A Piercing

They have been through a lot, these people of South Sudan.  Many have been displaced.  Many have seen family members perish violently.  Many have seen friends die.  It is very hard to put it all into context.  Most of it is hard to even imagine.

Notice the number spikes that are not visible above.

I had a hard time imagining what I saw last night.  A local Dinka man, a one time soldier, a one time pastoralist farmer came into our compound with a spear imbedded firmly into his body.  From what I could understand, the woman that he wanted to court into a marriage had chosen a different man.  This was the last straw.  This man had been through too much, and this was just one more thing that he didn't want to deal with.  But he did deal with it.  He took his Dinka spear and stuck it into his body as far as he could, as far as it would go.  And it went far.  We took him to the OT to see what we could do, knowing that he would probably die.  The spear, a fearsome thing, went through his lower chest and upper abdomen.  It pierced through his xyphoid, and went through and through the liver.  It glanced off of his heart, but did not obviously damage it.  It went all the way to his spine.  We wrestled it loose, by spreading out the damaged liver.  The large spikes on the spearhead seemed to anchor it to everything, damaging organs with every movement.  But we continued, and eventually freed the offending object.  We had no suction device, and essentially no cautery.  I pressed on both sides of the liver to try to stop the bleeding.  I held that pressure for minute after minute.  And the bleeding slowed, and then stopped.  We were able to start to close the incision.  This morning, he was alive.

Exit Wound Update

After the return of the man who had been shot by the AK47, we took him to the OT for re-evaluation of his wounds after he left the hospital for a traditional healer.  The family still did not think that the wounds were bad, until we showed them.  The wounds were grossly infected, and maggots wriggled in a couple of the wounds.  Pus, and an awful smell, seemed to come forth in waves.  It almost made me want to gag.  His hand is not salvageable.  In fact, his forearm is not salvageable.  I was hoping that we would be able to amputate below the elbow, to give him at least a usable 'hook' at the elbow joint.  We will not be able to do that.  The tissues are too far gone.  Tomorrow, if they consent, we will proceed with an amputation.  I just hope that the infection hasn't made its way up into the upper arm.

Exit Wounds

There is a man who, appearing violent, was shot, reportedly in defense.  The AK47 7.62 mm bullet that struck his arm entered near the elbow, travelled down the arm and exited just above his wrist.  Both bones of the lower arm were destroyed, and there is basically nothing but a few tendons and some skin attaching his hand to what is left of his arm.  He needs an amputation of his hand and lower arm.  When we initially evaluated him, he would only consent to debriding, or cleaning the area.  However, over the next couple of days, he has developed gangrene of this hand.  Again we discussed further surgery, but this time his family refused for him to go to surgery.  They recommended a traditional healer, and he left the hospital.  Today, I heard that he was back, and wants to go ahead with further surgery.  I'm not really sure how much we can save at this point.
The family dynamics of consent in this region are very interesting.  The family must all agree, and women are not allowed to consent for themselves, but must have their husbands give consent for them. We have learned that we cannot rush this process.  We just wait, sometimes knowing that the situation is becoming more and more grave.  It can cost a life.  But there are violent reprisals if we were to circumvent this process.  So we wait, and watch, and wait.  And hope for the best.

Cat in the Compound

On the MSF ex-pat compound, we have about four cats.  They are of the domestic kind, but are not very domestic.  We keep them here because they keep the number of snakes down.  Their lives are not always easy, either.  One of the smaller, younger cats was taken by a hawk, but fought bravely and escaped with a fall from the sky and an injured eye.  The hawk lost the cat, and the cat lost an eye.  She is now the one-eyed cat.  But she has compensated well.  She sits next to us sometimes, and will let us scratch her ears.

Neighbors

The MSF compound and hospital are on the south side of Gogrial.  I am told you can actually see it on GoogleEarth, but the flyby must have been one or two years ago, because not all of the new buildings are present.  We are, however, still in the neighborhood.  Grass huts surround the compound, which is fenced, and supposedly secured with guards.  This morning I met the neighbors.  Two children, who called to me. "Kawanja!"  I came over, and they let me take their pictures.  Getting photos of the Dinka people is difficult, and can be tricky.  I have had to let many great opportunities pass for reasons of safety.  But my neighbors said "good morning, how are you?" and wanted a picture.  Many of the children know some English, and want to try it out.  Primarily we hear greetings.  Sometimes we even get a smile back.  And this is from a people who do not readily smile.

A Mosquito Net Among Friends

It is malaria season in South Sudan.  It is the rainy season, and the pools of water make great breeding grounds for the mosquitos.  We are seeing severe malaria cases in the the MSF hospital.  Many of these patients would have died, and many may still die of the disease.  There are several forms of malaria, and the one that is endemic here, is the worst kind.  So to help fight the malaria, MSF along with many other NGO's have handed out thousands of mosquito nets.  Some of our workers recently did a series of site visits to see how many people were using the nets.  The findings were pretty interesting.  They were being used for fishing nets, and for protecting young plants.  Some were being used to trap ants.  Very few were being used as mosquito nets.  It is all very interesting.  A question of priorities, but this is Africa, and life seems to be pretty cheap at times.  It may be worth the cost of a mosquito net.  A few cents.

Abdulahi and Me

The core of the surgical team is the anesthesia provider and the surgeon.  We also have two OT nurses, and one somewhat in training.  Abdulahi is the anesthetist.  He is from Kenya, the northern province, and is of Somali origins.  He has a very positive attitude.  Despite the fact that our anesthesia machine does not work properly, it does not slow us down.  He hand ventilates all of the patients.  We do patients from newborns to adults, and he never hesitates.  When we are not in the OT, we help out on the wards.  Today we used a variety of salvaged materials to rebuild a suction machine to be used in the maternity ward.  It is amazing to me all of the combined ingenuity that is used in a project like this.  There is no Home Depot or Menards to scour.  Everything that is used has either been carried in or is adjusted and made to work.  Yesterday, we tried to rebuild some fans to be used for cooling the tents.  The wards are full of people with severe malaria and malnutrition, and we have had to place mattresses on the floor to have a place for everyone.  Sometimes there are enough sheets for the beds, and sometimes not.