This Friday morning at 6:20am I was called to the hospital before I had a chance for my breakfast. There was a boy got shot last night while he was playing in the bush with his friends. He had just arrived our hospital. He was shot at the head, chest and the abdomen by pellets of a shotgun and fell unconscious right after the accident.
There were 3 small holes in the skull, 4 in the chest and 4 at the abdomen. It was difficult to handle the bullets in the brain because our setting is very basic. So we rushed into the operating theatre to explore his chest and abdomen. There was limited blood in the chest but there were many holes in different parts of the intestine & even a tear in the liver: within the abdomen there was a pellet stuck in the abdominal wall. I tried my best to repair every single hole & stopped the bleeding but when I was almost near the end of the operation, the boy’s condition deteriorated suddenly and was not responding to resuscitation. Of course we knew, that’s the result of the brain injury, so despite all our effort, we still could not save the life of this 11 years old boy who died just because he was playing in the bush in a conflict country.
After that I needed to do a revision laparotomy for a 28 years old man with typhoid perforation of the small intestine which is very rare in Hong Kong. His situation was even worse because he came to our hospital after in pain for 7 days, that mean all his bowel content was in the abdomen for a whole week. I did the first operation and resect the segment with all the perforations but his condition did not improved, so today I needed to renew the resection & anastomosis. And to play safe I didn’t dare to close the abdomen which is a technique we never use in Hong Kong. Just imagine, will we have patients coming into hospital after many days of severe pain? I wish everything will be fine for him and I can close the abdomen for him early next week. 
Then there came a man with open fracture of his left leg. He was in an accident 10 days ago so now the wound was infected. In situation like that I needed to clean and cut all the dead and infected tissues, so that I can close the wound as soon as possible and fix the fracture.
Of course in between all these major cases, we always have a lot of minor procedures including change of dressing, incision for abscess, suture of wounds & after all that it was almost 3:30pm & I suddenly remembered that I had not eaten anything since I woke up. But here came a boy with badly infected wound in the lower abdomen as well as the left scrotal skin. The infection started 2 weeks ago but they only arrived today. So at the end I needed to cut away a lot of dead skin leaving a wide gap in the lower abdomen. I needed to plan for covering the gap in the coming week. That’s always our dilemma, if we do not cut away all the dead and infected tissues for the patients, the infection will remain and spread even the patients are given antibiotic, so the first operation is always for infection control, leaving the constructive part later to worry. At 4:30pm I can finally left hospital and back to the base for my first meal of the day. At 5pm of the day, my colleaque greeted me with “enjoy your breakfast”.
So as you can see from my day’s work, all these problems of conflict with its destruction on the existing medical facilities cause a lot of tragedies to the population. Direct killing by the conflict. Inability to access to proper medical care or too worry to travel to seek medical care. I wish all these will end one day and our planet will be a nicer place to live but before that I know we, MSF, still have a lot to do to help these populations in need!



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