First day in the Aweil city hospital

There are only around fifteen cases left for me. I had my ward round and made the management plan for most of my patients in the morning. A lot of them are suffering from gun-shot wounds, traffic accidents, or burns. I had two surgeries done in afternoon, one was to change the dressing for a small kid with a burn, the other was for a man who had an infection in the left knee joint with multiple operations and drainage done. At first I thought the infection may be due to tuberculosis (TB) but I found a large intra-muscular abscess without proper drainage. He is miserable and had no relatives or friends around. He can't walk or even go to the toilet. He only relies on the food given by the hospital which may be absent for unknown reasons. There is nothing to drink if nobody gives something to him. He is weak and emaciated. Our staff decided to carry him some unfinished food from the compound. I hope we can help him. It seemed that it was a quiet day. When I was having my dinner, there was a call from the hospital. There was a mother with a first pregnancy. She didn't know that it was a twin pregnancy. She gave birth to the first twin baby yesterday with the other one was still inside her womb. She was in labour. The baby was still alive but in transverse lie. When we saw her in the delivery room, mother and baby were well. We suggested a Caesarean section but the relatives refused. Her husband was working far away. They needed to discuss with other relatives. We had to wait for almost an hour for their relatives. Luckily, there were some gentlemen in the family speaking English. We could explain to them. They agreed to the  operation. They said, "Please, doctor. We have faith on you. Please do the best for our relative." When I prepared for my operation, I found that I had the most primitive and least resource I could have for a Caesarean section. I did not have my scrub nurse. I had to take my instruments from the trolley during the procedures.  I did not have the mid-wife or nurse to look after the baby. The anaesthetist had to do it. I could only have a nurse assistant helping me in the operation. We had to teach him how to scrub and how to put on the gown and gloves. The number of instruments I could have was also limited. I only had twenty pieces of gauzes in the set. There was electric suction but no electro-cautery. As before, I revised all the procedures before I cut. When I reached the womb, I could feel the baby's head on top and the legs on bottom. I had to be very careful to hurt the child when I cut into the womb. The first part I delivered was her left arm and shoulder, but I could not get the other part or head out. I decided to follow the body, getting the legs, then right shoulder and arm, finally the head. A lovely baby girl was out of her mum's womb. She gave us a big greeting cry when she had the first breath in the world. We were all delighted. The mother gave us a very encouraging smile. I finished the operation in a very respectable time, around thirty minutes. I got another credit with my OT Nurse from France. I finished the procedure with the given number of gauzes, including cleaning up of abdomen and vagina, and the dressing and four pairs of stitches. When I went out of the Operating Room to meet the relatives, they were all very grateful to us. I can see that they have a very strong family bond. The women have to listen to the men and the family seniors. They all support each other. They are grateful to those giving them a helping hand. When I left, I stood on the open ground outside the hospital. It was close to mid-night. It was so dark around.  I could see a very beautiful sky with thousands of stars, shining from millions of miles away and thousands of years ago. When we arrived at the compound, some of the administrative staffs were just resting from a whole day’s work. As a surgeon, it's very easy for us to catch the attention and glory from the public. It is the logistics making all our work possible and safe. When I praised one of them for his hard work, he thanked us for the work in hospital in return. I saluted all of them. That's how my first day in the hospital ended.   Au Yiu Kai