Diseases of infection and neglect, as well as violence related wounds are always the main part of our life here in Nasir as a surgeon. Last Friday morning, we heard the rumour that there was gun fight in our neighboring county involving many victims. So we prepared our surgical ward for vacancy for sudden influx of patients and got everything ready in our emergency department. And I stopped our operations at around 11am to get the operating theatre(OT) ready to deal with the wounded. 11am, no patient arrived, so according to the request from Maternity unit, I did a dilatation and currettage for a lady with incomplete abortion, then an emergency C-section for a lady in prolonged difficult labour. 1pm, we finally received a request from that county for sending a speedboat with a medic to escort 6 wounded patients. So we finally received 7 wounded patients after 4pm, they were all with gunshot wounds and were lucky that no one was critical. The OT team and I then started operations for them with a priority according to their wound severity. We started at 4:30pm nonstop for 6 hours and were able to finish operations for all seven of them. But of course, not a single one of us had stopped for our dinner. I went to take a shower and dropped dead on my bed right afterward without taking any food. Next morning, I continued with our normal routines in the OT with other patients including some outpatients that we were not able to handle yesterday. Then at lunch, I guessed I took some leftover from last evening and started to feel nausea with stomach cramps late in that afternoon, so the Project Coordinator need to replace my medical emergency on call with another medical doctor (that mean I am double on call. For the surgical on call, I am always 7/24). I was resting on the whole Sunday but at 8:30pm that evening, there was a knife stab wound coming into our emergency room requiring immediate operation. So without hesitation, I prepared for the operation and called back our national staffs in our OT team which included the anesthetist and the scrub nurse. The patient's condition was critical all the time and my stomach was cramping on and off during the operation and when I finally stopped all the bleeding from those torn vessels inside the abdomen and started closing up the wound, the patient suddenly stopped breathing. So we needed to resuscitate the patient in the middle of the surgery which finally succeeded. Afterwards we closed the wound quickly. We monitored the patient for one hour inside the OT and thought he should be stable enough to transfer to ICU unit. But after he had arrived ICU, he stopped breathing again and we needed to resuscitate the patient but without success this time. So at 1am, I returned to my bed with a tired mind and body, as well as a very bad mood. Next morning, there were a lot of wound revisions from those gunshot wounds and also a lot more from the outpatient department and even another emergency C-section for a lady with her child in distress. So we worked nonstop for another 8 hours that day with 20 interventions, major and minor altogether. On Tuesday, there were 2 more victims from the gunfight hiding in the bush just to turn up now with a very dirty and infected wound, there were worms in one of those wounds, and I've another elective hernia patient as well. So another day nonstop for 8 hours. After working nonstop and getting gastritis in between for 5 days, I was totally exhausted, but I was scheduled to have medical emergency call on that day as well. So I forced myself to stay alert and awake on that evening even though I really want to be on the bed right after some food. Then at 10:30pm that evening, there was a lady in difficult labour and she required my help for C-section which I had some difficulties in getting the baby out as I was too weak already, but finally the baby girl was out and healthy. But after that everyone in the team knew that I was totally exhausted and thanked to my MTL who took over my medical emergency call and asked me to go to bed immediately which I did without hesitation! Life can be that hard and busy in our missions but if we looked back, there are always satisfaction and gratitude in what we have done for the others and with that all our effort and exhaustion are worthy after all!
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Comments (1)

  • anon

    Ryan, Thanks for such valuable information! I am currrently undergoing my PPD course in Holland and should be in Nasir as the new MSF surgeon.

    Aug 15, 2012

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