For the intensive care team in Aden, southern Yemen, traumatic injuries are only one part of the story. Doctor Silvia Marchesi shares about the dedication of a team striving to save lives in the midst of conflict.
Aden was brutally caught in the conflict in 2015. “We received two hundred patients in one day,” one of my colleagues said. When I arrived in 2020, it was the fifth year of what the news calls a “civil war”, which looks a lot like an international war when observed a little closer.
After the brutal battle, Aden was mostly spared. But the increasing poverty and easy access to weapons has made violence a daily routine for southern Yemenis.
One night, a week after my arrival at the hospital, a call woke me at 3AM. It was the emergency room doctor calling for help: four patients had arrived at the same time, from the same shooting.
The most urgent was a 20-year-old man with a gunshot to his chest who couldn’t breathe.
While I was intubating him, my eyes fell on something bulky and awkward in his trouser pocket. As soon as the intubation procedure was over, I reached out to remove the object.
I froze: I was holding a grenade.
A Yemeni colleague gently took it from my hand and went to take it where all the weapons belong: out of our hospital.
The emergency surgical unit in Aden during the 2015 battle. © Benoit Finck/MSF
Soon my attention was attracted by something else; some of the patients we were receiving at the hospital were malnourished, both children and young adults.
Yemen is sometimes said to be on the brink of famine. In Aden, my colleagues told me that the slice of the population slipping into poverty is growing constantly.
Malnutrition is a subtle beast that can kill you as much as a grenade can, without making a sound.
In patients with traumatic injuries malnutrition makes things more complicated. The injured body needs 30 percent more calories per day than a healthy one: the tissues need energy to heal and to rebuild what was destroyed.
A malnourished body has less reserve to use in the rebuilding, so the healing process can take longer or never happen.
The intensive care unit at Aden Trauma Hospital (photo taken December 2018). © Agnes Varraine-Leca/MSF
Malnutrition can be overwhelming for children undergoing trauma treatment. Their bodies need to heal and grow at the same time.
Fariha, a five-year old girl, admitted to the hospital after a car accident – was worrying me more than any other patient. The accident had caused her a massive liver injury. When she was admitted she weighed 13 kilos – already extremely low for her age. Two months on and her weight had dropped to nine kilos and seemed to be in freefall. She stayed mostly in bed, struggling to find the energy to eat.
Observing the weight going down, I came to the edge of panic about Fariha and I decided to prepare a nutritional plan to be carefully followed. It changed dozens of times as we worked to adapt it to Fariha’s conditions. The nurses prepared her favourite food in the hospital kitchen a couple of times, and everybody helped to support her mother constantly.
After three weeks of attempts, failures and readjustments, Fariha’s weight started to increase. It was like witnessing a miracle: her body was responding. Fariha was discharged – just a few days before my departure from Yemen – to a round of applause from all the staff.
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