Doctor's casebook: Treating Monrovia's wounded III

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.

The morning started again with a series of four mortar shells exploding with a muffled thump in the ocean behind our hospital. The team sheltered in our bunker.

The bunker had been my bedroom in the house until our team evacuated Monrovia in early June. It was in the second half of June when we completed the transformation, converting our former residence into a 50-bed hospital.

Now, heavy tape on the window glass and piles of sandbags reinforcing the walls make it one of the safest places to hide when the shelling is close.

Our men with stretchers brought in two people injured in this morning's mortar attacks on West Point, a neighbourhood a few kilometres away. The young woman I worked on had a shrapnel injury of the lower right side of her chest, just over her liver.

Christophe stabilized another patient whose mortar injuries included a fragment that had entered the abdomen and others that had shattered a bone in his leg and another in his forearm.

Once stabilized, we loaded them into an ambulance for the 20-minute ride to the trauma surgery hospital run by International Committee of the Red Cross on the other side of town.

A third patient had only minor wounds but was deaf in one ear from the blast.

War zone

Most of the day was quiet. I tried to discharge the patients who no longer needed to be in the hospital to make room for the new arrivals.

Many didn't want to go, especially the ones from West Point where the fighting was still heavy. The kind-hearted side of me wanted to let them stay. After all, leaving the hospital meant going back to the war zone, to a crowded shelter without food or clean water.

Doctors are discharging people who have nowhere to go

We can't have big crowds coming seeking treatment for minor medical problems mostly because if fighting starts we'll have to shelter and provide for all of them.

For our hospital to function properly, for us to be properly prepared, anybody who didn't need to be in the hospital needed to go.

One lady with a shrapnel injury of the thigh had been discharged two days ago and still hadn't left.

"Look, mama. You have to go today," I told her. We had a bench just outside the hospital gate where visitors and others waiting to enter congregated.

"You need to wait outside on the bench until your people come to help you get home."

Trapped

A 70-year-old man was carried in to the hospital in a wheelbarrow. "What's wrong with him?" I asked the young man who'd brought him.

"I don't know," he said. "I just brought him for his daughter. She said she went to get some food for him and then she would come."

I smelled a problem. We already had a couple of elderly patients who had been abandoned by their families, left in the hospital because they didn't feel they could care for them or because the elderly person was too hard to carry from one sheltering place to another.

"What's wrong with you, pappy?" I asked. "I have rheumatism in my knees," he answered. "Why did you come to the hospital today?" He shrugged his shoulders. I was trapped.

"OK," I told the young man who'd brought him. "Bring him in to the emergency room. But, if his daughter doesn't come and he doesn't need to be admitted, you need to bring him back home."

The man nodded but I knew I was trapped.

Sure enough, the old pappy was doing fine. We gave him some pain tablets for his arthritis. He didn't need to be hospitalized.

Smile

"Now what?" the nurse in the emergency room asked. "Bring him out on the bench outside the gate. If his daughter doesn't come for him by night, we'll put him upstairs."

When lunchtime came, I asked the nurses to make sure to bring a plate out for the pappy. I had to be tough, but not that tough.

Later that afternoon, some more mortar shells fell nearby, again all landing in the sea. We hid in the bunker. It wasn't until after the mortars stopped falling that I remembered the old pappy who I'd put waiting outside on the bench, sheltered by nothing more than a plastic tarpaulin.

I went outside myself to check on him. "Hello, doctor," he said with a smile as I approached. He hadn't been hurt. "Come on inside," I said as I helped him hobble back into the building.

I felt like crap. My team members have read some of my journal entries. "They're all about people dying and you saving them," they said. "Why don't you tell the story about the old man you put outside for the mortar attack?"

Andrew Schechtman's second casebook