Colin Chilvers is an anaesthetist and worked in Nigeria and Pakistan.
Could you describe your work in Nigeria?
I worked as the anaesthetist at Teme Trauma Hospital in Port Harcourt. We operated on around 10 patients each day for injuries from road traffic accidents, gunshot wounds and machete attacks, so it was a very busy hospital. Teme was one of the first humanitarian hospitals in the world to provide internal fixation of fractures. I was a bit surprised to find that procedure available, as it involves relatively major surgery and anaesthesia. But the results were good. With the internal fixation of leg fractures it meant that patients could walk out of the hospital in days instead of spending months in traction.
Did your role involve a lot of hands-on operating work?
Yes, as an anaesthetist with Médecins Sans Frontières an extremely high percentage of your day is spent doing the hands-on clinical work. One of the things I like most is that compared to work back home you don't have to worry much about things like meetings, reports, phone calls. You're freed up to put all your energy into clinical work. The anaesthetist's role in the field also includes more than anaesthetising patients in the operating theatre. We assist in prioritisation and resuscitation of patients in the emergency room, day-to-day care of surgical ward patients, including pain management, and training local staff.
You’ve recently returned from Pakistan. What did your work there involve?
I was working at Médecins Sans Frontières’ Hangu Hospital. This hospital is in a fascinating cultural context, adjacent to Pakistan’s North-West Tribal Areas and the highly conservative society that lives there. I saw many children with burns from domestic accidents and many obstetric emergencies. There is little antenatal care in the area and women often only get brought to hospital when they are in extreme difficulties with obstructed labour or haemorrhage. In the week leading up to Pakistan’s elections there was an increase in violence with multiple bomb blasts in the area. In 2.5 days we received 68 injured patients, on whom we performed 21 operations. That’s a huge amount of casualties for a hospital with only a small staff, limited beds, and a single operating theatre. But all the people we took to surgery survived. That was a very good result under that pressure and conditions. What was done really well was the prioritisation. Médecins Sans Frontières had a great triage system which everyone followed. I actually brought all the paperwork back with me explaining the system because it was simple and effective and I think it certainly has lessons for a western hospital.
"As an anaesthetist with Médecins Sans Frontières an extremely high percentage of your day is spent doing the hands-on clinical work. One of the things I like most is that compared to work back home you don't have to worry much about things like meetings, reports, phone calls. You're freed up to put all your energy into clinical work."
Do any particular patients stand out in your memory?
One of the bombing victims in Pakistan had injuries to his chest and abdomen, and was bleeding heavily from both. We’d identified him as the worst of the injured on that day. We took him to theatre, and as well as the surgery to stop the abdominal bleeding, we used a technique of retransfusing his own blood that was coming out of his chest injury. I had never done that before, but it worked – despite him bleeding out his entire blood volume he survived. He was well enough to leave hospital in less than a week.
Had you always wanted to work with Médecins Sans Frontières?
Like many doctors I’d always thought I’d do it at some stage, but it wasn’t until I met a Médecins Sans Frontières anaesthetist that I thought ‘maybe I could really do this’. I looked at the website and realised that the requirements were within my experience and that the time commitment was manageable. It’s generally a six week placement for surgery and anaesthetics, which means I’m able to keep my family life and normal career. My plan is to keep doing one field placement each year.
What would you say to other anaesthetists considering this work?
One motivating factor is that the patients are all emergency cases, usually young, with conditions that are readily cured by surgery. It’s amazing how relatively uncomplicated, good anaesthetic care can have such benefit. There are challenges of course – expensive drugs, high-tech equipment, and post-op critical care wards are not available. But the anaesthetist on a mission like this does authentic medicine and useful, worthwhile work for pretty much every patient.