'It's amazing what you can be thankful for': surgery in northern Sri Lanka

“We now have 180 patients in Pompaimadhu and the hospital is full. A lot of our patients have chronic wounds like pressure ulcers and amputations which are healing poorly. There is a huge need for physiotherapy: everyone has joints that don't move well and fractures that are not healing.

"The MSF team is formed of nine international and national medical staff, a team of caretakers and eight motivational coaches. We are working alongside Ministry of Health staff. I am the only surgeon working in the hospital and I do an average of 16 to 20 surgeries, two days a week. Some of them are major surgeries such as revisions of amputations that haven't healed, and then there are smaller things, like taking off external fixtures and cleaning up wounds. On the other days I do ward rounds.

"One of the major procedures we're doing is a reconstructive plastic surgery operation called a muscle flap surgery. This two to three-hour surgery allows us to save infected legs that have been injured in shell blasts - legs that would otherwise have to be amputated. We have done this procedure 20 times now and so far it's been really successful. The first patient we did this operation on had been injured by a big bomb blast which tore out a chunk just below his knee – he had almost no bone left. Now he is walking again and today we decided that he's improved enough to leave the hospital.

"We have set up a spinal cord unit here and we are now the main provider of care for spinal injuries in the district. Other hospitals transfer their patients here and we now have 50, most of them adults between 20 and 40 years old who were injured by shell blasts in the conflict. Two patients are paralysed from the neck down and the others are paraplegic, paralysed from the waist down. There are two or three lucky ones who only have temporary damage and the physiotherapy sessions are helping them get their movement back.

"It's great that they're all here because it means they can all be treated together. They have wounds that will heal with good nursing. We have taught their relatives how to turn them in their bed and care for them, and when necessary we treat their sores in the operating theatre. The motivational coaches talk to them and help them find ways to cope emotionally. People feel better when you work with them even if they will never regain their movement. It's amazing what a big difference this can make: some nursing, some physiotherapy to keep their joints moving and some moral support.

"One patient I see every day in the hospital has really stuck in my mind. He is about 20 years old and he was in the conflict zone when a shell landed on his legs. It did not explode but it did crush both legs. When he got to Pompaimadhu we saw he'd had two amputations. They hadn't gone well and so he now had the bone sticking out and needed further surgery. We redid both amputations in the operating theatre so everything is now nice and clean and maybe one day he can walk on them.

When we asked him what had happened he told us about the shell and the funny thing is that he smiled about it, as if it was a good thing. And we were like, why? And he said, 'the shell landed on my legs - it did not explode. If it had exploded it would have killed my whole family.' It is one of those stories where you go wow, how amazing. He has no legs but he is thankful because it did not explode. He is quite a cheerful person. You might think how depressed you or I might be in his situation, but he gets in his wheelchair and he goes off and he is thankful for everything. Despite all the bad stuff that happens, it is amazing what you can be thankful for."