At a rural hospital recovering from
civil war in Sierra Leone, a surgeon from New Zealand confronts...
Full Name: David Friend
Nationality: New Zealander
Country: Sierra Leone
Episode: "Borders and Babies"
SIERRA LEONE | AFGHANISTAN
In this episode, Amir Hussein was initially turned away from the hospital in Chaman, on the Pakistan/Afghanistan border. The Afghan government doctor did not want to treat Amir because the hospital's U.N. contract had expired. What does this mean and why wouldn't they treat him?
U.N. agencies often provide funds to government hospitals
for refugee patient care. In these cases, medical services will
be reimbursed according to an agreed fee scale. The U.N. had allowed
its contract with the Chaman hospital to expire. Even though MSF
offered to pay for Amir's surgery, the doctor was concerned that
he would need follow-up care and the hospital would have to absorb
the cost. In this case, the doctor was eventually satisfied and
In the Sierra Leone segment of this episode, a sick boy (Osman) must have his leg amputated. Would he have received the same medical treatment in the U.S.? What happens to the boy?
According to Dr. David Friend, the MSF doctor who
treated Osman, even in a western country this child likely would
have required surgery, including possibly an even more extensive
amputation, because of the size and fast-growing nature of the tumor
in the child's leg. After about six months, Osman returned to the
MSF clinic. He was quite thin and the stump of the amputated leg
was a bit swollen. MSF was able to get x-rays at a UN field hospital
that showed recurrence of the tumor in the stump with extensive
deposits in the lungs, which is a common site for the cancer to
spread. Because chemotherapy is not available in the region and
the cancer had spread rapidly and extensively, it is likely Osman
died shortly after this last visit to the MSF clinic.
In this episode, a mother dies of preeclampsia during child birth. The MSF team cannot save the child. What is preeclampsia? Why couldn't they save mother and child?
Preeclampsia is high blood pressure that occurs during
pregnancy. It most often affects women in their first pregnancy,
teenagers, or women over 35. Women who have high blood pressure
before pregnancy are also at increased risk. Preeclampsia usually
develops in the third trimester and doctors often prescribe bed
rest and medication.
Severe preeclampsia, characterized by a widespread
constriction of the mother's blood vessels, can cause liver and
kidney damage, seizures, coma, and death. It can also interfere
with blood and oxygen flow through the placenta and affect a baby’s
development. Women in developing countries who do not have access
to adequate prenatal care are more adversely affected by the condition.
Sometimes labor must be induced prematurely or a c-section performed
to save the mother and child. In this case, the mother showed up
at the hospital with a severe case during the last days of her pregnancy.
Like most pregnant Sierra Leonean women living in rural areas, she
had no access to the prenatal care that might have prevented a tragic