Bangladesh: Dr Maverick

Ian is in Bangladesh, where MSF / Doctors Without Borders is providing medical care to Rohingya refugees. Since August 2017, over 620,000 Rohingya people have arrived in Bangladesh, fleeing violence in neighbouring Myanmar.

My medical colleague at the hospital calls me a maverick. She says it’s the reason we get on so well, working together as a great team. If there isn't a conventional way to treat a patient, I think laterally and may adopt another, less conventional, approach.

Image shows a child with a broken arm

A little girl with her arm still in plaster. Photo: Ian Cross / MSF

The most common children's fracture we see in the Emergency Room is just above the elbow: a "supracondylar" fracture. In severe cases, the broken bone can damage a nerve or artery, so it is best not to manipulate it blindly, without x-rays. It needs to heal in a good position for optimum range of movement at the elbow. We send the children to a nearby hospital where the surgeon aligns the fragments of bone and fixes them together with a wire. To prevent movement, the child has a plaster of Paris cast for a few weeks and then comes back to our hospital to have the pins and plaster removed.

Image shows a little girl and her mum, who holds a box of mango sweets

Plaster cast off, but the little girl needs to start moving her arm to get back her full range of motion. Photo: Ian Cross / MSF

The results of surgery are excellent, but the children are often very wary about moving their elbows once the cast has been removed. This physiotherapy is essential for them to regain a full range of movement. Speaking in a stern voice, commanding the child to bend their elbow results in tears. I thought of a cunning plan, which admittedly involves bribery...

image shows a little girl eating a sweet with great enthusiasm

Success! Photo: Ian Cross / MSF

I give the reluctant child a sweet in their affected hand. To get it to their mouth, they must bend their elbow. Once they see that this is not as painful as they expected, coupled with the reward of a sweet, they soon see the benefit of gentle physiotherapy. I can place the TicTacs strategically to increase the range of movement.

But don't blame me for their questionable dental hygiene!