Australian surgeon Dr Ivan Thompson shares what drives him to work with Médecins Sans Frontières (MSF), reflecting on his recent assignment aiding Cameroonians affected by violence.
What led you to work with MSF?
I’d always wanted to work overseas. I’d also long admired MSF and it had been on my mind to join. Once I retired, I thought it was time to do something.
You’ve recently returned from working as a surgeon with MSF in Bamenda, Cameroon. What are our teams doing in Bamenda?
MSF is responding to the medical and health needs of local populations affected by violence in the South-West and North-West regions of Cameroon. Tens of thousands of people have fled the country and hundreds of thousands more are displaced within the western regions. There are frequent clashes between armed groups, most schools are closed, and many health centres have been destroyed. Many people have been forced to seek shelter in the bush to avoid attacks, where they face a lack of food and difficulty reaching healthcare.
Even if patients can reach a health facility, many cannot afford treatment. In Bamenda, the capital of the North-West region, we are supporting a private hospital and working to strengthen the capacity of the health system to respond to emergencies.
“The patient’s brother was killed, and he was hit by a bullet which damaged his spinal cord. He was brought to the hospital in a taxi, having been turned back from reaching another hospital due to roadblocks.”
What did you find most rewarding about this assignment?
Despite the challenges, it was hugely rewarding to feel that we were making a difference to the health of the people. There were regional ambulances in Bamenda, but these were highly inaccessible to the population as they were expensive and required pre-payment. Region-wide curfews also made it difficult for people to reach the hospital at night. There were many cases of women having to deliver their babies at home without any medical care, as they were unable to travel. MSF set up an ambulance service to improve the ability of these patients to reach our care.
We also began a decentralised medical care program involving an outreach team of health workers, who work with local health centres to deliver medication and health education. The aim is to catch conditions like malaria and diarrhoeal diseases, which are common causes of morbidity and mortality, early. This reduces the number of patients who arrive at the hospital at a very late stage, extremely sick. The MSF team is now developing surgical and anaesthetic services to bolster the level of care.
Was there a particularly memorable patient you treated?
One day we received a young boy who had been hiding in the bush with his family to avoid armed groups. When they came out to find food, they became caught in fighting. The patient’s brother was killed, and he was hit by a bullet which damaged his spinal cord. He was brought to the hospital in a taxi, having been turned back from reaching another hospital due to roadblocks. In theatre, I excised his wounds and performed a debridement (removing the bullet and the damaged tissue). While it turned out that his spine was essentially intact, the injury to his spinal cord caused by the cavitation effect of the bullet was severe. It remained to be seen if he could make any significant recovery. We were eventually able to successfully transfer him to a hospital with higher resolution capacity for long-term management of his treatment.
There were many times when we couldn’t transfer patients needing higher level care to this hospital due to the security context and roadblocks. Towards the end of my time in Bamenda, the hospital was forced to significantly reduce the provision of surgical care due to security concerns. It was very apparent that the violence is having a significant impact on Cameroonians needing urgent medical care.
“I was lucky in that I had broad, general exposure to lots of procedures during my training as a surgeon, which has proved very useful. Even if I haven’t handled something for 30 years, I often find it is still there in my head somewhere!”
How have you drawn on skills or experience from previous jobs for your role as a surgeon with MSF?
I was lucky in that I had broad, general exposure to lots of procedures during my training as a surgeon, which has proved very useful. Even if I haven’t handled something for 30 years, I often find it is still there in my head somewhere! You won’t always be at ease, but when you can bring things back to basic principles, generally you can cope. I have been confident in relying on my skills and doing the best I can in the circumstances. The futility can get to you – I have sometimes wondered in frustration, “why can’t people stop killing each other?” But at the end of the day, if you focus on what you can do, you can make a world of difference.