Dr. Roy Kirkpatrick, local physician and surgeon, occasionally suspends his practice in Huntsville to help patients in need around the world.
In the spring he travelled to Hangu, a town in northwest Pakistan, 230 kilometres west of the country’s capital, Islamabad, and 100 kilometres east of the Afghanistan border for a one-month stint with Medecins Sans Frontieres (MSF) or Doctors Without Borders.
“It’s a region with a history of volatility and religious tension and the MSF’s original work there was focused on aiding victims of violence,” said Dr. Kirkpatrick. In the mid-80s, civil unrest caused many of the well-off people in the area, those who had the means to leave, to head for safer areas, he said. That included many of the local hospital’s doctors. MSF entered into an arrangement with the local health department to provide medical staff to fill in the gaps. “The volatility has diminished over time and many people have returned to the area so the project is actually winding down.”
But there is still need.
Kirkpatrick worked in the hospital’s emergency department. Surgeons stationed there are on call 24/7 for the duration of their stay and perform urgent or emergency procedures and care. “Early on, the midwives at the hospital recognized that there were obstetrical complications that would benefit from surgical intervention, so the MSF surgeons assigned there do many Caesarean sections.” He did a total of 24 of them while in Hangu.
He also saw a range of problems that he doesn’t normally see in his every-day practice. Kirkpatrick was surprised at the number of burned children – largely a result of home accidents in close living quarters – he saw and realized that, even as an experienced doctor, he still had much to learn about treating burns.
Communication proved to be a challenge in treating patients, as well. The region’s primary languages are Pashto and Urdu and all of Kirkpatrick’s patient encounters were via a translator or sometimes two. “I recall an Afghani woman who spoke Pashto. There was an Afghani nurse working at the time who spoke both Pashto and Urdu but didn’t speak English very well and a Pakistani nurse who spoke Urdu and English but not Pashto. So I talked to the Pakistani nurse who translated for the Afghani nurse who translated for the patient. It was like that game ‘telephone.’ It’s harder to emote when you’re communicating that way and nuances on both sides get lost.”
MSF is sensitive to cultural norms wherever they provide care. Local garb is mandatory – Kirkpatrick wore the traditional shalwar kameez while in Hangu – and local customs are followed as much as possible. He learned not to offer his hand to a woman, for example, and to eat meals with only his right hand.
Another challenge was living with a team of people from all over the world – a situation that could be positive or negative depending on the mix of personalities. “It’s like being in residence in university but at 63 instead of 23 and with people of all different cultures. Most of us are set in our ways. I was lucky – I had a wonderful experience but spending that much time with strangers could potentially be difficult.”
And then there were the rocket attacks overhead one day.
Despite these challenges in providing medical care in a foreign hospital far from home, the working conditions Kirkpatrick experienced were good.
“The hospital was probably built in the 1930s and is within a walled compound, which we didn’t leave during our time there. It is mainly staffed by nationals – professionals who provide good quality care,” said Kirkpatrick. “The wards are similar to many overseas hospitals – there are separate men’s and women’s wards but not semi-private or private rooms as you would expect in Canada. Big wards are more efficient but not great for patient privacy and private communication.”
The hospital’s lab had fewer tests available than a Canadian hospital would and its x-ray facilities were limited, said Kirkpatrick, but the MSF pharmacy carried first rate drugs and the operating room was at an international standard, containing high-quality, MSF-supplied standard instruments. The organization is conservative in their administrative spending so that the bulk of donations – 80 per cent – goes to their projects. “The conditions (in the Hangu hospital) were not primitive. It was at or above the standard of other similar places.”
Kirkpatrick is no stranger to providing medical care in foreign lands. He spent two years at the beginning of his career in Papua New Guinea and travelled to Haiti after its devastating 2010 earthquake as part of the Canadian Red Cross’s relief effort.
He has also offered surgical assistance in Nunavut. “For a while they had only one surgeon in Iqaluit. I offered to help so she could take a break now and then and have been almost every year since 2004. They now have another surgeon so my help may not be needed as often.”
Despite his commitments in Huntsville – he has a family and a medical practice and is working on a master’s degree in International Health from the University of British Columbia – he will make himself available for future MSF projects as time allows. He was also asked by the Red Cross to travel to Nepal in June, but the notice was too short. He remains on their emergency response roster.
Kirkpatrick’s initial, long-ago inspiration for working overseas came from those who had gone before him. “As a medical student, I read about Norman Bethune and Robert McClure – Canadian doctors who have worked overseas – and it seemed like a cool thing to do. As I’ve gotten older, it’s become less about the sense of adventure – I’ve realized that there are needs that I can use my skills to help with.”
Photos supplied by Dr. Roy Kirkpatrick.