Stories from The Field 4 – James

Doctors Without Borders work in a number of contexts – natural disaster, epidemics, conflict and exclusion from care. This latter context can be driven by a couple of factors. first of all overwhelming demand – this can occur with large population movements such as people displaced by fighting who move to places of relative safety. When this happens there may be no medical facilities or existing services quickly become overwhelmed by the influx. The other type of denial of access is by sheer remoteness of communities.

I have worked in South Sudan twice, once setting up primary health care clinics near the border with DRC and the second time in an established hospital in a town called Leer in the north.

The catchment area of Leer hospital was vast , it often took patients days to get there. There is no 999 to call, no ambulance service. If patients couldn’t get to hospital / a clinic then they were simply cared for as best as possible at home.

This was the problem faced by James. Im unsure of the circumstances but James was shot in the right thigh about 10 days before being brought to our hospital. This delay could easily have cost his life.

James immediately pre-operatively

It was quickly established that amputation was the only option for James. This was discussed with him at length. He was very reluctant to go ahead with this despite our making it clear to him that he would be overwhelmed by sepsis if we didn’t operate. It took a lot of discussion with our magnificent surgeon Stefanie and the intervention of a little boy called Khan to convince James that surgery was his only chance.

Khan was about 6 years old, he used to hang about our office and would cheer us up with his lovely smile. A couple of  years earlier Khan had been in a road accident and lost his left leg. He had made a decent recovery though he still had problems now and again. He was however incredibly positive about life and the future. He spoke to James who was able to see this remarkable little boys optimism and that life can go on despite such a devastating loss. Following this , James consented to the surgery.

Khan

I became involved as I was running the Nutrition centre of the hospital. We primarily dealt with in / outpatient children in various states of malnourishment. It was unusual for me to have to come up with a plan to support a malnourished adult. James however was massively underweight and would need a lot of input IF he survived surgery. We rigged up a stretcher and weighed it, then transferred James to the stretcher and weighed him – just over 50kg (7st 8ib).

Setting up to weigh James pre op.

The theatre team then set up for his surgery which was carried out later in the afternoon.

In theatre

Final dressings before transfer to the ward

Post operatively, James was transferred to the ward, lots of pain relief and careful nursing care followed. I sorted out his nutritional support and am both pleased and proud to show you the last photo of James and his wife about a month later. He gained weight, rehabilitated very well and was discharged about 6 weeks later. He wasn’t from the Leer area as I mentioned earlier so it was impossible to discharge him sooner. This was fine by us as we got to see him all the way through his journey. He was a remarkable man and I was lucky to be part for a remarkable team.

James and his wife

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Permission to use photos was obtained as always from the patients / parents of patients

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