Chinese illegal workers in Liberia

It's my last call duty last night. Perhaps I'm a bit excited, I can't sleep any more after about only one and a half hour's sleep. Although these are the last two days of my duty, it has still been full of excitement and surprise. We have had four ectopic pregnancies in two days. Gerhard (the gynaecologist) took care of the first one on Monday morning. The patient's blood pressure remained low after the operation despite blood and fluid replacement. Haemoglobin was low. This made our sixty-seven year old gentleman very puzzled. He repeatedly performed USG for her and found that the fluid in the abdomen was increasing. He had no choice but to open her up and have a look, so I volunteered to assist him. Disappointingly, there was a bleeding point at the excised fallopian tube and another two litres of blood in the abdomen. We ligated the tube again, and the bleeding stopped. Gerhard felt very frustrated. Before we finished, there was another suspected case of ectopic pregnancy arriving in the ER. Gerhard went to see her and performed a USG. When I was there, the blood pressure of the woman was low. He took her urine for a pregnancy test and checked the haemoglobin. He told me the USG showed there might be an enlarged ovary but little free fluid. The uterus was enlarged but empty. He suggested observing and waiting for the result. After Gerhard left, I tried my simpler way of diagnosis, putting a needle into the abdomen and drawing some blood. The resulting pregnancy test returned just in time and confirmed the diagnosis of ectopic pregnancy. Gerhard was amused; I always surprised him. Having assisted him for the first and second cases, he was then called in the middle of the night for a third. This afternoon, there came a fourth one. I guessed he was getting too tired. He then asked me to take care of this fourth one, at which he assisted. It is difficult to imagine that I could complete a laparotomy for an ectopic pregnancy without suction. Jam (another surgeon) had been doing another laparotomy for a woman with an intestinal obstruction. We had to use that other dirty OT for the operation. Suction was not working. I guessed there should have been at least two litres of blood in the abdominal cavity and once I opened the abdomen, all the blood came pouring out. In a C-section I had just finished, I did not have the cautery because all the diathermy pens were under sterilization. There just are not enough spare instruments in our OT. Yesterday morning we admitted two major burn cases, both caused by an explosion of a generator. One patient has fifty percent burns and the other eighty percent, with only both thighs spared. Fifty percent would be very difficult for us to treat but we would try. The mortality rate would be very high. Eighty percent is impossible for us in Mamba Point. He is a fit young man. It was a very difficult decision. But I decided to give only palliative care to him and not to intervene. We gave him fluid replacement and intravenous morphine for pain relief. It is the first time I have had to decide giving up on a young, healthy person who is still able to talk with me. But we have to strike a balance in our limited resources. In the afternoon, there were two more Chinese workers coming in to the ER. They had been sent by the UNMIL correction service (prison). There have been altogether five during the last two weeks. They could neither speak nor read English. The staff found me for interpretation. Four of them had malaria. One had a hand infection. They came from Liao Ling in China. They told me that there are a total of twelve in their group. They had come to Liberia for five months work. It was apparent that there had been a "minor conflict" between them and their employer after which the employer had called the UN police. They were all then charged with illegal immigration and employment. I feel sorry for them, and more for our country, China. People in our homeland have to travel a long distance to this poor country as illegal workers. As they cannot speak and read English, I imagine their living and working environment must be very poor. At this moment, four out of the twelve men have malaria. I can guess there would be more to come. It is lucky that they are in the UNMIL prison and that the authorities bring them to see us. If not, all of them might not have had the chance to ever see their families again. They told me that the Chinese Embassy had already contacted them and they might go home soon. As I am leaving tomorrow, I wrote down a translation of the common symptoms for them, so that they could communicate here if required. It's five o'clock in the morning. I have to stop. I hope that I can take a short sleep and prepare for my last day in Monrovia. Au Yiu Kai