June 27, 2012 -- “They attacked the town,” said Dr. Jordy Cox, a Colorado-based trauma surgeon who was working in the Congo with Doctors Without Borders when civil war broke out in 2008. The rebels came but Dr. Cox’s medical team stayed. “We never left the hospital. There was actual fighting in the streets right next to us.”
When doctors like Jordy Cox travel to conflict areas, they typically bring along kits of medical supplies, such as those provided by Doctors Without Borders. But that's not all. Detonating bombs and insurgent activity can destroy fundamental infrastructures, like power grids, that make treating patients a major challenge. To that end, doctors often bring along their own personal equipment and tools. That way if the power goes out or computers are nowhere to be found, they're prepared.
Medical doctors with experience working in acute conflict areas describe here some of items they pack, just in case.
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Dr. Jacques Bérès is a septuagenarian French surgeon who has already sneaked into Syria several times this year to perform life-saving operations on dozens of wounded people. He had to pack extra light since he was crossing the border illegally.
"The risk is so important; it's impossible to have heavy luggage with you,” he said. One of the few things he did bring: a personal tourniquet. These devices apply pressure around a wounded extremity to control blood flow. “It’s such a pity to have to cry for a tourniquet in case of emergency bleeding.”
Dr. Cox, who has worked for Doctors Without Borders in several conflict areas, also packs extra tourniquets. “Especially if I’m going to an area that I know is potentially going to have bombs and explosions,” he said. “It’s a way of temporizing injuries.”
Lightweight Body Armor
Whenever tensions increase and fighting spikes, Dr. Cox slips on his own personal body armor and puts a sterile surgical gown over that. “It’s a level 3A, so it will take a direct impact from a 45-caliber,” he said. “They’re nice and light and comfortable.”
Dr. Cox said he’s careful not to make a big show of donning the armor. When underneath a gown, the vest is hardly noticeable. Despite its advantages, the armor won’t stop a direct hit from an AK-47, he added. That would go through the vest, through him, and out the other side.
In Syria, Dr. Bérès was able to find enough supplies to perform dozens of emergency surgeries, but there was nothing available for specialized surgical procedures. “That’s normal in war conditions,” he said.
One piece of equipment Dr. Bérès brought was his pair of binocular loupes, special small magnifying lenses fitted over glasses that are designed to help him perform microsurgery.
Dr. Cox normally wears glasses so when he performs vascular surgery to repair blood vessels he puts on loupes as well. “I take them because they’re mine,” he said. “They’re my prescription.”
Besides his binocular loupes, Dr. Bérès packed other tools needed for microsurgery that he knew wouldn’t be found easily in Syria. They include a needle holder and extremely thin microfilament sutures. “The very tiny, tiny stitch of microsurgery -- number 8- and 9-zeroes,” he said, “I used to not find them anywhere in the world.”
Dr. Bérès performs microsurgery because he doesn’t like to just stop hemorrhaging and repair broken bones without paying attention to problems such as nerve damage or internal lesions to a liver. If he doesn’t address those injuries, they may never be addressed.
“I don’t like to leave it,” he said. “It won’t be set up in the next month because people have to escape, to hide.”
Dermatome Skin Graft Machine
“Scalpels, and scissors, and needle holders, and stitches -- I will find it,” Dr. Bérès said. “I just have to bring very special brings which I would not find.” One of those instruments is a dermatome skin graft machine, a device that resembles a high-tech cheese slicer. With a lightweight dermatome, the surgeon can take skin grafts necessary for reconstituting burned areas.
While Dr. Bérès was in Syria last spring, the regular army attacked twice so he had to work quickly and couldn’t stay in one location for long time. “Altogether I performed only 45 operations in Idlib in two different places,” he said.
Before leaving the country, Dr. Bérès said he always gives the specialized equipment he’s brought to the people with whom he’s been working. It’s not fair to just show it to them, he said. “That’s not possible. We have to leave it.”
The first rule in a siege, Dr. Cox has learned, is to shut off the water and power to a city. In the Congo while he was there, fighting was at its most intense. The city was in flames and there were no lights.
“We’re operating with our head lights,” he said. “I always bring a very powerful head light.” Although he used to wear mountaineer headlamps, he now brings a battery-powered dentist’s headlight.
During that siege, wounded patients kept arriving so the surgical team operated nonstop for about 24 hours before the three men sterilizing instruments said there were no more instruments ready. They all had to wait a few hours.
“The machine went ding. The instruments were ready,” Dr. Cox said. “We started up again.”
In the United States, doctors are surrounded by nurses, systems and computer assistance. But in a developing country, having a medical handbook with basic reference information can be helpful, said Dr. Emmanuel d'Harcourt, the senior health director for the humanitarian aid organization the International Rescue Committee.
Dr. d'Harcourt, a pediatrician by training, has relied on a Johns Hopkins Hospital guide to pediatric diagnosis and treatment called the Harriet Lane Handbook. The book is named after Lane, who acted as first lady to her uncle, President James Buchanan, and left a generous endowment for invalid children to the hospital.
“That’s more for my personal need as a clinician,” Dr. d'Harcourt said. He got the book while in medical school at Johns Hopkins. “It helps you with things like how much fluid to give a kid according to their weight.”
Doctors Without Borders has medical standards that mimic those used in Western medicine. “It’s amazing how much quality care they provide despite the fact that we’re in extreme conditions,” Dr. Cox said. For example, the use of antibiotics in the field is highly regulated by clear scientific data.
In addition to his body armor, headlight, tourniquets and loupes, Dr. Cox also brings a pulse oximeter, a small, noninvasive tool for measuring a patient’s oxygen level. “MSF has their own but I just like to have my little guy that I can carry with me,” he said.
Dr. érès didn’t want to place too much emphasis on the specialized medical equipment that he packs. “The tools are not important,” he said. “The importance is to be with them during the bombing, or just after to help them. That’s all.”
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