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Surgery in the field: "The kid had been shot in his abdomen by accident"

Shadi is a surgeon who has recently finished his first assignment for MSF. He blogs about two boys with gunshot wounds, the determination of a mother to help her son survive...

Arriving at Juba airport, I couldn’t help but notice that the number of NGO airplanes far exceeds that of commercial ones. There are many organizations working in South Sudan.

I spent a night in Juba and left in the morning for my mission site in Agok. Agok is located in the Abyei Special Administrative Area (ASAA) between Sudan and South Sudan. MSF runs a secondary care hospital in Agok which is the only source of secondary health care for many.

There are other actors in the area, including the Ministry of Health, but the MSF hospital is the only center that can offer secondary care, including surgical emergency and obstetric service, which is where I come in. The new surgeon.

Surgeon Shadi stands outside of the operating theatre in the Agok hospital, in Abyei, a region between Sudan and South Sudan

Shadi stands outside of the operating theatre in the MSF hospital in Agok. Photo: Alec von Bargen

This was my first assignment with MSF, and I had been looking forward to it.

The hospital exceeded my expectations. With over 150 beds in all departments and 400 staff, it is a large hospital by any standards. Everyone is friendly and welcoming and ready to offer the new surgeon, which is how I introduced myself until the next surgeon arrived, a tour around their department.

I spent the first day touring the hospital and the living compound. The arrangement is simple, but efficient.

Time and distance have never meant so much as they did in Agok. I will never forget the woman who had to travel with her seven year old son for two days from Mayom, a place which is about 80 miles from Agok, where MSF has another project but with no surgical capabilities.

The kid had been shot in his abdomen by accident during a quarrel between two families, neither of which were his own. His mother had to travel with him to our hospital because we were the only hospital that could possibly help him.

He was lucky to have survived thus far, but his luck didn’t stop there

The MSF project in Mayom usually arranges transport to Agok, but the mother opted to take the child herself. It took her two days to cross the 80 miles.

We had to operate on the child in the middle of the night. The bullet had caused some damage to the liver but missed his bowel. He was lucky to have survived thus far, but his luck didn’t stop there.

After two weeks, he was walking out of our hospital. Considering that we had to operate two days after the injury, with no ventilator and no ITU, I think the kid was very fortunate.

Others were not as fortunate. A couple of weeks later, we received another child, 15 years old, who was also shot in the abdomen during a cattle raid.

He did not take as long to reach us, but the damage the bullet had caused him was far more severe. The bullet ran across his upper abdomen, perforating his colon at two places, his small bowel, and his stomach and damaging the lower part of his spleen. We operated on him, but he did not survive the night.

Surgeons use different kinds of formulae and scores to try to know the outcomes of surgery, calculate the risk and predict morbidity and mortality. However, every death has its toll, and a death of a child is always more devastating.