Fieldset
Yemen: A dangerous diagnosis

Finnish surgeon Heidi Wikstrom has just arrived in Yemen, where an unexpected diagnosis could have a wider impact in the community

Heidi outside the MSF health centre in Yemen

Just getting to Yemen was an arduous job.

The visa process was long and difficult, and travelling here all the way from my countryside home in Vesivehmaa, Finland, took almost one week.

First, I flew to beautiful Geneva, where magnolias had just started to bloom. I had my briefings plus some delightful strolls by the lakeside in the Mon Repos Park, which is also featured in a quite famous Finnish “schlager” pop song.

It is natural and even sensible to be a bit worried about putting you or your loved one’s health – or even life – in the hands of a complete stranger

From Geneva I continued via Djibouti, where I made my first Yemeni friend – a doctor like myself, aspiring to one day become a surgeon and to help her people.

Although I received a cultural briefing in Geneva, it was reassuring to have her by my side when landing on the unfamiliar soil of Yemen – all new to me – and to have her show me the proper way to wear my hijab.

At the airport, I immediately started to understand how polite Yemeni people typically are. Although my belongings were scrutinised and eventually my camera was confiscated (I’m to get it back on my way home), everything was done in a respectful and calm manner.

Dusty mountain roads to Ad Dahi

From the airport, we headed to our guesthouse in Sana’a, the largest city, and the next afternoon, after a five-hour drive on dusty, zigzagging mountain roads, I arrived at Ad Dahi rural hospital. A new MSF project.

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Yemeni doctors and nurses at the morning meeting
Yemeni doctors and nurses at the morning meeting

Since the project is so new, daily routines such as ward rounds and meetings have not yet completely settled in, so the surgical team’s important task is to build up and maintain these, as they are important to maintaining the quality of care for our patients.

Also, much of the essential surgical equipment is still lacking. Our duty is also to try to speed up the process of acquiring this.

Luckily, and delightfully, the Yemeni staff are professional and willing to do their best for the patients.

“Doctor, ice cream?”

In a rural community like the one here in Ad Dahi, it seems that word spreads rapidly amongst the community. Quite soon after starting work here, I heard the ice cream man on the street by the hospital shout: “Doctor, ice cream?”

If the man doesn’t make it, what might they make of us then?

And still, as our facility is so new, the locals don’t really know if we are any good at what we do.

It is natural and even sensible to be a bit worried about putting you or your loved one’s health – or even life – in the hands of a complete stranger. It is therefore important that no misinformation about our practices, intentions or professionality is dispersed from the hospital to the streets of the town.

What can we do to prevent this? Nothing. Just do our jobs. And be open and willing to explain all our actions to the patients and their relatives.

A most vital organ

All this made me a bit concerned two days ago.

After starting to operate on a patient with something that was supposed to be appendicitis, I found the diagnosis to be thrombosis of the major artery supplying the small bowel. A most vital organ.

This meant a dangerous obstructive blood clot had cut off blood supply to his intestine.

What to do? I decided to take away most of his damaged bowel and preserve only as much as was absolutely necessary to keep him alive - if he survived the immediate post-operative recovery period.

Sadly, I considered the patient’s survival to be highly unlikely since most of the bowel that I had to leave in place looked to be quite oxygen-starved.

However, I was worried not only about the 70-year-old patient, but also for the project.

When he was taken into the operating theatre, his waiting relatives were not expecting something this bad. If the man didn't make it, what might they make of us then?

The best we can offer

Later in the evening, by the patient’s bed in the intensive care unit, I started the patient on morphine – which I’m used to administering only to fatally ill patients. I thought that painlessness is the best and probably the only thing we can still offer him.

I then returned to our guesthouse for the night, planning to come back to the patient the following morning.

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The patient cared for by Heidi
The patient cared for by Heidi

However, the next day, I found our patient in a surprisingly good mood and condition. And this trend continued today, which is the second post-operative day.

His blood pressure and heart rate are normal, and he has no fever. Tomorrow we’ll start letting him eat small quantities of solid food.

In the operating theatre, when the prospects looked quite gloomy, the local staff said:

“Insha’allah he will survive, we are Muslims and we trust in God.”

“So do I,” I responded, “The best we can do from now on is to pray.”

So, we will see. We have done what we can.

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Read Heidi's next blog from Yemen

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Read more: Stories from Yemen's civil war

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