Salute to the patient with determination to live

If I were to forget everything else about Ethiopia, the memory of Abdi would remain. His persistent determination to live was truly honourable. Abdi was skinny and around fifty years old. He had been suffering from a swollen abdomen for ten months. In the last two months or so, an abscess developed. The pus and inflamed area was larger than both of my fists combined. I still remembered how the pungent smell scared away other patients in the clinic. No one wanted to stay next to him and we had no choice but to put him in a treatment tent on this own. Even then very few people went anywhere near his tent, the smell was recognisable from more than ten metres away. To deal with the abscess, we made three incisions to allow the pus to flow out. To my surprise one of the incisions was so deep that I could not see the bottom of it. I knew this was no common abscess. At the very beginning, we cleaned his wound everyday and put him on intravenous antibiotic therapy. After two weeks, the abscess did not smell as bad but the pus continued to flow from the incision. In the region of Somali in Ethiopia, tuberculosis was endemic. We suspected that Abdi contracted TB which caused the abscess. He also told us that he received TB treatment a few months ago. Unfortunately, he only completed two months of treatment instead of the usual eight. In regions such as Somali, we did not have all the necessary tools to diagnosis and treat chronic diseases. Even for conditions such as TB, we had no way to make an accurate diagnosis. In the case of extrapulmonary TB, diagnosis was especially difficult. Although we did not recommend treatment to show whether the original diagnosis was correct, this was the only option provided as other diagnoses were ruled out. Recalling the months I spent with Abdi, I respected his determination in the treatment and his persistence to live. Everyday or two we had to clean his pus-filed incisions. We could only anesthetise him locally, but the pain he endured with a wound that was as large as a fist and so deep that we could not see the bottom was simply unimaginable. However Abdi never complained. Not even once. Each day, he carried his weaken, skin-wrapped skeleton from the tent to the treatment room. He continued to endure the pain. Towards the end of my mission, Abdi, who was usually quiet, asked me to stay behind when I met him. He was worried. He feared that once I left, no one would care for him anymore. His abscess no longer produced a pungent smell. Two of his three incisions had healed however the third pus-filled incision did not show any sign of improvement. He wanted to know what else could be done. He was not ready to die. We decided to send him to another clinic to do an ultrasound scan, in order to accurately assess the size of the abscess. But in this extremely remote area it would take him two days to get to the nearest MSF clinic. The trip was tough for him and I feared that he might not make it. Later I heard from a doctor at my clinic that the scan was not able to determine the cause of the abscess. That clinic sent him to a hospital at the Ethiopian capital, Addis Ababa. The doctors there suspected that it was a tumour. But it was impossible to operate on him because he was so weak. They could not do anything for him. So they sent him home. The last chance to cure Abdi was exhausted. He went through all those months of bed-bound life with a pungent smell. Deprived of the dignity he deserved, he was determined to live on. All that came to nothing, but he never gave in. I salute to his determination to live. And more importantly, his refusal to give up. Joyce

Dr. Joyce CHING, who graduated from HKU in 2002, has been a volunteer with MSF since 2005. In 2006, she was sent to Cherrati, Ethiopia to join an MSF tuberculosis treatment programme. She shares stories of this nine-month mission with us here.