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Liberia is currently in a rebuilding phase
following a 14-year civil war that ended in 2003. The war
destroyed 95% of health facilities, and today MSF runs eight hospitals
throughout Liberia.
Australian volunteer Dr
William Wilson, from Upper Beaconsfield in Victoria, is
two months into his first mission with Médecins
Sans Frontières
(MSF) in Lofa County, Liberia. In this interview William talks of
his experience of the
difficulties of working in isolated parts of West Africa as well
as the positive impact volunteers can make within a short period
of time.
What are two examples of cases from your ward round this
morning?
There were two interesting cases that I will now refer to MSF’s
hospital in Monrovia, the capital of Liberia. Firstly - a young eight
year-old boy who has gone blind over the last four months. He was reading
and writing at school before this time but now has no vision at all.
Hopefully he will have a reversible cause and hence I am referring him
to Monrovia for opthalmological review.
The other case is a three year-old boy with possible Hirschprung's Disease,
a rare disorder affecting the nerves supplying the bowel. He presented
with a massively distended abdomen, which apparently has been this way
for over two years. There is much liver disease related to chronic viral
hepatitis in this area, so at first glance I assumed the cause of the
distension to be ascites (fluid) related to cirrhosis. However, clinical
examination revealed the abdomen to be tympanitic consistent with gas
and with no features of acute obstruction otherwise.
Are there
any unusual or interesting medical conditions you have come across so far?
One of the most surprising things to me is the severity of anaemia related
to malaria...it is not unusual to see children presenting with seizures
due to malaria, who also have a haemoglobin of
3 (where normal is usually >10). Relatives usually act as blood donors, but unfortunately
the patients have often travelled many kilometres from the border to reach here
and hence only come with one or two relatives, which can limit availability of
blood donors.
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| Dr William Wilson during a consultation
in Lofa county |
Can you provide an example of a typical successful
intervention recently?
There are many success stories that come from cases similar to what I
just described above (anaemia etc.), who present obtunded due to severe
malaria. However with appropriate treatment are often up and are walking
around the following day. A recent success was a 65 year-old man who
presented very unwell early in the night with severe abdominal pain due
to peritonitis (due to a perforated gastric
ulcer as it turned out). He had a very low blood pressure and evidence
of renal failure. We are unable to transfer patients during the night
so we had to care for him here until the morning with IV fluids and antibiotics.
Incredibly, he not only survived the night but also the three-hour drive
to Vonjaima, and the subsequent operation.
What do you do in your time off here in Lofa?
I try to keep fit by jogging regularly to the nearest village, but this
can be difficult with a tribe of kids following you. I have also played
in some local soccer games with limited success...the local staff with
whom I play are a lot quicker than me!
What is the best thing about being on mission in Liberia with MSF
so far?
The local liberian staff are very welcoming and great to work with. I
also enjoy teaching the PAs (physician attendants) who I supervise in
the outpatient department. They are not doctors but have completed approximately
three years of medical training (that was interrupted due to the war),
and are very keen to learn.
What do you find hard about being on mission?
Certainly the limitations of treatment due to our remote location can
be difficult, especially for example, when you can make a diagnosis clinically
of something readily treatable back home but can offer little in terms
of therapy here. Otherwise the poor road conditions prohibit rapid transfer
to a surgical centre for a simple operation, such as an appendicectomy
and consequently the patient can die from a readily treatable condition.
It is also difficult dealing with cases that present very late in the
course of the disease, owing to the patients having trialled traditional
herbal medicines for weeks or months prior to coming to MSF for help.
Often, there is the initial disease to manage as well as the side effects
of the herbal treatment which can be quite severe, such as liver failure.
At what stage are you professionally in your medical career and
what experience did you have prior to volunteering with MSF?
My background is in specialist medicine/internal medicine, so the work
is very different here, especially managing paediatrics. I graduated
in 1999 from the University of Melbourne and completed the physician
specialist exams last year, and will return to specialist cardiology
training next year in February. I was working in northern Australia (Tennant
Creek and Fitzroy Crossing) in aboriginal communities earlier this year
prior. The work is very similar in many ways, in particular the difficulties
in managing chronic disease. There is obviously more infectious diseases
such as malaria, schistosomiasis, TB and HIV/AIDS here in Liberia, but
less cardiovascular disease, diabetes related morbidity and alcohol related
problems here than in indigenous communities in Australia it seems, although
life expectancy is roughly about the same.
Haemoglobin (Hgb,
Hb) a measure of the degree of anaemia
Anaemia is a deficiency
of red blood cells, which can lead to a lack of oxygen-carrying
ability, causing unusual tiredness and other symptoms.
Peritonitis is inflammation
within the abdominal cavity |
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