Cries, damn flies and statistics

The bad news is that Mark's colleagues come down with food poisoning soon after his arrival and Mark picks this up too. The good news is that his luggage has arrived ! He also shares some background on Yemem and the hospital that he will be working in.

I thought this would be a catchy title when it came to me, but after a week, I must admit the bugs really aren’t bugging me much. Not the flying type anyway. Unfortunately, I can’t say the same about the microscopic variety; the day after my arrival three other expats came down with what looked like food poisoning. It made for a very quiet evening in the expat lounge. Not to be left out, I followed suit two days later, which explained my aversion to coffee. While not back to normal (whatever can be considered normal in a 49 year old white male physician who volunteers to go to Yemen), I am able to eat more adventurous foods than rice, bananas, bread and water. The Nescafé still left me queasy so I will likely stay on “the wagon” for another few days. Come on, I was just joking about being in rehab this month!

The good news is my luggage arrived, dry and intact as promised, the afternoon after my arrival. I was greatly relieved having imagined weeks of washing out my unmentionables and sprinkling cornstarch under my arms. This trip I was trying to minimize the weight of my backpack, but I will have to make an addendum to my packing list; make sure the cheese, sausage and chocolate are in the carry-on! Once everyone recovered, the Brie and saucisson were welcome additions.

Before leaving, I spent a little time Googling Yemen and Aden, since neither showed up in the curriculum when I went to school back in the Dark Ages (of Jimmy Carter and Ronald Reagan). I won’t bore you with all the details except to mention that the Wikipedia entries are quite interesting. Most people will remember that Yemen is one of the countries where a large number of Somali refugees have landed since 1990. Most will also recall the suicide boat attack on the USS Cole in Aden harbour in October of 2000.

Yemen is made up of two regions (North and South) which were unified in 1990 and form the “heel of the boot” of the Arabian Peninsula. Since then they have endured many difficulties including separatist movements, religious differences (especially between the Shiite Houthi and the Sunni in the North), economic woes (as oil production has been falling off and reserves drying up) as well as the usual anti-government, anti-corruption, anti-military, anti-establishment… Al-Qaida in the Arabian Peninsula (AQAP) is active here, which is part of the reason that US drones have been attacking.

Our hospital was built by the Aden Governate (administrative region) but was never opened. MSF negotiated an arrangement with the Ministry of Health and this project opened in 2011. The goal was to provide free medical care to victims of trauma, especially violent trauma (mainly gunshot and bomb wounds). While many patients with non-violent trauma have been treated, the focus has recently been narrowed to “war” victims in and around the Aden Governate.

We have space for 45 inpatients, including women, children and long-term care (often amputations). We have a 6-bed “ICU” – actually an “Intensive Monitoring Unit” since artificial ventilation is not possible with the equipment and training available.

At present we have twenty-five or so patients, many of whom are undergoing repeated surgical dressing changes in preparation for skin grafting. As you can imagine, when a modification of Newton’s Laws occur (an irresistible force meets a soft-and-squishy-human-object) a large exit wound often results and the resulting skin deficit begs to be replaced.

We have a good working relationship with other local NGOs and private hospitals and help arrange referrals for patients we are unable to treat and for post-op rehabilitation and prosthesis planning. We have two operating rooms and perform anywhere up to a dozen operations a day, ranging from dressing changes to laparotomy for abdominal gunshot.

Currently, the Expat team consists of medical; Nurse/Manager (NM), Physio (PH), & Anesth Physician and organizational; Project Coordinator (PC), Log (LO), Admin (AD) & Hospital Manager (HM). Most of my team members are on relatively short missions (six months or less) so the changeover has been high – our Operating Room Nurse/Manager just went home a couple days after I arrived and there is no plan to replace her in the near future.

The National Team is much larger and includes the majority of the “hands-on” workers (ward and operating room nurses, cleaners, surgeons and a Yemeni Anesthesiologist and Anesthesia Assistant as well as administrative, security, drivers… sorry if I missed anyone!) In the month before I arrived, there was no Expat Anesthesia provider so the local team has had lots of independent practice. I was informed by my “boss” hours after my arrival that it was now my turn – I was to be on-call every night until I left in four weeks. Have a nice day!

As I have found with most surgical missions, our accommodations are quite comfortable. The brand new facility adds a nice touch – all the lights, fans, appliances and plugs work. As an added bonus, we even have air conditioning (shhhh – don’t tell anyone). I haven’t made much use of the AC but it did come in handy when I was writhing in bed with cramps and it was too hot and loud outside to keep the window open. The housekeepers throughout the hospital and our living quarters are pretty diligent so the new tile floors and linoleum in the OR Suite are spotless. Our cook is inventive and thoughtful so I’m afraid I might gain a few pounds (assuming I don’t relapse with my tummy troubles).

The amenities include private rooms, often with private bathrooms, Wifi throughout the living quarters, two spacious (as in basketball-court-sized) lounges and cable TV. We even have an open-air patio on the roof, although I haven’t taken the time to suntan yet. Maybe this afternoon while cooking dinner on the barbecue (my specialty – Chicken-on-a-Can). Recent renovations have provided a pristine white wall which we plan to use as a projection screen for Movie Night tonight. The only downside is that the Wifi doesn’t reach my bedroom (but this ensures I don’t hibernate in my room instead of mixing and mingling with the rest of the team, so all is good).

Expat Mafrash Room © Mark Kostash

Expat Mafrash Room © Mark Kostash

You have heard of, “Extremely Loud and Incredibly Close”? That about sums up what the team glibly refers to as “Happy Shooting”. It is believed that for the Yemeni population of approximately 30 million, there are also 30 million Kalashnikovs. Birthday parties, wedding parties, funerals, Wednesdays are but a few reasons for bursts of AK-47s into the air. Personally, the sound of machine-guns does NOT make me wanna get down and party… just Get Down (as in; Mark! Duck!!). I will keep my eyes open for souvenirs while on the patio, since another of Newton’s Laws deals with gravity (as in; what goes up must come down).

And finally, I have continued my habit of waking at 4 am. This was convenient at home since it was 6-hours after my last pain killer and it allowed me to take a pill and get back to sleep for a couple hours so I wasn’t in agony when I got up for work. The same doesn’t apply here – I could quite happily wake at 6 and still have a nice lie-in for a couple hours before the morning meeting and rounds. Tell that to my internal (infernal?) clock. The good news is, I finished this week’s statistics on the computer, had breakfast, washed last night’s dishes, showered and loosened up my back with a borrowed hot-water bottle (thanks PH – you saved my life) all before rounds! Woo Hoooo!

So life is great! But as I’ve said before – any day you walk away from is a good day! Stay tuned,


Friday, January 10th, 2014

“The postings and views expressed here are mine alone, and do not necessarily represent the position of Medecins Sans Frontieres”.