Impacts of Civil War

I woke up early again at 00:30. I was kept awake because of so many stimulating thoughts. I have lost only two patients in three days of working here. The first one was a 29 year old young man with a seven-day history of ruptured appendicitis and peritonitis, whom I operated on my first call day. He died finally due to the uncontrolled sepsis. We don't have any ventilation or resuscitation facilities in the wards. We could only look at the patient dying in front of us and pray for him. The second patient was another 26 year young man brought in by his father from far away; also on the night I was on call. He claimed that his son was strong and fit before. He had history of TB and was treated about three years ago. He had developed multiple discharging sinuses on his neck over three months. He was seen in the other two hospitals and later referred to us. The HIV test was negative. He could hardly swallow. He needed to be fed. He had lost so much weight and weighed at most an estimated 40 to 45 kg. CXR showed milliary TB. I intended to put in a gastrostomy feeding tube to feed him and give him medication. Unfortunately, he died before we could offer any help. These two young men just died of simple, treatable diseases because either there was delay in seeking treatment or there was no accessibility. Both families lost their breadwinners. This may make their living even worse. I learned that Liberia was a wealthy country in West Africa of the past. Monrovia was a famous port. If you can remember, there were a lot of big cargo ships and oil tankers registered in Liberia. After the fourteen years of civil war, all the basic structures were destroyed. Electricity, water and health care systems were all lacking. Recently, there was an outbreak of cholera and many people died. I really feel sorry for this country and her people. I have talked with some of the young ones and I guess education in Liberia before the war was quite good. Most of the people can speak good English, or at least understand it spoken. There are more than ten 'Physician Assistants' employed by the hospital. They receive some basic health care training and work as house-officers in the ward. They have ward rounds early in the morning before we take the rounds at eight. They will write down their observations and suggested treatments on the patient charts. They will discuss management with us. I like to teach them. One young man told me that he would like to go back to the college to study Sociology and Public Health after few years of work and saving. He really deserves my highest respect. Au Yiu Kai