Posts tagged surgeon

We first met Karim when he had sustained a severe head injury, he was comatose and from the start his survival was doubtful. Long story short: his family took him to a Neurosurgical centre in Pakistan when MSF could no longer help. Days later he returned but still needed some basic care and antibiotics, which MSF provided. He was discharged from MSF and walked out of the hospital with his family. I’m not saying that MSF saved his life nor that we can take full credit for the fortunate outcome; what I am saying is that it has been a privilege to be involved in his story. There are enough tragic stories in Kunduz, so when a case does turn out as well as Karim’s we are pleased (to say the least!)
The newest member of our Afghanistan blogging team, emergency doctor Stefan Kruger, talks about his favorite patient. Please leave your questions and comments for Stefan below his blog post. 

Surgery In Syria, Part 2: “It Really Is A Drop In The Ocean”

Dr. Martial Ledecq is a surgeon who recently completed a one-month mission in Syria, where he worked in one of the four makeshift medical facilities Doctors Without Borders/Medecins Sans Frontieres (MSF) set up in the north of country. Since the end of June 2012, our teams have treated more than 2,500 patients and carried out some 550 surgical procedures.

The non-medical personnel deserve as much credit as anyone for the medical care provided here. Many people don’t realize how many non-medical people it takes to do what MSF does.
US surgeon David Lauter pays tribute to the logisticians and other MSF staff who make our projects work. Please leave your questions and comments for David in the comments box below his blog post.
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.
Excerpt from MSF surgeon, David Lauter’s, Wait, Watch, Act field blog post.
I love surgery. I am grateful to be a surgeon. But I have always thought of it as something that I do for work, not who I am. However in Paoua, I am nothing more than the surgeon. It is who I am, what I do.

When the hospital radios the residential compound after hours, the call is for “le chirurgien,” not for me by name. MSF brought me here to be their surgeon. Their expectation was that I could practice broadly in my own field plus was willing and able to practice outside the realm of general surgery including performing c-sections. I am also asked to provide care for problems that back home would be handled by other specialists; orthopedic surgeons, ENT doctors, urologists and dentists to name a few.

In the US, I never practice outside the field of my expertise. Although my training covered a broad range of surgical specialties, I have pursued a sub-specialty practice over the years. In the US, if I see a patient with a problem that can be better addressed by another specialist with different training or experience, I refer the patient. In Paoua, I have no referral options. There are no other surgical specialists in Paoua and only a limited number in Bangui. Most people I see here have severely limited resources and are no more able to seek a consultation in the capital as to take a trip to the Mayo Clinic. If we can’t help them in Paoua, they don’t get help anywhere else.

In his latest blog post, US surgeon David Lauter describes having to decide whether or not to treat an infant girl for a gynecological condition outside his area of expertise. David is working in MSF’s hospital in Paoua, Central African Republic. Please leave your questions and comments for David in the comments box below his blog post.

Photo: MSF staff examine a patient at the surgical trauma hospital. Syria 2012 © MSF

Syria: ‘We Just Kept Working, Day and Night’

"One young man accounted for nine out of the first 29 operations we did. His injury resulted in a hindquarter amputation [an operation in which the entire leg and part or all of the pelvis are removed]. He came back regularly for surgery and we were eventually able to close the wound and he was discharged. After that, he would come back on crutches, with his brother, both with huge smiles on their faces, happy to see all of us who had been involved in his care. It was so good to see his recovery and that he was doing well. Quite a few weeks later we received the sad news that this young man had been killed in a bomb blast in Aleppo. It was devastating for all of us."

-Interview with Ruth Priestley, an Australian operating theater nurse who recently spent nine weeks working in Syria. 

MSF established its surgical trauma hospital in Syria in mid-June in collaboration with the Union of Syrian Medical Relief Organizations. By the end of September, more than 1,100 patients had been treated, and more than 260 surgical interventions had been conducted.

Photo: MSF staff examine a patient at the surgical trauma hospital. Syria 2012 © MSF

Syria: ‘We Just Kept Working, Day and Night’

"One young man accounted for nine out of the first 29 operations we did. His injury resulted in a hindquarter amputation [an operation in which the entire leg and part or all of the pelvis are removed]. He came back regularly for surgery and we were eventually able to close the wound and he was discharged. After that, he would come back on crutches, with his brother, both with huge smiles on their faces, happy to see all of us who had been involved in his care. It was so good to see his recovery and that he was doing well. Quite a few weeks later we received the sad news that this young man had been killed in a bomb blast in Aleppo. It was devastating for all of us."

-Interview with Ruth Priestley, an Australian operating theater nurse who recently spent nine weeks working in Syria.

MSF established its surgical trauma hospital in Syria in mid-June in collaboration with the Union of Syrian Medical Relief Organizations. By the end of September, more than 1,100 patients had been treated, and more than 260 surgical interventions had been conducted.

What strikes me the most about my accommodation is that compared to how the average person in Paoua lives, my residential compound is like staying at a five star luxury hotel in New York or Paris. As far as I can tell, no one in Paoua has electricity in their home.
While we can’t save everyone, or bring an end to the fighting, we can save the lives right in front of us, and let people know they are not alone.
Dr. Cristiana Bertocchi, MSF surgeon from Pittsburgh, PA, Abidjan, Ivory Coast, March 2011
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.
Surgical specialist Anna Nowak has completed more than 20 missions with MSF. She has just returned from Syria, where she helped to set up a refugee hospital project.

MSF has been working on the ground in Syria for the past two months, trying to provide humanitarian assistance to people affected by the conflict. With the help of a group of Syrian doctors, in six days a team was able to transform an empty house into an emergency hospital where wounded people could be operated on and hospitalized.

Interview with Doctors Without Borders surgeon Kathrine Holte, who spent a month operating in a secret field hospital in Syria.

Dr. Juan Robinson, an orthopedic surgeon, reviews a patient’s X-ray with other medical staff during rounds in the inpatient ward.

Before the opening of the MSF surgical hospital in Kunduz Province, northern Afghanistan, people in the region suffering from severe injuries had two options. They made the long and dangerous journey to Kabul or Pakistan, or they visited an expensive private clinic. As a result, few patients received the trauma care they needed.

In less than a year, the MSF trauma center, equipped with an emergency room, two operating theaters, and an intensive care unit, has seen more than 3,700 patients. The majority are victims of so-called “general trauma”—road traffic accidents, domestic violence, or civilian gunshot wounds.More photos: Trauma Care Where There Was None in Northern Afghanistan

*All patients’ names have been changed.Photos: Afghanistan 2012 © Michael Goldfarb/MSF

Dr. Juan Robinson, an orthopedic surgeon, reviews a patient’s X-ray with other medical staff during rounds in the inpatient ward.

Before the opening of the MSF surgical hospital in Kunduz Province, northern Afghanistan, people in the region suffering from severe injuries had two options. They made the long and dangerous journey to Kabul or Pakistan, or they visited an expensive private clinic. As a result, few patients received the trauma care they needed.

In less than a year, the MSF trauma center, equipped with an emergency room, two operating theaters, and an intensive care unit, has seen more than 3,700 patients. The majority are victims of so-called “general trauma”—road traffic accidents, domestic violence, or civilian gunshot wounds.

More photos: Trauma Care Where There Was None in Northern Afghanistan

*All patients’ names have been changed.

Photos: Afghanistan 2012 © Michael Goldfarb/MSF

A Mission in Syria

In late March, an MSF team crossed the Turkish border into Syria in an effort to provide medical aid in the Idlib region. The two-person team was composed of a surgeon and an anesthesiologist. To evaluate needs, they also sought to observe the treatment that wounded patients were receiving.

Their first observation was that medical workers were so terrorized that they would offer only first aid in cases of extreme emergency. To treat broken bones, for example, they would simply use makeshift splints. In dealing with hemorrhage, they applied compression bandages even when they had access to technical resources enabling them to provide more appropriate and complete care.

“They told us that the risk was too high, the MSF surgeon explained. We were told that, ‘being caught with a patient is worse than being caught with a weapon.' A Syrian colleague also told me that that meant death both for the patient and for him.”Photo:Staff performing surgery in the Idlib area of Syria, while it was still possible to do so.
Syria 2012 © MSF

A Mission in Syria

In late March, an MSF team crossed the Turkish border into Syria in an effort to provide medical aid in the Idlib region. The two-person team was composed of a surgeon and an anesthesiologist. To evaluate needs, they also sought to observe the treatment that wounded patients were receiving.

Their first observation was that medical workers were so terrorized that they would offer only first aid in cases of extreme emergency. To treat broken bones, for example, they would simply use makeshift splints. In dealing with hemorrhage, they applied compression bandages even when they had access to technical resources enabling them to provide more appropriate and complete care.

“They told us that the risk was too high, the MSF surgeon explained. We were told that, ‘being caught with a patient is worse than being caught with a weapon.' A Syrian colleague also told me that that meant death both for the patient and for him.”

Photo:Staff performing surgery in the Idlib area of Syria, while it was still possible to do so.
Syria 2012 © MSF

Syria: Safety of Wounded and Medical Workers Must be Prioritized

Wounded people and medical workers remain targeted and threatened in parts of Syria, preventing people from receiving life-saving emergency medical care MSF said today, following recent visits to parts of Syria by MSF medical teams.

After reaching the governorates of Homs and later Idlib, MSF teams found patients and doctors at risk of attack and arrest. MSF first reported in early February on the abuse of health facilities and the targeting of patients and medical workers. All parties to the conflict must fully respect the safety and integrity of wounded people, doctors, and healthcare facilities, MSF said.

“Being caught with patients is like being caught with a weapon," said an orthopedic surgeon whom MSF met in a village in Idlib governorate. “The atmosphere in most medical facilities is extremely tense; health care workers send wounded patients home and provide only first aid so that facilities can be evacuated quickly in the event of a military operation.”Photo:A burned out medical center in Idlib.
Syria 2012 © MSF

Syria: Safety of Wounded and Medical Workers Must be Prioritized

Wounded people and medical workers remain targeted and threatened in parts of Syria, preventing people from receiving life-saving emergency medical care MSF said today, following recent visits to parts of Syria by MSF medical teams.

After reaching the governorates of Homs and later Idlib, MSF teams found patients and doctors at risk of attack and arrest. MSF first reported in early February on the abuse of health facilities and the targeting of patients and medical workers. All parties to the conflict must fully respect the safety and integrity of wounded people, doctors, and healthcare facilities, MSF said.

Being caught with patients is like being caught with a weapon," said an orthopedic surgeon whom MSF met in a village in Idlib governorate. “The atmosphere in most medical facilities is extremely tense; health care workers send wounded patients home and provide only first aid so that facilities can be evacuated quickly in the event of a military operation.”

Photo:A burned out medical center in Idlib.
Syria 2012 © MSF