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Stanford Q&A: Surgeon discusses Doctors Without Borders work in Ivory Coast

STANFORD, Calif. - Sherry Wren, MD, professor of surgery at the Stanford University School of Medicine, spent five weeks this summer in the Ivory Coast as a volunteer surgeon for Doctors Without Borders.

Since 2002, the country has been embroiled in a bloody civil war, fought over religious and tribal differences. The rebel-controlled northern region has descended into chaos, with no civil infrastructure remaining, said Wren, who worked at a hospital in Bouake, the region's largest city with a population of a half-million. Most of the hospital's senior physicians fled to safer parts of the country when the civil war started; left were inexperienced surgeons, akin to junior residents in the United States.

In 2002, Doctors Without Borders took charge of the hospital and with it much of the region's health care. Wren recently gave a lecture on her experience there and afterward did an interview about the hospital and the patients. The following transcript is adapted from those comments.

Question: What did you do at the hospital in Bouake?

Wren: My role was twofold. I was there to supervise all the surgical care - to teach the local surgeons who had been caught in the middle of their training when the civil war occurred. The second thing was to provide surgical care. I saw gunshot wounds, stabbings, tons of motor vehicle accidents, a lot of pediatric cases, typhoid, cancer, hernias. It's a different way of practicing because we didn't have the resources you'd have in a normal U.S. hospital. There was no sink; we had kind of a jury-rigged hand washing system. One of the hardest things was that we could only offer surgical care to people with true emergencies. I'd see people who had a problem I knew we could fix, but if it was not an emergency, we could not take care of them.

Q: What are the cases that hit you the hardest and that you still think of today?

Wren: One case was something I'm so incredibly proud of because it was so beyond my comfort level - it's nothing I would ever do in this country. I had a man who had an AK-47 wound, who basically lost the left half of his face. I thought, 'I'm in the operating room. I can name every bone that's missing, I can name which part of the sinus is gone. I can see the orbit of his eye falling down. But what am I going to do to fix it?'

The man was in the hospital the whole time I was there. Each week I could see what happened to the repair I had done. Part of that was incredibly frustrating because he was missing a bone that makes up the bottom part of the orbit, and we didn't have anything to substitute for it. But when I compare what his face looked like when he arrived with what I was able to reconstruct - at least he looks normal enough to get by in society.

Q: What about all the children you treated?

Wren: Cases that were really hard were childhood cancers. I saw kids come in with sarcomas, which are soft tissue tumors that usually affect their legs. The most frustrating thing for me was that all we could offer them was an amputation. And then we'd send them home to die. There was no chemotherapy, there was no radiation and there was no cancer center to care for these beautiful children with these horribly disfiguring tumors. Of all the things that still haunt me, that was the hardest. Cancer is what I treat on a daily basis, and there I was just stuck with it - doing nothing.

Q: How was the transition back to California, especially in terms of practicing medicine?

Wren: Upon returning, one of the first things that struck me was when I went to the operating room and looked at the supplies. We had 50 different types of suture, we had stapling devices, we had everything. A few days after I got back, the hospital installed a surgical robot, which costs about $1.6 million. The whole budget for all the health care and all the staff and all the drugs that we used in Bouake was about $1.9 million. We're spending $1.6 million on a robot, and yet you could do other things with this money. I believe our patients here deserve the best care we can give them, and we have so much technology that makes doing surgery faster and easier. But without all that technology, I was still able to provide outstanding surgical care and do those things also - they were just harder and they took longer. In some ways it's still difficult to think about what you have here versus what you don't have in other places, like Ivory Coast.

Q: Do you feel you made a difference?

Wren: Whether you make a difference or not is such a tough question. I wish I was going to be the person smart enough to invent something or do something that would save millions of people. That's just never going to be me. But I can impact people's lives one at a time. When I look at a 7-year-old boy who is going to die if he doesn't have an operation, to that kid, to his family and to everybody who loves him, what I can do makes a difference. While over there, I faced huge language barriers - many of the people didn't speak French let alone English and instead spoke different dialects of African languages - so I could not talk with them at all. Yet 'thank you' in whatever language seems to be the same.

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