Fieldset
30 hours

Surgeon David blogs about his operations on his patients as well as his journey to a new location and the challenges that conme with his new surroundings.

I'm sitting in the Bloc Operatoire (aka the Operating Room for American readers) waiting to start my next case. Earlier we did a pair of operations in addition to a few simple dressing changes under anesthesia plus I stuck my head into the orthopedic surgeon's OR room to try to learn something.
 
My two earlier operations were on young men for trauma, both laparotomies meaning I make an incision somewhere between the xiphoid (the little bony thing at the bottom of your sternum) and the top of your pubic bone. If you're still wondering what I mean, google search it.
 
The first patient had a stab wound that left a small half inch hole just to the left and one inch above his belly button but managed to put holes in his stomach and small intestine in several places, all of which we repaired. The second young man had been shot 4 days earlier along with two others. He had been shot in the back, just to the left of the spine and below where your kidney would be and the bullet exited out his left thigh. He had increasing abdominal pain and distention since then and now when he showed up in the emergency room (aka Sallle d'Urgence for French readers) his abdomen was quite tender to the touch.
 
I operated on him fully expecting to find an intestinal injury, likely to the colon which would mean a colostomy for him. So it was a happy surprise when I found that the bullet had stayed in the area called the retroperitoneum (another google search if you want) with only a small rent in the tissue that had let blood slowly seep into his abdominal cavity and cause irritation.
 
I’ve been in Bangui for about 30 hours. Coming into the airport for the landing one can see the refugee camp that has grown along the edge of the airport in the past months. Technically it’s not a refugee camp but an internally displaced people (IDP in NGO lingo) camp as the occupants are all from CAR, many from Bangui itself. It’s an amazing site that to my estimate looks to cover an area equal to 20 or more football fields. On the ground I get a closer look though no photos. It’s not a pretty picture with makeshift lean-tos made from multi colored tarps and plastic, some with UN printed on it but most from whatever materials people seem to have been able to salvage. Even at a distance, the crowding is obvious. You would need a pretty compelling reason to stay in a camp like this. The internet news says that people are here because they fear being killed if they leave.
 
After clearing customs and getting my luggage, the MSF Landcruiser took me to the main office where I met a French nurse anesthetist that had arrived the night before. We filled out some more paperwork and had our briefing together. We are both going to be on the new hospital team. Just the week before for a variety of reasons, MSF had turned over the surgery service at the Hospital Communitaire to the Red Cross and opened a “new” hospital near downtown. It’s a large hospital in a large compound that includes a pediatric hospital run by a different NGO. The hospital we will be in was closed down 5 years earlier and stripped so everything from our OR tables to the X-ray machine has been put into place by MSF.
 
We will be part of a team made up of two surgeons, a MD anesthetist and two nurse anesthetists. Additionally there is a large ex-pat team doing a combination of running and teaching local staff at the hospital that includes an ER doctor and two nurses, two OR nurses, two ward nurses, a psychologist, an internist, a physical therapist, several logistics coordinators, pharmacy, human resources and finance….basically everyone you need to run a hospital. For the time being the living quarters for the team are in the hospital. We are also told that part of the team may be asked to be part of a mobile surgical team during the next few weeks.
 
After that, we rode to the hospital for more briefings, introductions and a tour of the hospital including our living quarters. This is a new project with a big team and the living quarters are still being sorted out. During my previous work with MSF I’ve always had my own small room to myself. Having a little private time to myself and a shower first thing when I wake in the morning are two of the simple pleasures I value when I’m working with MSF.  So it was disappointing when I’m told that for now I’ll be sharing a room with 2 other ex-pats, plus we only have 2 showers for 20 people. I’m a bit embarrassed as I write this, realizing how ungrateful I was about my living situation just hours after passing the IDP camp where privacy and clean water are scarce or non-existent.
 
They are moving my next patient back to the OR. This one is a 60 year old women, relatively old in a country where the average life expectancy is somewhere around 48. She has a bowel obstruction, possibly related to an old operation for what sounds to have been an ovarian cyst some seven years ago. She came in to the hospital after the technician who recently installed the X-ray machine and software had left and we don’t have any X-rays. But her belly is as distended as can be and she says she hasn’t passed much gas or any poop for 7 days.  So we will go ahead with a laparotomy tonight and see what we find. Hopefully it will be something easy and fixable.