Maban County Hospital, South Sudan
3 October 2012
Dr. David Hardin
Editor’s Note: The story you are about to read requires a little background. As we reported in previous Africa Messengers, the Jihadist NCP government in Khartoum last year launched a massive offensive in the northern Sudan states of Southern Kordofan and the Blue Nile. In the Blue Nile town of Kurmuk stands a hospital that has been administered by PPF partner Samaritan’s Purse (SP). As fighting intensified in August of 2011, NGOs pulled their staff out of Kurmuk – with one exception.
Dr. Atar is a South Sudanese physician and has worked in the Blue Nile for many years. When the evacuation flights arrived to remove all staff, Dr. Atar refused to leave his patients. He soldiered on alone in Kurmuk until November, when enemy troops finally launched an attack against the town. Thankfully, Dr. Atar was able to escape. With the hospital in Kurmuk lost, SP was invited by South Sudan to administer the Upper Nile State Hospital in Bunj, where thousands of refugees from the Blue Nile conflict were gathering.
Fast forward to October, 2012. There are now more than 120,000 Blue Nile refugees in Maban County where Bunj Hospital is located. An additional 30,000 refugees are expected to arrive at the start of the dry season. PPF President Brad Phillips visited the hospital in October, ahead of a shipment of medicine donated by The Voice of the Martyrs that PPF has since delivered to Bunj as well as to the SP hospital in Yida to the west.
While in Bunj, Brad met Dr. David Hardin, who recently volunteered a month of his time to give Dr. Atar some much-needed leave. Dr. Hardin related to Brad this amazing story of a miracle that had just happened in the hospital, and we wanted to share Dr. Hardin’s story with you. You can follow Dr. Hardin’s work by visiting his website at Hardinfamilyblog.com.
We praise God for the unsung heroes like Dr. Hardin, Dr. Atar, and all the folks at Samaritan’s Purse, who PPF has the pleasure to partner with in active compassion for the persecuted. Please keep these dedicated servants in your prayers.
The day started out last night. It is still the rainy season. We had a hard rain that left everything muddy, but it cooled the temperature down very comfortably….
While I was still seeing patients on the wards, the S. Sudan Police brought in a fellow police officer who was shot through the chest with an AK-47. He had a wound in his left chest near the nipple and a second wound on his back just to the left side of his spine.
In trauma, we call this an injury to “the box.” These are often lethal. The patient did not have any breath sounds on the left and was having difficulty breathing. The patient needed a chest tube placed to drain the blood out of the chest and re-expand the lung. There weren’t any chest tubes. We improvised a chest tube out of a foley catheter bag. It worked well. The tube was already connected to the bag which made it even easier. I placed fenestrations on the tube with scissors and inserted it. The patient had some relief breathing, but the amount of blood returned was ominous. The bag drained nearly two liters of bright red blood. When I emptied the bag, it began to fill again. We do not have the ability to measure a hemoglobin or hematocrit or a complete blood count. In some ways, it makes things easier–the algorithm is pretty simple and short here.
The patient began sweating and asking for something to drink. The is the last thing I have heard many patients say as they bleed to death. Often, shock causes the patient to have immense thirst. The patient’s blood pressure dropped into the 60s and his heart rate rose into the 140s. He was bleeding to death.
At this point, a huge crowd had gathered. Some crying, most just taking up space and adding to the confusion. I told all the family and the patient’s fellow police officers to queue up next door at the lab and go donate blood. I explained that the man was dying and if he did not get blood quickly, he was not going to live much longer. I think much of the family was resigned to the fact that the patient was going to die.
An interesting thing happened. Isaac and Camille Hatton are visiting here for a week. Isaac is a third year medical student, and Camille is a nurse training to be a midwife. Both of them are blood group O blood types. This means they are universal donors. They both walked over and donated 500ml of blood each. One of the hospital staff noticed the people around talking. Apparently, Isaac and Camille’s gift had not gone unnoticed. Soon after, a large line formed and we had no lack of blood after that. It was well needed. The patient required over 4 liters of blood.
In the United States, a patient who has lost two liters of blood would be taken to an operating room. He would be put to sleep and an endotracheal breathing tube would be placed. We did not have a ventilator here. We did not have an endotracheal tube nor did we have any thoracic equipment. We also do not have general anesthesia, and we cannot do a thoracotomy under spinal anesthesia. I asked the OR staff if they had ever done a chest operation. The answer was “No.”
I was not really sure what to do to be honest. The man was dying. More blood was coming out of the tube than we could pour in his IV through transfusions. He was fully conscious, and his family wanted to spend time with him. His wife was sitting with a baby who was about 18 months old at the bedside. The wife had the baby sharply dressed in a double breasted suit. I did not want them to be robbed of their last minutes together. I went to the corner of the room and prayed and gathered my thoughts. I pulled the trigger, and we loaded the patient on a worn out stretcher and took him to the operating theater.
By the time we got the patient on the table, the patient was unconscious. I could barely feel a pulse; his oxygen saturation was in the 30s. Saddiq, my assistant, gave ketamine sedation. I did an anterolateral thoracotomy and opened the chest. The lung was bleeding. I oversewed the lung as best as I could. We placed three improvised chest tubes and then closed. The wound went from the patient’s sternum to below his armpit.
When we finished, I could not see any more bleeding. I knew we might win when the bleeding was stopped and the patient asked if he could have some porridge. I have never sewn up a patient’s lung and had the patient ask me if he could eat. Saddiq asked the patient who had shot him. He said, “Finish up, and I’ll tell you later.” We finished up with close to 3 liters of blood on the floor and suction canisters. We improvised underwater seal chest tube bottles out of used suction tubing and suction canisters.
We brought the patient out of the operating theater and were met by a large crowd. I told them the man had lived and that God should be thanked as He had allowed the bleeding to slow down. I asked if we could pray for him. Saddiq was translating. They told Saddiq they were all Muslims. Saddiq said in Arabic, “It’s okay, I’m Muslim too.” They all bowed their head, and I thanked the Lord for what He had done and asked Him to save the man’s life for His Glory and that He alone be glorified in this.
At 8pm tonight, I walked over to the hospital and checked on our patient. As of now, the bleeding has stopped. The patient is awake. He says he is doing well but is having a little bit of pain. He is eating porridge. To God be the glory!