Friday on the news, I heard about the death of Dr. Gino Strada, Italian surgeon and founder of the medical NGO Emergency. He was 73. He’d worked in war zones including Afghanistan and Rwanda.
Wait a second, I think. So up to the attic, to a box of cassettes. One has Kigali hospital scribbled on the label. I play it. Yes. In September 1994 Dr. Strada showed our group of journalists and Canadian Forces officers around the hospital.
I’m a war surgeon
“My name is Gino Strada. I’m a war surgeon. I’ve been here in this hospital since the beginning of July.
This was quite a peculiar war. The ratio between the killed and the wounded was rather different. Here they had more than a million deaths and the weapons used were mostly machetes to wound people. So compared to other places, say Afghanistan, much less mine injuries and shelling injuries and much more people injured by knives or machetes.
This is the surgical department. Here you have basically two categories of patients. Either war wounded or surgical emergencies like car accidents. I would say about 80 per cent war wounded and 20 percent car accident or other emergencies.
Even now? After the war has ended? Yeah, well, now you have all the people who have come back with old injuries or needing reconstructive surgery or stump revisions to fit protheses.
And you have the fresh cases, the fresh war wounded, wounded by mines. Like this girl here. She’s 18. She went back with her family to the house. She was the first one to walk on the path, and she stepped on a land mine. Her sister died here in the hospital three hours later, from penetrating shrapnel. She has bilateral above-knee amputations. Her father was injured also. It’s the usual sad story of this inhumane weapon that kill civilians.
When was she hurt? I think it was the first, second of August. Now she’s here, ready for physio. She’s okay, the stumps are clean. She just needs to do some physio to fit prostheses.
Some, like that man over there, both hands were blown off. There are no hand prostheses here. The only thing you can do is a lay procedure – make kind of chopsticks that can hold a fork or a pen or whatever.
We had about 45 mine injuries in the month of August, from the war. 44 civilians and 1 soldier, which is more or less the exact proportion that happens normally with this weapon. I know it is difficult to talk about land mines in front of military but I think we all agree these are absolutely inhuman weapons.
Particularly the indiscriminate laying of mines. Well, as far as I know, there is no discriminate use. When you start to scatter land mines by helicopters, how can you know where they go? You fly a hundred metres higher, you have an umbrella much wider. So it’s an excuse, this distinction. Nobody knows. You know better than we do, nobody’s mapping where the land mines are. Particularly the irregular armies – they just throw the mines wherever they can.
For the moment, the hospital has open four basic departments: surgery, and this is the general medicine. The other side is the paediatrics and the maternity. We are in charge of surgery and maternity.
Who is we? Emergency. Yes, your t-shirt, ‘Emergency – Life support for civilian war victims’. It’s a new organization. The headquarters will be in Geneva next month. At the moment, it’s still in Milan. We only established it six months ago with the idea to have an organization with political independence that doesn’t accept funds from the government. We rely only on private donations. We want to have an organization composed of professionals in this field.
I’m not interested in those who want to have a 3 month adventure experience and then they go back to their private practice. I mean, it’s much better to try to build up a group of people who want to do war surgery, surgery for victims of war, on a regular basis, as a professional choice. Because this is a difficult discipline.
To do war surgery is to do something completely different from surgery. It’s a different job that you have to learn. So you have to spend a lot of time always working in this kind of situation to gain experience.
How long have you been doing war surgery? Since 1987, almost by chance. I’d been sent to the border between Pakistan and Afghanistan, and I found it extremely interesting even from the surgical point of view. If you really do your job and you’re dealing with your patients, your clients, it’s very stimulating. You learn to do surgery with a Swiss Army knife and a couple of ampoules of ketamine.
Working in a ruined hospital
We didn’t want to reopen all the services in the hospital because we had no means to run it. The hospital was abandoned, parts of this building were destroyed. The roof had got a mortar shell. Blood was everywhere, dead bodies, signs of massacres in the hospital. Patients and personnel – they were killed in the hospital. A couple of people were living inside because they had no house.
Personnel had disappeared. We had to recruit new people, just take people off the street. We picked up the first 25 people who were passing by and said would you mind helping us to clean up a bit and we’ll give you some money. And that’s the way we started!
No water in the hospital for one and a half months. And we were forced to do surgery because the news spreads quite quickly that the hospital was open. So patients arrive, and you have to do something.
At the beginning, you couldn’t expect to have extraordinary results in terms of the surgery because you don’t have the facilities to sterilize your instruments. You have to be ready to accept a certain rate of infection. But now the situation has improved quite a lot, I would say. Now we are on a good standard or an acceptable standard, I would say. Also considering that 80% of the personnel are not qualified. There are nurses – well, we call them nurses or nurse helpers, but they were, I don’t know, professors of mathematics before, or cleaners or whatever.
Why no doctors? I don’t know. What they say is that the majority of doctors, they were Tutsi and they’ve been killed. Others escaped to Zaire or Burundi or wherever. They’re probably scared to come back, if they’re still there. Nobody knows exactly. But this is the result. So far we have not seen surgeons.
How many people do you see a day? Between surgery and outpatients, I’d say between 30 and 40. This was a 650 bed hospital and I think it was working rather well. There were 25 Belgian doctors before the war. There was the Belgian co-operation here, and they brought in a lot of equipment. Of course most of that material has been looted.
How many people do you have here? At the moment, we have nine. Nurses, doctors, surgeons, anesthesiologists, there’s a midwife, a gynaecologist.
Do you have the supplies you need? Yes, we have the basic ones. We will never use sophisticated equipment because, anywhere you go, it is important to teach a few locals to do some basic war surgery. If you teach them to rely on high-tech, then everything will stop because they’ll never be able to afford it.
How many patients? I think all together about 350. 120 in the surgical ward. There are about 70 in maternity, about 40, 50 in paediatrics and the rest is general medicine.
So Emergency runs the surgery and maternity ward? And Samaritan runs paediatrics and general medicine, and then there’s a dispensary run by MDM – Médecins du Monde. They see I think 300, 400 cases per day. And the Australians are here running a hospital within a hospital. Their mandate is to take care of the UNAMIR troops. What they do in fact is to take care also of civilians and give us help – great help. We do surgery regularly together. So it is good co-operation although the mandate is not the same.
When we knew they were coming, ah, it was great. To have UN troops beside you is beautiful – in terms of security, in terms of all the help they can give you, the support, the logistics, and supplies and material when you need something you don’t have.
How long will you stay here? Another 3 or 4 months, unless there is a new emergency in the country. We’ll see.”
I edited this transcript a bit for continuity and length. Questions and comments were from several members of our party as we walked the halls with Dr. Strada. I never saw him again, but he has always stayed in my mind. Emergency’s website has more about Dr. Strada and their work around the world.
Also see my Rwanda for more about being there in 1994 with Canadian peacekeepers.