Considerations in relief operation

I'm glad I can work with Philip, the Sri Lankan German Gynecologist. He has so much experience in the humanitarian work. He had joined 17 projects in Africa. I learnt a lot from him in last two days. He taught us, the young African doctor and myself, how to do ultrasonography, how to perform a Caesarean Section (C-section) and dilation and curettage (D&C), and other obstetric care. I guess it is the most valuable gift I receive in this mission. I performed my first proper D&C this afternoon. The Head of Mission and the Medical Coordinator also came to Aweil last Friday. We had an overall review of the programme. We had several meetings during the weekend to finalise the proposed project to the Operation Centre. We proposed a Mother and Child Health Programme. MSF is going to inject more resources to provide more comprehensive maternity care in the hospital, including inpatient, antenatal, and outreach care, together with 24-hour operating theatre facilities, laboratory service and blood bank in the hospital. And we all agreed that there is a great need for nutritional support for children, both inpatient at Aweil and two outreach programmes in two other IDP (Internally Displaced People) camps. The hospital Therapeutic Food Centre was opened today. 29 patients are already admitted. In addition, MSF will take up the paediatric ward in the hospital. They are going to launch a measles vaccination programme shortly and prepare a malaria treatment programme in the coming rainy season. On the other hand, Philip and I both suggested including emergency surgical service in our project, but it was not accepted. Our argument is that judging from the statistics of the emergency surgical activities in the hospital in the previous month, it seems that the need of emergency surgical service is not big enough and worth MSF providing it by itself. However, MSF has already committed to a number of vertical services in Aweil, including Therapeutic Food Centre (TFC), a nutrition programme, and paediatric and obstetric services. And the horizontal services like the other supporting services have been in place, including an operating theatre, laboratory facilities, 24-hour anaesthetic support, together with a large MSF logistic support team in Aweil. The addition of an extra surgeon, perhaps another ward nurse, wouldonly mean little compared with the resources input, but this would help MSF provide a much wider scope of service in the hospital. Surgical and obstetric service can support each other. MSF may react quickly in case of conflict which may occur anytime in this region. However, for the coordinating persons, they have to not only consider one specific project, but also consider from the global perspective, especially the distribution of resources. And once a surgical programme is open here, we have to commit and ensure there is enough human and other resources for a period of time. In short, we could not convince the other members. Only the plans of mother and child health programme, nutrition, malaria treatment and measles vaccination would be submitted to the Operation Centre. Philip and I wrote up our suggestion with different options, considerations and resources implications for their discussion. Anyway, one of my tasks here is giving recommendation to the surgical service in Aweil. We hope this may serve as a reminder at their review of the project. I like working with this kind, 'old' man. He is so knowledgeable, but he is rather straight.      Au Yiu Kai