Yemen is a “young” country: 40 per cent of Yemenis are under 15 years of age. Only 3 per cent are over 65. Australia, on the other hand, has an older skew. These age profiles are then reflected in the patients that healthcare professionals see. Yet for anaesthetist Richard Lees, this coloured his time in a way he hadn’t predicted. Richard Lees is on his first mission with Médecins Sans Frontières in Khamir, Yemen.
“About 50 per cent of the patients I saw were paediatric. At the other end of the spectrum my oldest patient was 70, and quite often in my normal work in Australia all my patients are older than that. In Khameer we treated many cases of appendicitis, but it was also interesting to deal with young people who have been injured. In any country, younger people have a lot to offer. I got a lot of satisfaction from the idea of making a difference when someone’s young. But I also learned that sometimes it’s just not possible.” One day during Richard’s placement two young men, both in their early 20s, arrived one after the other, shot in the stomach. Every patient who has been shot receives damage control surgery first. The surgeon operates on the immediate, life-threatening aspects. Having survived this and then stabilised, the patient undergoes multiple subsequent operations to complete the repair and reconstruction. This has become the standard treatment of trauma worldwide. The first man responded to his initial surgery extremely well.
“The two young men had the same injuries on surgical findings, but there were tragically different outcomes."
However, “The second young man had been shot a few hours before coming to the hospital. His surgery was fine, but we were unable to wake him up and to take him off the ventilator. He developed multi-organ failure while still in the operating theatre complex. In Australia I would send the patient to intensive care while still on the ventilator but in Khamir there are no facilities for longer term ventilation. So we kept him in the operating theatre under intensive care, and I looked after him for around five hours, while surgery continued in the other theatre. When it became apparent that he wasn’t going to get better on the treatment that we could offer him, we decided to transfer him.” For security reasons, as a non-Yemeni, Richard was unable to make the trip, but the well-established referral system assigns a referral nurse with each patient.
Richard recalls the mixed emotions of that day. “The two young men had the same injuries on surgical findings, but there were tragically different outcomes. The man we transferred to Sana’a never got there; he died in the ambulance. Perplexingly, the man who had had the operation before was fine. That’s when you want more of an intensive care department, with more monitoring and the ability to do investigations and provide further organ support.”