Somali symbiosis, part 2: what I did

As a surgeon, I realized I needed to get past my judgments of how things could be, and my horror at situations I saw, and get down to the business of offering medical and surgical care to those in need.

I was part of a Médicins Sans Frontières team that consisted of an anaesthetist, nurse/midwife, medical doctor, logistician and local field coordinator. We hired and trained 150 local staff as nurses, assistants, surgical and anaesthetic clinicians, guards, laboratory workers, pharmacy attendants, cleaners and sterile supplies technicians.

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Surgeon John Barnhill and the operating theatre team. Image by: Sara Barnhill

So really, “I” did nothing on my own.

I taught constantly while we performed emergency operations daily. We did caesarean sections on seizing moms, sometimes saving the mom, sometimes the baby, and less often both. We repaired tears in the birth canal, stopped bleeding when we could, and removed the uterus when we could not. We lost a mother and baby who had been in labour for 4 days before her uterus ruptured.

We operated almost every day on the effects of armed conflict. I removed body parts that were not viable — blast injuries would often take part of an arm, foot, leg, fingers, etc. — with the goal of having a stump that was not infected in a live patient. We removed parts of eyes that were blown out. These were often in children running about town and refugee camps, or nomadic kids tending animals. I grafted skin on areas that had been burned, blown off or sloughed due to infection.

I taught what I knew to the nurses, operating staff and a surgical clinician (formerly an operating room nurse). This is truly what would last beyond our departure.

Much effort was spent trying to instill the belief we could do better and that some of the deaths and disabilities they were accustomed to seeing could be prevented.

We introduced standards, protocols and treatment algorithms that demonstrated in patient outcomes that we could indeed do better. With the instruments, supplies and medications at the Médicins Sans Frontières hospital we reliably improved outcomes. We taught and encouraged everyone to bring their illnesses to our attention sooner, as that would lead to improved results.

Encouraging cleaner hygiene standards in an attempt to decrease infectious diarrhea, dehydration and death was a priority. That public health teaching was often integrated with identifying and treating malnutrition.

We even treated non-emergencies when possible. We had normal deliveries, hernias and fractured arms from soccer matches. But, sadly, such treatments were in the minority.