Attachments
Introduction
Facing the challenges
One night while on duty Dr X, an experienced surgeon working in an ICRC field hospital in the midst of a civil war, performed a craniotomy on one patient injured by a bomb, an amputation following an anti-personnel landmine injury on another, and a laparotomy after a gunshot wound on the third; not to mention the emergency Caesarean section that arrived, as always, at the most inopportune time, after midnight. She was the only surgeon available that night. This was common practice at the time, and not very much has changed in the last thirty-odd years.
Standard peacetime health services are already limited or lacking in many low-income countries, and faced with the added burden of weapon-wounded they are quickly overwhelmed. A precarious healthcare system is one of the first victims of armed conflict: the disruption of supply lines, the destruction of premises and the flight of medical personnel are all too common.
The lack of adequate resources is not limited to diagnostic and therapeutic technologies. Above all there is a dearth of human resources. Surgeons trained to practise in multidisciplinary teams find themselves alone to face the entire surgical workload and deal with subspecialties with which they have, at best, only a passing acquaintance. Reverting to the philosophy, so common 50 years ago, of the multidisciplinary single surgeon who has to “do it all” is not an easy task.
ICRC teams usually include only one or two surgeons. They are generalists, able to treat all kinds of injuries from simple soft-tissue wounds to penetrating abdominal and head injuries and complicated fractures. They must also provide emergency non-trauma surgical and obstetric care for the civilian population in the area. Ideally, they should be very general surgeons with a broad approach and wide experience.