Trauma surgery in the Congo
Tuesday, December 01, 2009
Speaker Mr. Nott.
Trauma Surgery in the Congo
This was a rare opportunity to hear
a very brave yet modest man speak of his experiences with the medecins sans frontiers organisation with whom he voluntarily
spends one month every year. .For the
rest of the time he operates as a consultant general and vascular surgeon at
the Chelsea and Westminster, Charing Cross and Royal Marsden hospitals.
He was originally trained by the RAF.
When the time for his service
approaches he is telephoned with the place where he will be needed. This turned
out to be an impressive list of the most dangerous and horrifying spots on
earth, comprising Sarajevo, Kabul, Khandahar, Basra, The Ivory Coast, Chad,
Darfur and of course the Congo. The procedure is that on arrival he will liaise
for two days or so with the doctor who is about to leave, and having acquainted
himself with the situation, he will then operate and most importantly train the
locals, doctors, midwives and nurses,
so that after five years the medicins
can leave the local medical teams in charge. Occasionally he gets in some
sightseeing, such as a trip along the Khyber Pass.
I must also mention here that the power of his photography almost
allowed us to be among the sweat-soaked surgeons and smell the suppurating
wounds and the foetid air in the 55 degree un-air conditioned operating
theatre. The jungle with its ticks and
flies seemed to press in.
Mr. Nott spoke first of other
ghastly situations, such as the Yemen, where he locked himself into the
operating theatre as he feared being kidnapped. There were also the wild white-clad, bushy bearded doctors in
Afghanistan who needed some taming and restraining from their frightening
methods. They appeared to have
appreciated it.
However, heart-rendingly sad were
the pictures of the two million hungry
refugees from the Jinjaweeds, the
Arab mounted militias intent on robbing them of their livelihoods, and raping
and killing them in the process, snaking their way across the arid terrain of Darfur.
Here he operated on twelve and fourteen year olds, victims of rape who had come
to term, but due to their narrow pelvis the baby was obstructed and almost out,
the girls dragged their way, sometimes taking four days, to the makeshift
hospitals, for help. Many died on the
operating tables. He did caesarean
sections, which he had perforce quickly to learn, as in the UK they do not form
part of his work.
One should mention that medecins sans frontiers did ship out
equipment and drugs where possible, all donated by the charity.
I come now to the central subject
of his talk, the Congo. He recommended
a book by Tim Butcher, Blood River, for a very accurate picture of the
rubbish-strewn towns such as Goma and the horrors perpetrated in that achingly
beautiful country.
As you will know, the fighting is
mainly between the government of the Democratic Republic of the Congo and the
rebels, intent on taking over and in the process getting their hands on the
considerable diamond and gold reserves. I believe Zimbabwe is also involved, as
are the Tutsis and Hutus from Rwanda whose battles spill over into the
territory. Here he found himself operating in dire surroundings with blood
swilling on the floor and the small recovery room packed with twenty patients. It was pitiful to hear of the mother
suffering from malaria, where the blood does not clot, and her ten children
lined up to give their mother life in the form of so many units from each.
The story carried by press and TV
was of the sixteen year old boy whose arm had been torn off, hacked off by
pangas or machetes, I know not, and who would die in a day or two. Mr. Nott was unsure of the procedures and
therefore decided to phone a professor in England. He, as you will recall,
texted him instructions. The result was
a removal of the arm and scapula and the very neat stretching and sewing of the
skin over what had been his shoulder.
He recovered and one hopes he lives.
Many times when operating on the
flow of routine cases, gunships would circle overhead and rain bullets
indiscriminately. At the same time fighting would break out around them, often
causing the surgeons to duck, and soldiers and civilians with children were
brought in with the most fearful injuries.
These were often caused by illegal dum dum, low velocity bullets, which
shatter the flesh instead of passing through.
I cannot adequately describe the dreadful pictures which showed, in one
case, a stomach wound from which the intestinal worms were wriggling. One day,
they operated for twenty-two hours without ceasing. The adrenaline kept them going but on one occasion when he came
home, at a debriefing, he collapsed in tears and suffered PTSD.
Enough of the horrors, what caught
my attention was Mr. Nott’s remark that
‘Man is a dangerous animal’ and it
is only the front cortex of the brain controlled ‘by police and governments’
which prevents us from descending to that level. Now briefly, in mature learners the frontal lobes of the cerebral
cortex become active, together with other parts, when asked to empathise, make
predictions, reason …think creatively and make complex decisions. The posterior
parietal cortex handles sensations, sounds, sight and touch. However, the development of the frontal
lobes of the brain lags behind in teenagers and sometimes even of those up to
the age of twenty-five. This means that
they are often not in control of their emotional reactions and impulses until
later. *
Could then this explain the actions of the fighters, who are mostly
young, and the instigators of the massacres who are often mature, and seemingly
evil? The philosopher J-J, Rousseau
{1712-1778} said that ‘morality and self restraint develop through education in
a civil society and substitute justice for instinct’.
The audience was much moved when we
thanked Mr. Nott for his challenging talk.
{* Terry Horne,
Simon Wootton and Susan Greenfield.}
Hans Danziger.
.
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