In the operating room: Yemen, Day 3

Yemen is in the grip of a brutal civil war, and millions of people there have no access to healthcare. From emergency c-sections to exploratory surgery, anaesthesiologist Kariantti blogs about the first three days of his new assignment...

The postings and views expressed here are mine alone, and do not necessarily represent the position of Médecins Sans Frontières.

Yemen. Arabia Felix - Happy Arabia. 
I just arrived here in Khameer two days ago, and already I’ve been treating patients left and right. Slowly I’m starting to settle in. So many things in the operating rooms are still new to me and different from what I’m used to back home, but if I’m only gonna work here for four weeks as an anesthesiologist you can’t expect to briefed for everything beforehand. You just have to take it one patient at a time (well sometimes two or three or four - you get the idea) and deal with whatever comes at you. The international staff surgeon Filip, the Yemeni staff and the other international staff are all very experienced. With these people beside me, I feel I’m ready for what comes next. And everybody is so nice you can’t believe it. So nice that you forget the war. The war that is only a two hours drive away from you. 

And everybody is so nice you can’t believe it. So nice that you forget the war. 

Yesterday we started the morning with an emergency c-section and finished in the evening with a teenage girl with learning difficulties, due to hypoxia (lack of oxygen) at birth. She had severe stomach pain and a palpable mass in the abdominal area. When the surgeons performed the laparotomy to her, they discovered that a part of her bowel was full of wood, bark and hair, that she had been swallowing for quite some time. The surgeons were able to remove the material from her bowel, but after the operation she was still very tachycardic (this is when someone has an elevated heart rate), so we started her on aggressive intravenous fluid-therapy.
Anaesthetist Kariantti at work in the MSF/Doctors without Borders operating theatre in Khameer, Yemen. He wears green scrubs and a surgical mask

Kariantti at work. Photo: MSF.

The next day we started again with an emergency c-section, which they called me for during the morning meeting. The mother was 40 years old and she already had seven children, but now at seven months of pregnancy she was bleeding severely. I was still not too comfortable and familiar with the anaesthetic machines in the operating room, but somehow with the help of a very experienced Yemeni anaesthetic technician we managed alright. Two units of blood later the mother and the baby were both alive and well - or so I thought. 
We carried on with many more operations and after that we did the afternoon rounds in the wards and in the intensive care unit (ICU). During the rounds me and the Yemeni anaesthesiologist were called to the neonatal ICU. The baby from the c-section earlier this morning had been deteriorating during the day and now needed constant manual ventilation due to severe hypoxia. She had already been started on iv-antibiotics for possible sepsis, but now she was probably suffering from severe meconium aspiration and quite possibly her small lungs just weren’t strong and developed enough for that, because of the early weeks of birth. But there was no possibility to intubate her since there was no ventilator to put her into in the hospital. Referral was not an option either. In a world far away from the high frequency ventilators and high tech neonatal intensive care units, we were her best chance.  Unfortunately, there was little we could add to the treatment anymore. So the only thing we could do was to assess the situation, continue the previous treatment and hope for the best.
By the way, did I mention this is my first MSF posting?