Médecins Sans Frontières (MSF) is running an operating theatre and a post-operative care program in Pompaimadhu Ayurvedic Hospital, in northern Sri Lanka. Many of the patients have been referred to the MSF team from the camps and the Vavuniya General Hospital. Tim Pruchnic, an MSF surgeon who has been working in Pompaimadhu hospital since May, describes his experience. We now have 180 patients in Pompaimadhu and the hospital is full. A lot of our patients have chronic wounds like pressure ulcers and amputations which are healing poorly. There is a huge need for physiotherapy. Everyone has joints that don’t move well and fractures that are not healing. The MSF team is comprised of nine international and national medical staff, a team of caretakers, and eight counselors. We are working alongside Ministry of Health staff. I am the only surgeon working in the hospital and I do an average of 16 to 20 surgeries two days per week. Some of them are major surgeries such as revisions of amputations that haven’t healed, and then there are smaller procedures like taking off external fixtures and cleaning up wounds. On the other days, I do ward rounds. One of the major procedures we’re doing is a reconstructive plastic surgery operation called a muscle flap surgery. This two- to three-hour surgery allows us to save infected legs that have been injured in shell blasts, legs that would otherwise have to be amputated. We have done this procedure 20 times now and so far it has been really successful. The first patient we did this operation on had been injured by a big bomb blast, which tore out a chunk just below his knee – he had almost no bone left. Now he is walking again and today we decided that he has improved enough to leave the hospital. It’s amazing what a big difference this can make: some nursing, some physiotherapy to keep their joints moving, and some moral support.

We have set up a spinal cord unit here and we are now the main provider of care for spinal injuries in the district. Other hospitals transfer their patients here, and we now have 50, most of them adults between 20 and 40 years old, who were injured by shell blasts in the conflict. Two patients are paralyzed from the neck down and the others are paraplegic, paralyzed from the waist down. There are two or three lucky ones who only have temporary damage and the physiotherapy sessions are helping them get their movement back. It’s great that they’re all here because it means they can all be treated together. They have wounds that will heal with good nursing. We have taught their relatives how to turn them in their bed and care for them, and when necessary we treat their sores in the operating theatre. The counselors talk to them and help them find ways to cope emotionally. People feel better when you work with them even if they will never regain their movement. One patient I see every day in the hospital has really stuck in my mind. He is about 20 years old and he was in the conflict zone when a shell landed on his legs. It did not explode but it did crush both legs. When he got to Pompaimadhu we saw he’d had two amputations. They hadn’t gone well and so now the bone was sticking out and he needed further surgery. We redid both amputations so everything is nice and clean now, and maybe one day he will walk on them. When we asked him what had happened, he told us about the shell and the funny thing is that he smiled about it, as if it was a good thing. And we were like, why? And he said: “The shell landed on my legs. It did not explode. If it had exploded, it would have killed my whole family.” It is one of those stories that make you think, “Wow, how amazing! He has no legs, but he is thankful because it did not explode.” You might think how depressed you or I might be in his situation, but he gets in his wheelchair and he goes off and is thankful for everything. Despite all the bad stuff that happens, it’s amazing what you can be thankful for.

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