Doctor adapts skills to refugee camp needs

Sherry Wren

A patient at a Doctors Without Borders hospital in the Democratic Republic of Congo braided hair while recovering from surgery by Sherry Wren of the medical center. The woman had severely fractured her ankle in a truck accident. To see more photos, click here

The photos Sherry Wren, MD, brought back from the Democratic Republic of Congo aren't your typical summer-vacation shots.

On her computer screen, an armored personnel carrier lumbers down a rutted road. She scrolls to another page, which shows an 8-year-old boy with an infected gunshot wound on his leg. 'It's from a high-velocity military weapon that makes a big hole when it comes out,' Wren explains. 'The exit wound is really bad.'

Wren, a professor of surgery and associate dean of faculty affairs, recently spent her third summer in Africa with Doctors Without Borders, an international medical humanitarian organization that helps people in some 60 countries. After previous stints in Ivory Coast and Chad, she went last summer to the DRC. 'The Congo is the most under-reported humanitarian crisis, with 6 million dead, millions displaced and thousands dying each day.'

Assigned to Rutshuru hospital in North Kivu province, near the Rwandan border, Wren spent four weeks doing caesarean sections, skin grafts, amputations and orthopedic surgeries - many without benefit of high-tech instruments and resources available in the United States. 'You have no idea how physically hard it is to crank a six-millimeter pin into someone's femur with a hand drill,' she said. 'And I'm strong.'

A specialist in gastrointestinal cancer surgery as well as a general surgeon at Stanford Hospital & Clinics, Wren scrubbed in with Stanford colleagues in obstetrics, orthopedics and plastic surgery to prepare for the range of surgeries she would have to do in Congo. But much of the care she provided was more fundamental. 'There are minimal lab tests, and you're really doing things the old-fashioned way: you touch the patient and talk to the patient.'

Because she spent every other night in the hospital, Wren said she also had opportunities to talk with her patients and with the relatives who cared for them. One woman arrived with a fractured ankle and stayed on, recuperating and braiding other patients' hair, for a month. 'We'd all sit outside the hospital at night, on benches, and just talk,' Wren recalled. 'I speak French like a 5-year-old, and they mostly spoke tribal or regional dialects, so the translators were busy.'

On occasion, Wren said she also had to make decisions about whether to perform certain procedures. 'In Congo, where rape is used as a tool of war, you see women with fistulas that are difficult to repair,' she said. 'And you have to decide, 'Am I going to do more harm, doing something I'm not prepared for and don't have resources for? Or am I going to do more good by choosing to do a surgery?''

Although Wren, chief of surgery at the Veterans Affairs Palo Alto Health Care System, did some teaching about how post-op recovery is approached in the States, she calls herself the 'ultimate student,' learning much from the nurses she worked with. 'They know all the local diseases and the weird complications of sickle cell anemia.'

Because of her summer missions with Doctors Without Borders, medical school students often turn up in Wren's office to ask about doing similar public service work. 'There's a lot of interest in doing international medicine, but I'm not sure students have quite matured in their thinking about how they're going to do it,' she said. 'I do it once a year, and that's easy. But how do you build a practice, how do you put food on your table, how do you have a family? I think they don't quite understand what the parameters mean.'