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Last Updated: Thursday, 24 July, 2003, 23:59 GMT 00:59 UK
Doctor's casebook: Treating Monrovia's wounded
Doctor Andrew Schechtman in his emergency room
Helping Liberians is 'worth the risk'
Andrew Schechtman of charity Medecins Sans Frontieres has been witnessing the tragedy unfold in the Liberian capital, Monrovia. He has sent parts of his diary to BBC News Online.

Tuesday was much quieter than the heavy artillery attacks of Monday.

One 18-year-old boy was hit by shrapnel from a mortar shell and had a deep wound in the side of his neck.

"Do you feel this?" I asked as I pricked him with a needle, marching from his stomach, up his chest, towards his head. The answer was "no" until I reached his upper chest. He could move one of his arms a bit but was otherwise paralyzed from the neck down.

For every lucky little girl there were probably two who weren't so lucky, dying at home from their injuries
The hole in his neck contained bits of bone from his shattered vertebrae. The fragments had also collapsed his left lung. I put in a chest tube to re-expand the lung.

There was not much we could do for him.

I do not understand how lobbing artillery shells into a densely populated area can be considered a legitimate tactic in war.

Is it overly simplistic for me to say that, unequivocally, this is just plain wrong?

Another patient yesterday was an 18-month-old girl who was taking a nap when she woke up screaming.

Her mother did not know what was wrong.

There was a streak of blood on her left cheek and she would not stop crying.

MSF volunteers in Monrovia
Doctors are discharging people who have nowhere to go
She had been hit by a falling bullet. The bullet had entered her left cheek and passed through to underneath her right jaw without damaging any of the vital structures in her neck.

I sedated her, made an incision over the bullet and, with a little manipulation, pulled out the copper-coloured AK-47 bullet from her neck.

I explained to the nursing staff that this incredibly lucky little girl was not a typical case.

The whole family

I discharged two children today, a 12-year-old boy and his nine-year-old sister.

Their father came to pick them up. He had also been injured by the exploding shell.

The severity of her injuries looked incompatible with life, so much so, that I was startled when I first saw her move
I passed the three of them standing all together in the doorway.

Smiling, I touched the man on the shoulder and said, "The whole . . .".

I caught myself and stopped mid-sentence. I was about to say "the whole family" before I remembered that their family was far from whole.

Two days before, their mother had also been wounded in the same attack - each of her four limbs had been mangled by the blast.

Both arms hung on her body attached only by thin pieces of flesh. One leg was missing half way past the knee. The other leg was shattered, fragments of bone protruding from the foot which laid at an unnatural angle in relation to her leg.

I had never seen anyone so severely torn apart. I hesitated before I approached her.

The severity of her injuries looked incompatible with life, so much so, that I was startled when I first saw her move.

She was alive! Our team worked on her aggressively. There were many patients to be seen that day, more than 70 flooded into our emergency room in the 30 minutes after the mortar barrage.

I was busy with someone else when I heard that she had died about 15 minutes later. Her son laid on a bed across the room from his mother, watching everything. "My mother's dead! My mother's dead!" he wailed.

Their family is far from whole.

Going Home

The morning after the heavy artillery attacks, I walked through the hospital ward where we had put our wounded.

The room, which was our dining and living room before we had converted our residence into a hospital, was far too small to accommodate the 25 patients that were there.

Liberians in Monrovia
Liberians have nowhere safe to flee to
I walked through the room discharging patients, sending them home.

Sending them home is a bit of a euphemism since most of them left their homes days or weeks ago.

None of the patients want to go home. Here in the hospital they have food, water, and a dry place to sleep.

I feel like a jerk for kicking them out but, if I did not, the hospital would soon be overfilled, our stores depleted.

Worth the risk

Today, a stray bullet broke through the window of our emergency room and skidded to a stop on the floor. No one was hurt. It is all so random.

Doctor Andrew Schechtman
Doctor Andrew: Baffled by the tactics of the war
Our team has been sleeping in the hospital. I have not left the hospital grounds in the past five days.

I cannot help but think. "What's stopping the next artillery shell from landing right here in our front yard?"

I could be the wounded one.

I picture myself in the place of any one of my injured patients and then I quickly try to put it out of my mind.

So far our team has been very lucky.

The work is so important that it is worth taking some risks.


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