Doctors Without Borders surgical field hospital in Mocha under construction photo was taken July 2018. Following the recent offensive by forces loyal to President Hadi and supported by the Saudi and Emirati-led international coalition on Hudaydah, Médecins Sans Frontières (MSF) has opened a 20-bed surgical field hospital in Mocha, 180 kilometres south of Hudaydah, to respond to increased medical needs. © Nuha Mohammed/MSF
Dr Ryan Ko, a Hong Kong surgeon with Doctors Without Borders, has worked in 15 missions in nine countries. © Dr Ryan Ko
One of the situation at the emergency room of Doctors Without Borders' surgical hospital in Mocha. 12 December 2018. © Agnes Varraine-Leca/MSF
However, chronic and long-term war and conflict limit the development and acquisition of new skills which are essential for medics. The availability and access to medical training is seriously lacking. That’s why capacity building and sharing of our knowledge and experience with our colleagues in the field is one of the less talked about but essential responsibilities of field workers like me being deployed to the field. I felt that surgeons from Hong Kong like me are in a position to impart our expertise, given the standard and quality of skills we have been able to acquire. We can support the aim of ensuring that our fellow medics in war zones can run the hospitals on their own with confidence.
We strive to provide a high standard of medical care. And supporting our colleagues with training, workshops and coaching to upskill them would mean that we could help more patients at a time of distress. So in the three months I stayed in Mocha, I had some very good and friendly knowledge and experience exchanges with my colleagues in every area possible, including wound reconstructive surgery.
This procedure was completely new to them so I needed to train them in a more systematic way. After the training sessions they practice flap surgeries, a technique that is typically used to repair defects left behind after traumatic injury. During my time there, the team conducted 45 flap surgeries which benefitted 42 patients with very good results – shortened hospital stays and fewer follow-ups. The wounds healed well and lots of patients avoided the amputation of limbs, which can seriously affect the mental wellbeing of patients and their loved ones. This procedure would have been especially beneficial to the hospital, given the immense number of trauma patients we saw every day. So this new skill acquired by our surgeons brings relief to patients and also prestige to them as professionals.
At the same time, we built the capacity of the team on diagnostic ultrasound dedicated to identify trauma bleeding in the abdomen and chest. In the surgery world it’s known as extended focused assessment with sonography for trauma (eFAST). In a humanitarian surgery care settings, where patients present with major injuries, this skill can improve decisions on what could be the appropriate course of action for our trauma patients. This capacity building was also extended for our medical doctors, especially for those working in the emergency department where initial assessments of our trauma patients were done.
Within a short period of time, I was very happy to make a difference by imparting my experience and knowledge to our colleagues in the field. They are the staff with the constant presence to care for people and communities in the midst of war and violence.Dr Ryan Ko
I have also shared my perspective as a surgeon on wound management. Since the hospital handles mostly patients who need ongoing treatment of their wounds, it is essential that our teams are able to provide the best care for healing and to prevent the breakdown of skin.
It is equally important for our nurses to be provided with new knowledge. We worked closely with those in our various wards (operating theatre, outpatient, and inpatient) on nursing care for flap surgery. Apart from concepts and theories, whenever I had time I accompanied them in their daily care of these patients.
