Emergency Surgery in Rutshuru
November 24th, 2009
“Here at the Rutshuru hospital, we perform every kind of surgery, from Cesarean sections to open fractures, peritonitis, uterine ruptures, bullet wounds to the abdomen and ruptured spleens.” The operations are so many and so varied that Claude, a Congolese surgeon who has been working with MSF in Rutshuru for two years, cannot list them all. On average, the surgery department performs 98 operations every week. It is under constant pressure and treats only emergencies because the Congolese province of North Kivu, where Rutshuru is located, is in the grips of an armed conflict that sets off constant population movements.
Because of the situation, MSF has set up a second operating room where burn victims’ wounds are also dressed. It has the same equipment as the first: oxygen extractor, anesthesia machine with halothane (an anesthetic gas), Monal respirator, multi-function monitor (to check pulse, blood pressure and concentration of oxygen and carbonic gas), ventilator and electric syringe. Three surgical teams rotate between the two operating rooms. “We work seven days a week,” Claude explains. “We have night duty every third night and it’s very unusual to have a quiet shift.” The work doesn’t stop during the day. “Everything runs smoothly,” adds Ian, a Czech surgeon. “There’s no break between surgeries.”
That’s another indication of the surgical program’s diversity – the surgeons come from all over the world, including the Democratic Republic of Congo, Canada, Germany, India, the Czech Republic, France, Georgia and the U.S. But they all speak French. Even if they practice medicine somewhat differently – for example, the Americans do not place tubes like the French – they must be able to understand each other and adapt. Surgeons, like anesthetists, follow MSF protocols. In addition, says Claude, the unit manager, “there are surgeons with very particular specialties who do not know how to do a Cesarean section, but if they’ve had the standard training, they figure things out and we help each other.”
Specialization is the norm today. “It’s the trend now, although slightly older people, like me, have a lot of varied experience,” says Michael. He usually runs an operating room in an Oregon hospital, in the U.S. Since his first mission in Ethiopia in 2001, he has gone on MSF missions every two years. He takes a month’s vacation so that he can join the standard one-month surgical mission. He values these “holidays.”
The Congolese staff members – surgeons, anesthetists, nurse-anesthetists and operating room nurses – are highly adaptable and know how to respond in critical situations. In late 2008, when National Congress for the Defense of the People (CNDP) rebels launched a major offensive against the Congolese Army, the surgical team remained on site and had to treat a flood of wounded patients. “During normal periods, we see about 15 bullet wounds a month,” says Paul, a nurse-anesthetist. “At that time, we saw 40 wounded patients over two hours in a single day. Another day, in October 2008, we had 85 wounded patients.”
Rebels no longer occupy the city of Rutshuru today. The front lines are not clear. But while the nature of the conflict may have changed, the population must still deal with regular violence. Fighting between the Congolese Army and the Democratic Forces for the Liberation of Congo (FDLR) occurs further away, but patients with bullet wounds sometimes arrive at the hospital. In October, there were 30. At that point, the team applied a basic principle of war surgery: extensive debridement of wounds. “To prevent the wound from becoming infected, we leave it open for five days and then we close it,” explains Richard, a physician anesthetist.
In addition, Cesarean sections represent a major share of the activity and constitute nearly one-third of surgeries. Women often arrive from far away, using the ambulance system that MSF has set up. If the nurse at a health center cannot treat a patient, he or she will notify MSF, which sends an ambulance. But women’s health care can be proactive, too. Women with complicated pregnancies can be housed in the “mother’s village,” a separate section in the hospital where they may stay until giving birth.
Based on availability, an OB-GYN is there sometimes, which reduces the surgeons’ workload, which also, of course, includes monitoring patients post-surgery, including 24 orthopedic patients, 50 more divided between the two surgery rooms whose wounds, skin grafts and limb mobility must be checked and the nine patients in the new burn unit.
