Surgery in Agok: Some patients you remember forever

Some patients you remember forever. Heidi shares this emotional blog from the Médecins Sans Frontières / Doctors Without Borders (MSF) hospital in Agok, which lies in a special administrative area between Sudan and South Sudan. 

What is the most difficult part of being a field surgeon? It is not simply that you see so many patients with terrible injuries and diseases you cannot cure. It is the overflow of once-in-a-lifetime experiences. During my seven-week assignment, I met hundreds of new people. I will probably never see them again, although some of them I will never forget.

There was this woman, 30 years old. She was on the surgical ward already when I arrived in Agok.

The woman was seriously ill with a post-cesarean section infection in her abdominal cavity. She looked very unwell when I saw her for the first time. I thought she was septic, and wasn't sure she was going to survive.

Ayak and the Bogota bag

The woman had been operated on many times already, and during the first week of my time in Agok I took her to the operating theatre twice.

After the second of these operations, she had what’s known as a ‘Bogota bag’ fitted.

A Bogota bag is essentially a sterile plastic bag placed on a wound on the abdomen. The wound is deliberately left open. This is done when all other means to control an infection have failed. These patients are always critically ill and are ideally cared for in intensive care units.

Every day I changed her dressings, wiped her clean, and tried not to hurt her too much."

This woman, let’s call her Ayak*, became my personal patient since I made the decision to put her on open abdomen treatment. I also did most of her daily dressing changes during my stay at the project.

Ayak had many issues, and despite being on enhanced nutrition, she steadily lost weight. Every day I changed her dressings, wiped her clean, and tried not to hurt her too much: her skin became very sensitive and she even developed a bedsore at her back.

The crossroads

I knew she was suffering and I felt strangely guilty about my unsuccessful efforts to help. I tried not to look in her eyes so much, partly because they seemed so big in her starved face.

Then, one day, she grabbed my arm when I was doing my routine of cleaning her. She looked at me and said, through a nurse who translated for us, that she would allow no one else to do this but me.

After wavering at the crossroads of dying and getting better for weeks, one-day Ayak, astoundingly, weighed more than she had two days before.

Another day I arrived to learn she had been walking outside the ward and had watched some television. Our smart Austrian nurse had contrived this special corset for her which she could wear when she was not lying in the bed. It seemed to work quite well, though it had to be washed every evening because of the soiling from the small-bowel fistula she had.

All of a sudden Ayak was so well that every morning, after dressing change, she was corseted and could go outside of the ward to sit in the shade and socialise with the other patients and visitors.

Saying goodbye

At the beginning of my posting, Ayak always looked very sad when her baby was brought to her. At the end of my time at the project, this had changed altogether. Now, it was such a delight to see her surrounded by her family with the baby boy in her lap.

I can be amazed by how many different people - from unlikely parts of the world - govern corners of my heart."

The looks on the relatives’ faces had changed and the tension I once felt when explaining to them the complicated facts about their loved one's situation had also vanished.

I don’t like goodbyes. I often feel awkward and don’t find anything appropriate to say in these situations. But I wanted this one...

I bought Ayak’s small son some clothes from the market, gave them to her and took some pictures of her and her family.

I will most likely never see her again, but at least I can go back and find that one good picture, take a look at it every once in a while and be amazed by how many different people - from unlikely parts of the world - govern corners of my heart.

*Names have been changed. Top image shows the ward in Agok, but does not depict the patient described in this story.