One late night, our hospital received a patient with a gunshot wound and he needed emergency surgery. In Bor, you have to prepare everything yourself before operations, from electricity supply, to surgical gowns, instruments, etc. Fuel has been lacking in days of war and the price of fuel was soaring high. Wearing headlights to surgery was basic since the power supply would cut anytime and your headlight would save the day.
Before we went to the hospital, our logistician secured fuel and we had to bring the fuel to the generator and kick start the engine. There was also no cleaner that night and the nurses had to take up the job of cleaning the operation theatre. We also discovered we did not have enough sterile equipment we needed so we had to search the MSF protocols for a quick sterilization for the equipment. Finally, the surgery was over but the work was not yet completed. The patient remained critically ill and we had to stay overnight to continue resuscitation.
The generator in the hospital. Photo source : Dr Shannon Chan
Living in Hong Kong, there are simply too many things that are being taken for granted. Back at home, the click of a button and a phone call would mean everything in the operating theatre would be prepared. But in Bor, everything, even the most minor details has to be done by you and your team. Washing your own equipment, cleaning the OT theatres, filling the water bucket, etc. This makes the completion of an operation worth more cheers than anything. In the field, every little success is a big success.
New challenges come by every day. In December, we received a young man who had a very bad wound in his hand. He was suffering from a severe bacterial infection, leading to a condition called “Necrotising Fasciitis”. His infection was so severe his blood pressure was very low, and he was in what we call “septic shock”. Necrotising fasciitis is notoriously infectious and spreads rapidly along the fascia. Treatment must be prompt or else the patient’s life would be at stake. To make things worse, the patient also had HIV and hepatitis B. HIV weakened his immune system and made him vulnerable. If he was in Hong Kong, we could have done repeated wound debridement and when he stabilizes, reconstruction surgery can be done. But in South Sudan, if his condition worsened after the debridement, we had no ICU to support him. Our principle is always to “save life, then save limb”. Amputating his arm seemed to be the best option.
Our infection control nurse Evelyn from Belgian reminded me that for such a case , strict infection control measures must be implemented. However, we had no advanced equipment for safeguarding infection control in Bor. We were then in a dilemma------given the possibility of rapid deterioration of the patient’s condition, we must intervene with surgery. But if we proceded to surgery without sufficient safety precautions, we would put the lives of other patients at risk. The nurse then spent over an hour to wrap the white operating theatre and table with blue and red waterproof disposable drapes, leaving no gap that would allow direct contact of the patient’s body fluid with the room.