Wednesday, October 26, 2011

October 20, 2011 in Misrata, Libya:The day the humanitarian imperative, unexpectedly, meets freedom

Mullaly with colleagues at Qasr Ahmed Hospital, Misrata, Libya.

Thursday, October 20th, begins as “just another day” for MSF (Médecins Sans Frontières) staff and volunteer national staff at Qasr Ahmed Hospital in Misrata, Libya. The day begins with morning rounds on the 18-bed, second floor IPD (In Patient Department). Patients newly admitted from the night before are interviewed and examined. Civilian and military patients (both rebels and loyalists), with the traumatic, post-explosive and infective sequelae of war, lay before us. Hard copy x-rays are pulled from the brown envelopes stationed at the foot of each bed and are passed to the physicians of the rounding team. One by one, each physician holds the films to the available light and then returns their visual focus to the waiting patient to reconcile the completed injury. Is this injury open or closed? There is the entry – where is the exit? How is your breathing? What are the vitals? What is the hemoglobin? Do you have pain? The patient in bed 2 is a prisoner with a partially amputated left lower extremity whom we resuscitated hours before. His hemoglobin is now 9 and he is stable for surgery. Previously admitted and postoperative patients are also reviewed and management plans are updated accordingly. Who can be discharged? Who will be evacuated today? Who will go to the OT (Operating Theater)? Is there blood available for this patient? Does the ICRC know about this unaccompanied minor? Dressings are changed, new and postoperative wounds are inspected, antibiotic plans are updated and a priority list for surgery is made.

With the bulk of rounds complete, I make my way to the OT suite – a differentiated space on the first floor of Qasr Ahmed Hospital. It consists of two operating rooms (OT1 and OT2), a recovery room, a pharmacy/ workroom and a sterilization room all put in place by MSF France for this emergency, humanitarian surgical program at Misrata, Libya. I prepare OT1 for the first patient of the day – a prisoner – keeping in mind the needs of the patients who might follow. Would they have extremity injuries? Could regional anesthesia techniques be used? Would general anesthesia be needed: GA+ or GA- (with or without intubation)? Do I have what I need, or might need, to safely implement the anesthesia plan?

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