08 Dec 2009 | Article

 

MSF surgeon Lynette Dominguez cleans the wound during an amputation of a 25year-old man's right hand. Photo: Jodi Bieber

People used to call it a dustbin, a place not worth stopping in for help unless they could afford to pay for hospital care elsewhere. But now, two years later the people of Dargai, a town in the Malakand District of Pakistan’s Northwest Frontier are able to put their trust in the Dargai Tehsil Head Quarter (THQ) hospital.

 

That trust and acceptance is evident as scores of people line the benches in the waiting area of the Dargai THQ hospital each day, seeking help when there have been traffic accidents, shootings or when everyday maladies take a turn for the worst.

 

Médecins San Frontières / Doctors Without Borders (MSF) started working in Dargai in December 2007, by establishing an emergency room and soon after an operating theatre, where trauma and elective surgeries are performed. A maternal and child health clinic was also set up to deal with complicated deliveries, while a 40-bed inpatient department was also built as a support service.

 

MSF is an independent medical humanitarian organisation relying only on private donations, and is the only international and private medical organisation providing access to free quality medical care while lending support to the national health structures.

 

Across the road from the small and unassuming Dargai hospital stands the skeletal hulk of a new three-storey, 120-bed hospital that has been under construction for almost a year. But the new hospital is no good to anybody just yet. It is in the two bed emergency room at the Dargai hospital where lives are saved, critically ill or injured resuscitated before being referred by ambulance to bigger and better equipped regional hospitals in Peshawar or Islamabad, respectively one and two hour’s drive away.

 

It has been a busy morning in the emergency room where two young boys, injured in road traffic accidents are being attended to by nurses and doctors and the corridors are bustling with several other patients and their various attendants.

 

Meanwhile in the hospital’s operating theatre next door MSF surgeon Lynette Dominquez is completing the last sutures during an appendectomy procedure, before moving on to another patient.

 

Although the majority of the surgeries here are elective procedures – like the 35 year old man whose appendix Lynette has just removed – around 38 percent of all the patients who make it onto the operating theatre table are emergency and trauma patients.

 

Lynette’s next patient is a 25 year-old local farmer, who needs to have the amputation of his right hand completed and surgical work done to repair the damage wrought by a hand grenade blast.

 

“He was angry at his wife and he threw a hand grenade at her. But a second after he pulled out the pin, his child walked into the room. He tried to put the pin back, but it was too late,” Lynette explains while she works.

 

The mother and child both survived with minor injuries. But the force of the blast ripped the man’s right hand apart, while shrapnel fractured his jaw and damaged his right foot very badly.

 

If the operation had to be done elsewhere, it would have cost the farmer and his struggling family between PKR20 000 (160 Euro) to PKR40 000 (320 Euro) for the first operation alone.

 

Many of the patients Lynette and anaesthetist Margarita Quilala, both from the Philippines, encounter have such tragic stories. “But you have to realise, it is part of saving lives. You don’t question how the patient comes to your table. You just deal with it taking one case at a time,” Margarita concludes.

 

MSF doctor Jonathan Starke, from South Africa, examines Kareem, aged 17, who suffers from Tuberculosis at the inpatient department of the Dargai Civil Hospital in Pakistan's North West Frontier Province. Photo: Jodi Bieber

Back in the emergency room, Dr Jonathan Starke, a South African doctor, is in the midst of trying to determine how best to treat an unconscious young girl named Rubina, who has just been rushed in. Despite her doting uncle carrying a bag containing dozens of bottles of pills, prescriptions and other medical documents, it doesn’t make it easier for Jonathan and other Ministry of Health doctors to diagnose the underlying problem. Rubina suffered from fits and the family took her to a local dispenser who gave her an injection upon their insistence. She vomited, collapsed and lost consciousness.

 

“We have no idea what kind of injection it was and it is difficult to determine if her condition is due to the treatment, or if it is because of something else. This is a difficult case,” Jonathan says.

 

As is the case elsewhere in Pakistan, patients are sometimes prescribed more medicines than necessary. Many patients often demand injections and several courses of medication, believing that a vast array of medicine constitutes a high level of medical care. The over-prescription of antibiotics in particular is a grave concern and it leads to patients invariably building up antibiotic resistance which means that fewer drugs are effective to battle infections.

 

“Antibiotic resistance is a huge problem. It means that you are left with a few remaining bacteria that are completely resistant to everything. And the next time when the patient gets sick there is nothing that will work because there are only a limited number of antibiotics available,” Jonathan says.

 

His next task is to join fellow MSF doctor Asmatullah Sayyed, on a ward round at the inpatient department where Kareem, a 17 year-old boy suffering from Tuberculosis is being treated in the isolation ward.

 

Kareem developed a persistent cough four months ago, suffered sudden weight loss and started feeling weak while he helped his father till the fields on a farm.

 

As the two doctors assess his condition, Kareem’s bright green eyes light up. He says he is feeling better even though he is confined to his bed. “I know more about my disease and I know how important my treatment is because of the doctors. My father is strong man, and I hope to be like him when I get better here,” Kareem says.

 

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