capability for an operation or transfer him to Paoua by LandRover with the risk of making any potential bleeding worse, as the trip is slightly less jarring than playing a game of rugby. We told them to send him over as soon as they could. Due to a combination of vehicle availability, road conditions and security issues, it was a full 24 hours before he arrived in Paoua, now almost six days from his initial injury.
Sleeping on the ground in day-old, fishy, muddy, sweaty clothes isn’t my idea of a great night out, but still it gave me time and reason to reflect and understand the people I’m working with better. Not the staff, though yes them too somewhat, but the patients. The oldies that come with general body pains that we send away with no medication, telling them its normal to have body pains after working in the fields cultivating, carrying 20kg drums of water for miles on their heads, cutting and carrying wood for miles just in order to live.
Kate Chapman is a nurse working with MSF in Matter, Ethiopia. Kate and her team have an unexpected camping adventure and gain further understanding of how local people live when they get stuck in the middle of nowhere.
Then, injured people started coming from everywhere. We had to come up with other ways of accommodating people, even if it meant putting beds on the terrace. Sometimes the wounded didn’t arrive during the day because of fighting, because the roads were blocked, or because traveling to the hospital was risky. Sometimes they came at night or at dawn.
This is…what we’re here for: responding to the most urgent and immediate medical needs. It is incredible what we have been able to achieve, but it’s not enough. There is always something more that can be done, and we have to fight to make sure these people have what they need, not just to survive, but to give them dignity, give them quality of life, make sure that they can maintain the spirit that they have.
Helen Ottens-Patterson, from the United Kingdom, is a nurse and Doctors Without Borders medical coordinator in Upper Nile State’s Maban County, South Sudan.