It has been crazily busy in last three days. I had to return and perform emergency operations in two consecutive nights. One laparotomy was performed for a Gun-shot wound (GSW) case with liver injury and the other was GSW in neck with emergency tracheostomy. I had done the fourth laparotomy in Teme today, for a man with perforated peptic ulcer. He was admitted for fracture leg days ago. Probably, he developed this complication because of stress.

Photo source: AU Yiu Kai

On Monday, we had performed 15 operations and ended at 9:45pm, but we had to postpone five. We need to cancel a few everyday. If not, we cannot come home. There are always emergencies added to the list. Like today, I had to perform the emergency laparotomy and James had to add another emergency for an 11 years old girl with road traffic accident and crush injury of left foot. In fact, this is a perpetual problem. I looked up the statistics and found that we had performed total 325 cases in May. If we take 27 working days in May, we had done over 13 cases a day. Yesterday, we had to ask two patients to go home and wait for another schedule list. They are one old woman with non-union of fracture upper arm, and the other young girl with a stiff elbow because of old injury of fracture dislocation of elbow. We don’t have time to cope with all the emergency admissions. It’s difficult for us to find time for these complicated, non urgent cases. We can only select those necessary one, like the young girl. But we really do not know when will be the date. Yesterday was the paid day of the local staff. Some were not happy. It was because they had to pay a new tax rate since January this year. One nurse working in OT can only earn 78000 Nigra (around HK$ 4900) but has to pay 15000 N (HK$ 750) of her salary each month for tax. It is almost 19% tax rate. The OT I/C told me that he had no money left for himself after paying school fees for his four children today. The unemployment rate in Nigeria is high and the wage is low. It’s difficult for them to find a job. He knows that the country is producing oil but he does not know where the money goes. Life is difficult in Nigeria. MSF is providing over 240 employments and helping thousands of patients in Port Harcourt. On Monday we had a case of examination under anaesthesia for a 6 years old girl with suspected sexual abuse. Luckily it was not. In Teme, we have a small center for the suspected sexual violence victims. There is a local gynaecologist and psychiatrist attending to these patients.
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