Do or die!…………….Experience of an Indian Medical Doctor, Animesh Sinha, working in an MSF mission in Lankein, South Sudan. Dr Animesh Sinha did his MBBS from AFMC, Pune, India and worked with Médecins Sans Frontières in 2011-2012. He shares one of the situations while he worked there.
As I enter the room I see a young man on the examination table. He is covered in layers of dirt and crusted blood. He has a cloth tied around his abdomen… dark from all the blood in it… blood still dripping from the sides. I grab a pair of gloves and proceed to remove the piece of cloth holding to the mystery of his injury. The man has been shot in the abdomen I learn in the meantime. The cloth is removed and his guts are badly damaged.
Let me roll back a little. I am in South Sudan. I wanted to be here after I read in the news that there was an escalation of violence in this area. And, as usual, I enjoy working in high-conflict areas managing patients with violence-related injuries.
The first few months were quite uneventful. Then there was a large-scale attack on a village by another tribe which left thousands dead and hundreds injured. I had flown in to triage and evacuate all the patients needing medical attention. It took me three days and innumerable flights to evacuate 67 patients from the muddy field that was supposed to be an airstrip.
And after all this I had just returned to my base.
And was having a peaceful night.
Until that moment.
“Hilary for IPD…” buzzes the radio. Not a good sign. I offer to accompany Hilary to the inpatient department.
And that is when I encounter this patient.
I quickly calculate the possibilities. The airstrip is muddy and won’t be landable for the next couple of days at least, even if it doesn’t rain. Which is unlikely considering it is the rainy season and I am in swampy land.
This patient won’t be able to make it for a couple of days with his guts open.
I don’t have all the expertise, equipment and qualifications to operate on him.
If I don’t do anything, he is effectively dead.
So I gather whatever I have and set out to explore him. Hilary is by my side and she is, as always, keen to assist. The midwife is there too. It shouldn’t be so bad. Four hours later we are done. Two large perforations in the stomach which I found and made an attempt at repairing. Inserted two peritoneal drains. Did a peritoneal wash with all the normal saline that I could find. Sutured him up.
Shifted him to my “intensive care unit”. Checked that he was out of ketamine anaesthesia and maintaining good vital signs. Went off to sleep.
Next morning it is a different story altogether. I am told that I have committed a blunder. That we are not supposed to operate here. I am amazed. I have to force down my point of view to make people understand the fix that I was in.
A month later…
My patient walks into the clinic and asks me if he can have a bar of soap for his bloodstained clothes. I happily hand him two!!
-Dr. Animesh Sinha
