Fieldset
Lessons from Bouar
I landed my first mission with MSF as the OT (operation theater/operating room) nurse for Bouar, Central African Republic. I had little idea what to expect, really, other than that I would be working with limited resources and in a potentially very tense setting.
I landed my first mission with MSF as the OT (operation theater/operating room) nurse for Bouar, Central African Republic. I had little idea what to expect, really, other than that I would be working with limited resources and in a potentially very tense setting. On arrival, I was assigned to design the sterilization room, assist in the OT, work towards the improvement of patient care in the post-op unit, and manage about 14 national staff. It's hard to believe now that I'm almost at the end of my mission.
 
I came to Bouar primarily to support the work in the BLOC OP (aka operating room). The hospital here has two rooms sectioned apart from the hospital for surgeries. While we work in cooperation with the local staff, one of the rooms is more or less reserved for MSF surgeries. I can't say that I was all that surprised at what I saw – an operating suite with no running water or electricity, a cord coming through the window of the room (so that when the generator runs, we could plug in the oxygen concentrator and cardiac monitor), an antiquated sterilization system and limited knowledge of sterile technique.
 
My first week here, you could feel tension in the air and see the fear in patient's eyes. The week before my arrival there was a bad auto accident and the hospital was saturated with close to 40+ surgical patients. Not only did the surgical team treat the accident victims, but we've seen everything from bullet wounds, snake bites, head traumas, difficult births, to a quinine injection resulting in necrotic tissue that ran the entire length of the left thigh and into the back of a young child.
 
It requires strength and flexibility to work in this type of setting and I'm amazed at how much we've accomplished – from organizing the post-op ward to training the local staff in basic nursing care, developing the skills of a scrub technician to setting up a sterilization room with proper techniques and protocols. Things are far from perfect and require continuous evaluation/revision, but from my first day here until now...we've come a long way.
 
I've focused much of my time here on training staff – in general they are always eager for new knowledge and look forward to the training sessions. I hope my participation in this project not only gives them lasting skills, but skills that are transferable and allows them to provide improved patient care. I must admit, it is a work in progress.
 
My most memorable night at the hospital occurred several weeks ago, when a young man presented to the emergency department with chest pain, swollen left chest, and pus coming out through a small wound over the mediastinum. We tried everything we could to help this man, including an operation to clean the wound (difficult due to the location of the wound and its proximity to vital organs/vessels). We finished the operation around 7pm, which of course by this time, we were working in the dark and without electricity.... At the time, we had 1 functioning hospital generator, 1 cardiac monitor, and 1-2 oxygen concentrators, and no trained local staff to care for such a critically ill patient. I think that was one of my hardest nights here. The entire MSF staff came to the hospital to try and save this man. We moved the hospital generator to the post-op ward in order to monitor and oxygenate the patient, and stayed late to work with the national staff and try and stabilize the patient. Unfortunately, with the complicated surgery, lack of resources, and unavailability of blood, the patient passed away nearly an hour later.
 
While that incident is one of my most memorable moments in Bouar, we also have happy/fun events as well. Most of my mornings here, I am happily greeted by the patients (often in Sangou, the local language) as I pass through the post-op ward. There's a large a mango tree in the front of the hospital. Some days, we go with the pediatric patients who are able to the courtyard and “fish” for mangoes with a long pole (essentially two long wooden sticks) tied to together to reach the mangoes which are now in season. It's a good end to the day and usually everyone ends up laughing.