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Tiring but immensely professionally enjoyable mission – Dr. Rajeev Tanwar

It was my first mission as an orthopedic surgeon for MSF to Teme hospital, Port Harcourt, Nigeria. The flutter of excitement was perceptible because it was my first mission as well as the fact that I was travelling to a distant country about which I knew very little.

I arrived in Paris after an overnight flight from New Delhi and managed to reach the MSF office by the Paris metro despite having to struggle with carrying my luggage to different platforms while changing at stations that lacked escalators and had only stairs – a lesson to travel light next time.


After tiring overnight international travel, the wait at the MSF office for the briefing was an avoidable hassle. Around noon someone informed me I had a briefing session in the afternoon. I pushed my luggage and myself to the nearby hotel and prepared myself.

The swift afternoon briefing session was conducted by Dr Patrick and Mr Ali, and I got to know something about the place I was going to for my first mission.

The next day, after a hasty breakfast, I reached Charles De Gaulle airport and, to my utter dismay, found it submerged under a deluge of travellers and total confusion all around. Only after significant struggle and patience could I get my boarding pass for the flight to Abuja.

On reaching Abuja I found that Air France had forgotten to load my luggage at Paris. I filled in some forms to claim my luggage once it arrived and then had to push off to the MSF office sans baggage.

I reached the MSF office in Abuja and was greeted by friendly staff and then sent off to the expat house for an overnight stay. Early next morning I left for the airport after a quick briefing session with the medical coordinator. The local Nigerian flight with Arik air was inordinately late, but somehow I reached Port Harcourt by evening. There I was first taken to Teme hospital and had a briefing session with the field coordinator. Later in the evening I reached the expat house.

The expat house is a nice, spacious building in an imposing residential area of Port Harcourt and has many independent rooms. I had a choice of the available empty rooms which had some basic furniture and beds. The expat house is formed by two different houses, one behind the other, and there are plenty of rooms available, offering washing and laundry facilities, for a constantly changing group of expats. My luggage finally arrived three days later, training me to manage without clean clothes.

A normal day starts early and, after a self-made breakfast, all expats leave for Teme hospital at 7.30 am. Normally the surgical team is the first to leave and the other members soon follow. It’s a 15-minute drive to the hospital through the heart of the busy city – no expats are allowed to go alone, so driving to and from the hospital is the only way to look at the city and its colourful, vibrant people.

Rounds begin from the emergency room where the local doctors who manage the emergencies fill in the surgical team on all the cases dealt with and admitted the previous night. The board is usually full and usually has seven to ten emergencies per night.

After completing the rounds in the wards, at around 9 am the surgeons move to the operating theatre to start the operations. There are two operating theatres and normally fresh orthopedic fixations are taken to OT1 while general surgical cases are taken to OT2. Both the operating theatres are air-conditioned and equipped with smooth-running Boyle’s apparatus; there is also a C-arm in OT1. The orthopaedic’s armamentarium has an excellent exfix with carbon rods. Intramedullary femur nailing is done with a sign nail (which is a solid nail) and has to be done open with distal locking using an external jig. DHS set and implants are available for Intertrochanteric fractures. Simple plates are available for plating long bones. Tibia and humerus fractures are treated conservatively except in cases of non-union, as per MSF protocol. Locking plates are not available – hence distal femur fractures and other intra-articular fractures pose a dilemma for operating surgeons and mostly have to be managed conservatively.

Plenty of really bad open road-side injuries (as well as gunshot and machetewounds and fractures) keep the surgeons busy all day long; occasionally there are night emergencies with type lllC injuries which the orthopaedic surgeon might be required to manage. The variety of cases is huge and all the surgeons are likely to have their operative skills tested. Having tackled some very difficult and bad cases does, in the end, give a sense of unmatched joy.

Lunch is brought to the hospital from the expat house and everybody has it at their convenience. The day ends late for the surgical team: the first car back home is at 5 pm, the next at 5.30 pm and the last at 6.30 pm. The surgical team usually manages to be in the last car or has to avail the facilities of a special car if it’s late in the night.

Back home everybody has dinner in their own time and, after some chitchatting, it’s time to go to sleep and prepare for a busy next day. There is TV with cable connection in the house for those who enjoy watching TV. The exercise enthusiasts have a jogger installed in the house and enjoy workout sessions. The expats have one shared laptop with internet connection in the house for their emails etc.

All expats have a mobile for the purpose of communicating with each other and the hospital. Mobile recharge coupons are freely available near the house in the supermarket as well as in front of the hospital gate. One can buy items for personal use from the everyday supermarket near the house. Expats are allowed to go for a walk on a specified route around the house. There is also a restaurant with a swimming pool, called ‘Blue Elephant’, nearby for the expats to go on Sunday afternoons. The cook is on leave on Sundays so everyone has to fend for themselves for their lunch and dinner.

On Sunday mornings only the medical team leaves for the hospital at 9.30 am. No routine cases are posted in the operating theatre on Sundays, but serious injuries from Saturday night have to be dealt with that afternoon. There is a handicraft market near the hospital where one can buy Nigerian artifacts for souvenirs.

Teme hospital has two local orthopaedic surgeons – Dr Sidney and Dr Charles – who help the expat orthopaedic surgeons in their work. Both surgeons are experienced and able and should be consulted for any difficult cases and some surgical problems. Nigerian patients are averse to amputations and hence the local surgeons should always be consulted before attempting any amputation – however necessary or imminent it might seem.

The operating theatre staff comprises many able and efficient nurses, including Peace, Margaret and Lemmy.

Time simply flies at this mission which, in a real sense, is a Mecca of orthopaedics – all orthopaedic surgeons would love to visit and work here.

Though tiring, it was an immensely professionally enjoyable mission. It ended on 18 August and I returned to New Delhi via Abuja and Paris after a series of debriefing sessions.

– Rajeev Tanwar

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