Episode: "Borders and Babies"

Full name: David Friend
Nationality: New Zealander
Profession: Surgeon
Birthplace: Queenstown, New Zealand
Other MSF Missions? Sri Lanka

What brought you to MSF / sparked your interest in humanitarian work?

I worked for seven years in rural district hospitals in Zimbabwe with other NGOs. I was a bit weary of working in very isolated stations on my own. The idea of working with a team and in an emergency setting was appealing.

In retrospect, what was your overall impression of your mission in Sierra Leone?

It certainly was a busy mission, but I was delighted to have been able to contribute. The volume of work and the severity of cases exceeded my expectations. The surgery was important for many, as not only would they have died without it, but they would have died with a great deal of suffering from conditions such as strangulated hernias, perforated peptic ulcers, obstetric complications, trauma from agricultural and road accidents, and uncontrolled bone and soft tissue infections.

Specifically, what were the most difficult parts of the work that you did?

One of the hard parts was that many patients arrived in extremis. There was nowhere else to send them and so one felt bound to at least try to help. After all, they were very tough people and one was often surprised at their strength and the severity of the illness from which they could recover. However, a significant number of these did die post operatively for lack of an intensive care unit.

A young boy named Osman went home on crutches after an amputation. Even whilst in hospital, he was going down to the market on his crutches, enjoying his newfound mobility. However, the size of the tumor at the outset meant that it was highly likely the cancer had spread, even by the time we first saw him. We can only guess that it was an osteosarcoma as we did not have access to a pathology laboratory to confirm it. Well, after about six months, he returned, quite thin and the stump of the amputated leg was a bit swollen. We were 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 cancer to spread. There was nothing much we could do but to have a talk with him and his father, give them some painkillers, and send them home. We did not see him again and likely he has passed on. It is so sad as he was a neat kid and he was the only son to the father.

What helped you cope with a case like Osman’s? How did you confront the need to perform a debilitating amputation on a child whose ailment would be treatable (albeit serious) at home in New Zealand?

Even in a western country, this child likely would have received surgery, including possibly an even more extensive amputation. Whilst there are sophisticated bone conservation techniques, which together with chemotherapy mean that many fewer amputations are done now, I am not sure if Osman's football-sized tumor would have been suitable. Chemotherapy would have helped for sure though.

This kind of surgery was the exception rather than the rule. MSF's mission was to perform emergency surgery, so procedures related to cancer or reconstruction were kept to a minimum.

All the time, one would see patients who could be helped by the full western health system. Whilst it would have been wonderful to fly out those who could have benefited, there was such a huge number it would not have been remotely possible. If that resource was available, it could be argued that it would be better spent on public health issues such as malaria, TB, HIV, water and sanitation, immunization, and nutrition.

Most of the specialties were not represented, such as urology, gynecology, ear/nose/throat, radiology, etc. There had been a particularly nasty civil war in the country for around 10 years, during which time the health system had largely collapsed. There were hundreds of thousands of displaced people and no guarantee of lasting peace. MSF was offering basic health care starting from almost scratch. The hospital initially had no running water, toilets, electricity, telephones, or x-ray facilities, and only minimal laboratory service. By my departure, there was running water in the operating theatre, pit latrines, and a generator for night theatre work.

Did you see any signs that the population of Magburaka was recovering from the war? What are your hopes for the population you were serving in Magburak?

I think the following are promising signs:

• The building and renovation of houses. I don't think people would do this if they thought they were going to have to run into the bush again.
• Lots of kids in school uniforms going off to school in the mornings.
• All the IDP camps have now pretty much closed and their residents returned to their home areas.
• People starting to move more around the country.

I hope the cease-fire holds. The people all seemed so friendly that how such a brutal civil war could happen there almost defies explanation. I was conscious that long after the shooting had stopped, the collapse of infrastructure meant that the suffering of innocent population was going to continue for a long time. If the cease-fire can hold, there is the chance for other development agencies to assist and for investment in the country.

Another hope is that there can be reduced corruption, which was likely a big contributing factor to the war in the first place. If an example could be set from the very top down, that would be a good step.

I understand the country does have significant wealth, especially in diamonds and gold. But the government does not have good control over the. If this wealth could be channeled into reconstructing the country, that would be wonderful.

Any other comments you'd like to share about Sierra Leone?

Any westerner working in such a setting cannot fail but to be moved by the experience. Home is never the same again. The materialism and overwhelming choice, which western culture offers, may now become a nauseating experience. Our throwaway culture looks dreadful when one sees folks raiding the MSF rubbish pit to take away the aluminum cans to sell. Whatever creature comforts MSF volunteers might be missing from home, it is nothing compared to those of whom we are serving. It becomes a powerful experience when right under your nose.

I sometimes wish that I could pick up whole sections of the population from my own country and drop them in a place like Sierra Leone. All of a sudden, we might look at ourselves differently and might, perhaps, be very grateful for all we do have and start really living instead of feeling like some kind of victim in a land of plenty.

There is a hope that a few more of us might be able to reach out across the world, or perhaps just as far as a neighbor, to offer a helping hand. Why do we hold on so tightly to wealth and a sophisticated lifestyle, which so often only leads to unhappiness and worse? The people of Sierra Leone do a lot more smiling than we do back home.