My first on-call day

I have to wake up early so that I can use the computer since the power supply is cut off at six. I worked hard yesterday and returned late, nearly at midnight. I had the first visit to the Mamba Point Hospital yesterday. We did ward rounds with the team. Just on arrival, there was a small child having convulsions in ICU requiring resuscitation who was probably suffering from cerebral malaria. After that, we had ward rounds and saw around fifty to sixty cases. MSF's mission in the country started during the civil war 14 years ago. The Mamba Point Hospital started operation three years ago. There are around six hundred hospital beds in the country of Liberia with a population of about 3.3 million. MSF is providing about 450 beds in the country, about 75% of the total and 100% of all the free hospital beds. The rest are in government or private hospitals that charge the patients. So even though the civil war is over and the city is quiet and safe, MSF cannot leave the country at the moment. MSF hospitals provide treatments to emergency cases and we are the only hospitals providing free emergency surgical treatment to the nearly one million inhabitants of the city. You can imagine how busy we are. There are 150 beds in this hospital with about 60 surgical beds. There is one Emergency Room, always full and one OT with two OT rooms. There are about 250 national staff and 11 expatriates. I started working in the afternoon of my first on-call day. I did two emergency operations in the afternoon including one incarcerated paraumbilical hernia and one close reduction for a dislocated shoulder. After a short break in the compound, I was called back into the hospital. I managed three cases of retention of urine, one with a large blood clot, followed by one laparotomy for a young man with seven days history of abdominal pain and distension with finding of ruptured appendicitis and peritonitis. He was quite sick when I operated on him. I then returned to the compound and had dinner at midnight. You could not imagine, from the time I saw the patients in the ER to the time I operated, it had taken less than half an hour. There are only very basic Ix available here, like Hb, malaria smear, no RFT, no electrolytes, no ECG, only plain X-ray on daytime. There is a small Blood Bank. We need the relatives of the patients donating blood for OT or transfusion for anaemia. The average Hb in patients here is 6 to 8 gm/dl (average for us is 12 to 15). They suffer a lot from malaria, malnutrition, chronic illnesses, like TB, HIV (the estimated prevalence HIV positive rate here is 10 to 20%). All of us work on our patients with our clinical judgments. We use more regional and ketamine anaesthesia. For GA requiring endotracheal intubations, we use a hand-pump ventilator. The anaesthetist has to inflate the barrel throughout the whole procedure. The only monitor in the theatre is the pulse oximeter. We can manage to do one case of skin graft a day as we only have one set of skin grafting instruments. This is my first day in Mamba Point Hospital. Au Yiu Kai