Yemen: “With or without COVID-19, the challenges here are endless.”

I arrived in Aden in May expecting to work at the trauma hospital, but within a few days of being here I joined the team setting up the only COVID-19 treatment centre in the vicinity. The situation went from bad to worse in a matter of days.

At the time, I described it to a friend back home as ‘hell on earth’ – walking through the hospital and seeing every patient suffocating in front of me. The patients needed intubation, mechanical ventilation, oxygen concentrators, tubing and masks. It was difficult seeing that level of suffering and feeling completely helpless.

It was tough for me knowing that the outcome for these patients would have been different back home in Australia, but here in Aden we didn’t have the resources. We didn’t even have adequate personal protective equipment (PPE) or a reliable supply chain. But we were determined to do the best we could with the little that we had at the time.

By early June, the number of patients admitted to the COVID-19 treatment centre in Aden started to slow significantly. The reprieve was a bit of a surprise as we expected it to go on for months. The challenge is preparing for the fact that there could be more cases out there, particularly in regional parts of the country, where there is limited access to healthcare.

“In my first week I saw more than 20 patients with gunshot wounds”

With or without COVID-19 present, the challenges here are endless. Conflict continues to disrupt daily life and there are many people who don’t have access to food or healthcare. My work here has shifted back to the trauma centre and we’re seeing a lot of patients from the frontline.

Patients come in here with war wounds which at first was quite confronting for me because in Australia we have limited experience with these injuries. In my first week I saw more than 20 patients with gunshot wounds; the last time I treated someone for a gunshot wound back home was about three years ago. The difference is quite staggering and reflects the situation here in Yemen.

I met Munir* during a mass casualty event. He arrived with shrapnel injuries to his right arm and chest, with significant damage to the brachial artery – the main artery in the arm. He had already lost a lot of blood before arriving. We rushed him to the operating theatre, attempting to repair the damage to his artery so that he could regain function to his arm. He underwent damage control surgery, before returning to the intensive care unit (ICU) for resuscitation and further stabilisation. Munir’s condition continued to deteriorate quickly, to the point where he developed liver and kidney failure – things we cannot manage here. We took him back to the operating theatre but despite all efforts, he died. His injury was so severe and the extent of care we could provide was somewhat restricted due to the limited resources and lack of specialty care available here.

“The Yemeni spirit is stubbornly resilient”

The biggest challenge right now is trying to manage things that feel unmanageable. I’ve had to learn to do things without guidance from all the advanced technologies like imaging and diagnostic equipment that we rely on in well-developed healthcare systems.

One case that really affected me was one-year-old Jamal* who came in with about 30 per cent burns to his lower body. We explained to his father, an English teacher, that we don’t manage burns in the trauma centre. He explained that he had tried every hospital in Aden, begging for help, but they all refused to admit Jamal. We agreed to take him in explaining that we would do the best we could with the limited resources we had. He was adamant that despite our limited resources, our attempt was better than having his son die at home.

Sadly, Jamal’s story is not unique here. Families often tell us that they travel from hospital to hospital trying to get their loved ones the care they need. They come to us as a last resort and often it’s simply about our teams offering palliative care. Despite it being misunderstood here, it’s a matter of providing comfort for these patients. It’s heartbreaking that the situation here is so dire that the best we can do is provide comfort. So much more needs to be done so that people here have access to the healthcare they deserve.

Jamal went on to do remarkably well – he was discharged from the ICU after a few weeks and really defied all expectations. It was testament to the whole team looking after him and definitely one of the happiest outcomes I have witnessed.

Despite the challenges, the Yemeni spirit is stubbornly resilient. The team in Aden is made up of some of the toughest people I’ve ever met. Some have been working at the hospital since it opened more than a decade ago and have been through extremely trying times. They are so dedicated and committed to help even when the situation is the way it is. I’m really inspired by them and that’s where I see the silver lining. The people here, and the patients we treat, they’re just so positive, they’re so grateful and it’s really quite humbling. It is an absolute privilege to work with the amazing people that I do and look after the patients that I do.

*names have been changed