James Cogbilll, MD, crouched quietly in a stripped down ICU in Rutshuru, a town on the eastern border of the Democratic Republic of the Congo (DRC). Huddling together with the ED nurses and several patients, he listened as gunshots blasted, wondering if the shots came from within the hospital compound. He’d heard plenty of shootings in the neighborhood of his emergency department in Saginaw, Michigan, but these were different. These shots, fired from fully automatic weapons, followed rapidly one right after another without a pause, signalling that though the Second Congo War was over, the fighting was not.
5 months earlier, Jim Cogbilll had approached the president of his group about taking a six month leave of absence in order to serve. Not only did the president allow it, says Cogbill, but everyone he spoke to in his group was understanding and encouraging. He completed the application and then interviewed with Medecins Sans Frontieres (MSF). When they asked him whether he was comfortable serving in a unstable area, he answered yes, wanting to serve wherever he was most needed.
Following the attack that day in Rutshuru, two trucks from a nearby military base brought about 15 injured soldiers and civilians to the hospital compound. Cogbill was no stranger to ballistic wounds, but this was his first time treating wounds inflicted by AK-47s and shrapnel. Violence deriving from the Second Congo War still erupts in this border area of the DRC even though the war supposedly ended in 2003. The Second Congo War is the largest war in modern African history and is the deadliest war since World War II, mainly due to deaths by disease and starvation.
Besides AK-47 wounds, the ramifications of the war were obvious in the clinic. Patients presented with tetanus, malaria, rabies, and cholera, diseases aggravated by the disruption of livelihoods and health systems. In fact, towards the end of Cogbill’s stay his medical station dealt with a cholera epidemic, partially owing to a new group of refugees moving into the area. Around fifty patients a day showed up at the clinic, testing its surge capacity.
“We set up beds and tents all over the place,” Cogbill recalls. “The equivalent would be setting up tarps in our hospital parking lots here which wouldn’t go over so well here. The Congolese people were able to put up with things we wouldn’t.”
Untreated cholera typically results in mortality rates around 50% (up to 90% in epidemics). Thanks to the efforts of Cogbill and the other MSF staff, the mortality rate during this epidemic was less than 1%.
But many in the Congo still die of preventable diseases. A survey released this past January by the International Rescue Committee (IRC) with Australia’s Burnet Institute, said that war, disease, and malnutrition kill 45,000 Congolese every month. Congo spends less money on health care than any other country in the world, at $15 per person per year. In comparison, the United States spends $6000 per person per year.
Wanted: Emergency Physicians
If you go to MSF’s American site (doctorswithoutborders.org
) and click on the link for physicians to volunteer, you will notice something interesting. The first specialty listed under the heading, “MSF is particularly seeking the following,” is “emergency medicine physicians.”
According to Cogbill, this is because emergency physicians are uniquely well-equipped for this type of work.
“We’re used to dealing with all sorts of people, young and old. We’re used to seeing all different maladies from viral infections to people shot in the chest. We’re also adaptable and will do things when we don’t necessarily have the perfect equipment.”
For example when a patient presented with facial lacerations that in the states would go to the OR to repair, he just sewed them up to make the best use of the clinic’s resources.
Cogbill found that his experience in the field improved his practice on his return. The medical center lacked many of the tests and equipment found in a typical U.S. ED and Cogbilll learned to rely on his skill as a diagnostician. On his return he found himself more confident in his ability to make a diagnosis.
And the two resident Congolese doctors benefited from Cogbill’s experience and training. For example, He taught them how to use hematoma blocks to ease a patient’s pain while setting broken bones without anesthesia. Cogbill plans to take another trip through MSF, once he can manage to get some additional time off. MSF requires a doctor to commit to a six month trip for their first time, but following the initial trip, shorter opportunities can become available.
To find out more about serving abroad through MSF, go to www.msf.org