Idealism is not enough
I often get asked why I go there, even using my vacation time to do so. Probably all of us physicians, or at least most of us, began studying medicine out of a sense of idealism. I wanted to help. Later I discovered that physicians must work in an economically viable fashion, and that hospitals must be run profitably as well. You do not necessarily get prepared for this reality during your studies. As an intern you don’t really get the big picture yet either, but by the time you have become a specialist, at the latest, there are clear guidelines that you must follow. Since completing my specialist training, I have often asked myself how much of my idealism is still left.
Let’s go to Burundi!
During my studies I always wanted to join Doctors without Borders, but this is a highly regulated program. Your work schedule is very rigorous before and after your deployment. I ultimately came across a small, self-sufficient association that is active in Africa: Helping Hands. It only has a few members, but they all travel to Mauritania or Burundi on a regular basis to help out there. They simply do what is possible under the circumstances. I liked that. My first deployment was in February 2019, when I went to Burundi for the first time, a country I had heard nothing about to date. Shortly before my departure I packed everything that I found lying around in our practice here in Mosbach along with things hospitals and companies like Erbe had donated to us – instruments, metal plates, screws, bandages, electrosurgical equipment. In other words, everything a trauma surgeon needs to begin with.
The hospital in Burundi is located in the northern part of the country, far away from the capital city of Bujumbura; it is a facility with only very basic equipment.. In the two weeks I spent there on my first stint, I saw more severe injuries than I had seen here over the entire course of my career. I am a trauma surgeon, and we see a lot of horrible things, but many of the cases I have seen in Burundi even traumatize physicians like me. When accidents happen, which is a common occurrence, emergency care is often unavailable. Dealing with such injuries is all part of daily routine at the hospital in Kirundo. Open limb fractures, burns, infections, malaria.
Banking on our experience, we operate using a fraction of the resources available to us for such surgical interventions here in Germany, screwing on some metal plates with no real x-ray machine for orientation. This has got to suffice. We have no alternative.
Dr. Ralf Krych
A young man is admitted, having incurred a severe fracture of the femur weeks earlier. How did he even make it to the hospital, one might ask oneself. Banking on our experience, we operate using a fraction of the resources available to us for such surgical interventions here in Germany, screwing on some metal plates with no real x-ray machine for orientation. This has got to suffice. We have no alternative. The instruments provided to us by Erbe help us perform such interventions, however.
The encounters you have haunt you
After a long day of performing surgeries, improvising along the way, my colleagues and I stand around in front of our rented house and drink a beer. After a short conversation, we go to bed and fall into a deep sleep. It is strange that one sleeps so deeply after such experiences. Does it have something to do with the tropical climate? The encounters you have haunt you. I often ask myself question upon question. Could I have done more for the patient? Could I have helped her in some different way? What did you become a doctor for anyway? You should know what to do! I now make a point of not finding out the names of patients with really terrible diagnoses. Otherwise I would never forget them.
Two-week stints in Africa go by quickly. I have never counted the number of operations we perform during such a stint. How many patients were able to go home, but also how many died after my return to Germany. Our team cannot always be there; we all have jobs here in Germany. For this reason, the last few days before our departure are particularly demanding. We must make grave decisions and leave behind patients who have just been operated on, placing them in the care of African colleagues with less experience and fewer resources. Uncertainty is a constant companion on the trip home to Germany. But also the good feeling of having been able to save a few human lives.
I will fly to Burundi again as soon as the Corona pandemic allows for it. I will return to this beautiful country with all its friendly, open people. Back to the patients who suffer and must endure so much more than those of us here in Germany. In light of all the experiences I have had as a doctor in Central Africa I am glad to have a family back home that supports me in everything I do, and that honors my reasons for doing it. That gives me an enormous amount of fortitude. My eldest son is now thirteen years old. He said he would like to accompany me on my next trip.