First week impressions

augusti 29, 2008

Hello again!

It’s been more than a week since my last post, but I’ve actually only been three days on site in Port Harcourt. On route I spent two days of briefing in Paris and one day in Abuja; the capital of Nigeria. The trip was quite uneventful, although some aspects of the Nigerian culture requires some getting used to; when checking in at the airport for my flight to Port Harcourt, one could easily make the mistake of standing in the line to the counter marked “Check-in Port Harcourt”. Needless to say, when checking in to Port Harcourt you should of course stand in the line “Tickets Lagos”… But on the other hand the airport staff was extremely kind once my MSF status was known. I carried some orthopedic instruments, and when asked what it was I said they were for MSF and Teme hospital in Port Harcourt. The staff then greeted me, said I was welcome and made my airport troubles vanish. Even the security guy at the metal detector presented himself and said I was welcome; whatever MSF is doing at Port Harcourt, it must be good and the word has reached even Abuja!

So, how is the hospital, work, colleagues and patients? In my next post I’ll walk you thru a typical day at work, but I’ll give you a short tease of how the setting is:

Traffic is horrific (can’t think of any worse word, but if I could I would use that word instead); 5 (yes, five!) people on a single motorbike is nothing unusual (all barefooted with no helmets). Traffic accidents are thus a major and unlimited source of patients. Health care is extremely limited (or expensive) and local healers are commonly utilized. One patient came with an open fracture of the ankle that an healer tried to treat with a dressing soaked in feces; suffice it to say that the wound had some unmistakable signs of infection… Other sources are gunshot wounds, knife traumas, or just plain street violence. All patients are young; the oldest three patients I’ve had (out of 16 cases in my first three days) were 71, 53, and 39 years old; the rest being in their twenties.

These first days I’ve been struggling with TLAs (Three Letter Abbreviations), my English (which is not at all the English that people in Port Harcourt is speaking) and names (there are a lot of Miracle, Godsgift, Bigman, Precious, Lucky, and Friday; and should we really operate Saturday Sunday on Monday? Shouldn’t we operate him on Tuesday instead? Lots of confusion and a giggle or two…). For the anesthesiologists of you: Ketamine is now my drug of choice, an Hb of 55 g/l is not uncommon (or anything really troublesome; we don’t have much blood anyhow so there is no need/use of worrying), and despite what it says in textbooks an abdominal gunshot victim with an Hb of 59 g/l does not necessarily react with a tachycardia…

So much for my effort of keeping it short…next time I’ll try to throw in some pictures to lighten it up!

Getting ready for Nigeria!

augusti 14, 2008

Dear all!

This is my first attempt at a blog, but I’ll do my best in the challenge to convey my experiences and impressions from my six week mission with Doctors Without Borders, or MSF (Médecins Sans Frontières), in Port Harcourt, Nigeria. I’ll try to keep it short and down to the point so you surely can find the time to read it, but bear with me as this first post is a little longer! I’ll try to keep you updated every week, but I can’t promise anything. Also, please let me know how I’m doing and give me feedback for improvement!

When writing this first entry I’m still at home in Sweden. I’m working as an anesthesiologist at a university hospital (Karolinska Sjukhuset) in Stockholm, and I’ve been in the pipeline for a long time to go on a mission with MSF. Finally it’s becoming a reality and all my training and preparatory courses are done with.

The reasons for me to volunteer with MSF are not in any way complicated nor with a belief of doing something heroic or altruistic. I volunteer with MSF for the same reasons I’m working back home: with a strong wish of doing something meaningful and helping people in need. However, and in contrast with my work at home, I think my ambition will be much more condensed with MSF and the results hopefully more obvious. At home we have next to endless resources and there is always a fully manned and equipped team to help me if I need – this will not always be true in the field with MSF! I strongly sympathize with the ethics and charter of MSF (more of this later); but, again, I don’t see any fundamental difference from my humanitarian work back home or my coming work in Nigeria. It’s the same humans, with the same medical and humanitarian needs. Maybe I’ll soon find out how incorrect and naïve my vision is…

Now for some background so you’ll get an idea of the MSF world! My hospital at home has an annual budget of 1213 million Euro (yes, 1.2 billion Euro!). With those more than a thousand of million Euro there are 15000 employees that annually deliver 10000 babies, perform 60000 operations, and do 1.5 million consultations. MSF on the other hand has a total worldwide budget of 568 million Euro. However, in spite of less half of the funding, MSF manages to annually employ some 30 000 people in more than 70 countries, deliver 100000 babies, perform 64000 operations, and do 10 million consultations. Those already quite impressive figures become even more impressive realizing that much of the work is done in a setting with extremely poor infrastructure and social and/or political instability. I feel honored to become a part of that work, but before anybody at home gets mad I must also emphasize that I really value and cherish my work at home! My friends and colleagues deliver first class health care and they are all a great bunch to work with. After all, if that was not so, I don’t think I would be ready for my mission with MSF. Thus, gang at home: keep it up, you are the best!

So – what am I up to? In less than a week I’m off to Teme Hospital Trauma Center in Port Harcourt, Nigeria. I don’t have the setting 100% clear, but I think the expat crew will consist of me, an anesthetist nurse, a general surgeon and an orthopedic surgeon. Together with logisticians and coordinators we make a total of 10 expatriates in the mission.

The Teme Hospital is active in a very turbulent city with a large number of victims of violence. I’m told there are around 20 knife or gun traumas every week; the city also has its share of “ordinary” traffic, work and domestic traumas. I’ll describe an ordinary day at work as soon as I can, but I think I can safely assume that the days will be very long and extremely challenging.

Speaking of challenge; I conclude this first entry by stating my two goals of my mission, each of equal importance: first I’m determined to do my best. For sure I’ll have to learn, for sure there will be times when I feel insufficient or frustrated due to a lack of resources, knowledge, or energy. However, I’m determined to nevertheless do my best and to be able to say to my patients, colleagues, MSF, and (most importantly) myself that I always did my best. I leave it to others to evaluate if my best was enough; at least I’ll rest assured knowing that I can’t do better, no matter the outcome.

The second goal might seem unrelated, unimportant, or even irrelevant; but in reality it’s not: I’ll try to learn to juggle seven balls during my mission. Considering the expected workload and my determination towards the first goal, I’m sure I need lots of stress relief, rest and recreation; I can’t think of any better or more effective than try to improve my juggling skills! While I’m determined to fulfill my first goal, I will merely attempt the second – we’ll see how well I succeed in my mission!