Mothers of war
After serving at Zwedru for two months, Soong was transferred to Redemption Hospital to work in the emergency room and the wards. Redemption Hospital, in downtown Monrovia, is the biggest hospital in the area, offering free medical services. The hospital is near the Duala Market and within ten kilometers there are three refugee camps, so the hospital beds are usually filled and there are not enough medical services to meet demand.
The most unforgettable aspect of Redemption Hospital was the maternity ward, located in a dim corner of the building. The dark, depressing delivery room reflected the status of Liberian women, who were in the lowest ranks of local society, every bit as crowded, silent and neglected as the delivery room.
"The birthrate among African women is quite high, and mothers here always want more children." At first, he would advise women to use contraception, but gradually he came to realize that the death rate among children is exceedingly high in this war-torn country: the greatest risks for infants during their first year are malnutrition and pneumonia, and up to age five, malaria, which is as widespread as the common cold, often claims these fragile lives within two or three days.
Amid constant fear at the prospect of losing a child at any time, the only way they can gain peace of mind is to keep having babies. After understanding this stark fact, Soong has nothing but great admiration for the risk-taking of African mothers and for their courage in combating death by having babies year after year.
The last stop before death
Intensive care units in developed countries are filled with advanced, precision medical equipment. Yet at Redemption Hospital, short on supplies, the intensive care unit is just a room with seven beds and some oxygen tanks. There wasn't even the most basic respirator (which mitigates respiratory failure) or any vasopressor (medicine to boost blood pressure).
In charge of the ER, he was at first reluctant to work in the ICU.
"The struggle against death here is pretty much doomed to failure. As doctors we have no sense of accomplishment here; just unending helplessness and despair." Because of a lack of diagnostic and first-aid equipment, plus the fact that patients often wait too long before coming here for medical treatment, the speed of death is startling.
"Often a patient would just die before I had the time to determine what disease he had." Once he signed six death certificates in a day and broke down crying from the sadness. In this faraway land, facing the lessons of life and death, he discovered things he couldn't do: maladies he couldn't treat, problems he couldn't fix, things he couldn't change. He asked himself, "What can a doctor do?"
When he began his ICU duty, he was upset about the undisciplined manner of the local doctors and nurses, but after a month, facing death on a daily basis, he found that he too started feeling numb, just like those doctors and nurses. His first thought when seeing a newly admitted patient was to assess whether the person would live or not, and what resources to allocate toward treating him.
"I found I was learning a very practical lesson, which was that I had to accept that many times I would helplessly watch a patient die and that there would be nothing I could do." Soong describes it as holding a handful of sand, and watching it quietly slip between his fingers.
Such a mindset pains him. He had an unshakable sense of profound powerlessness regarding his daily ICU work. Fortunately the words of Christina, a Swedish nurse, changed his thinking.
Christina told him, "When a patient is lying on the bed, we can at least maintain respect for life for his sake. Even sponging him off or repositioning him will let him know someone is looking after him, and he's not just waiting for his last breath all alone."
Soong started to think hard about this. In modern doctor-patient relationships, doctors focus too much on treating the symptoms and overlook whether the patient is being cared for. "For a doctor, it's easy to talk about what to do, but actually looking after patients others don't care about, and even getting our hands dirty changing catheters and bedpans... that is the true meaning of practical work."
This realization made his youthful face break out into a smile. Letting a gravely ill patient know someone cares about him and is looking after him in the last days of his life is like a spiritual release for the patient. The doctor becomes more optimistic and realistic, and the patient is at peace and liberated from fear.
Learning to say no
When he started his service in Liberia, Soong was full of passion, willing to dedicate all his ability to save everyone. That is, until at the insistence of Peng Chiu, head of DWB's Zwedru base, he had to say "no" to a patient with tuberculosis, not allowing him to transfer from Zwedru to Redemption Hospital, the only place with medicine for tuberculosis. Soong finally realized that no one person can save the world in a day.
In the 21st century, tuberculosis has resurged as a result of AIDS. The course of treatment for tuberculosis takes at least six months. Usually after a month of treatment, 99% of the pathogens have been eliminated, but the remaining 1% are critical. If one lowers one's guard and stops taking the medicine, not only will the tuberculosis reappear later, but it will most likely be a dreaded resistant strain.
It would be impossible for this patient to stay at the hospital for six months, and once released from Redemption Hospital, he would most likely wander the streets destitute and foraging for food. He would thus probably be transferred back to Zwedru. Needless to say, Zwedru had no medicine to give him, and even if they did, it was feared that it might become ineffective due to resistance.
Soong explains that when the Soviet Union broke up, many of the newly independent countries experienced a massive outbreak of multiple-resistant tuberculosis due to incomplete treatment. Medicines that could treat the disease were expensive and had major side effects, and the course of treatment was between one and two years. The social cost was enormous, leading to many tragedies.
"If I am rigid about my own good deeds, it could result in a worse calamity, and that's being too selfish." At this time Soong realized that devoting oneself can't be about pursuing one's wishful thinking. Sometimes one must step out of the situation and look at things from a greater perspective; sometimes one must be ruthless and say no in the collective interest. Recklessly saying yes may lead to more trouble.
Confronting death
Africa is home to several Class 4 viruses, the deadliest class of all. Most notorious among them are the Ebola virus and Lassa fever. Lassa fever was discovered in Nigeria in the 1970s, and currently there are around 500,000 cases in the world each year. Liberia lies in an affected area.
Lassa fever has an incubation period of 15-20 days. The initial symptoms are flu-like, but in the late stage of the disease patients die a miserable and tragic death from swelling in the larynx and blood pouring out from facial orifices. In this area where there are no advanced immunological screenings and people depend only on clinical experience, it is all the more difficult to diagnose Lassa fever.
One evening, Soong was on duty when a young person who seemed to have the flu was sent to the ER. The youngster died the day after entering the ICU. An old German doctor on duty with Soong had seen patients with Lassa fever and himself had once contracted the disease; therefore he suspected that this was a case of Lassa fever.
As the first person to see the patient, Soong was at high risk of becoming infected. For safety's sake, all medical personnel who came into contact with this individual, including Soong, had to take a specific medication for ten days. He was aware that the side effects included bodily weakness, but what concerned him most was whether the feeling of fatigue they experienced was merely a side effect of the medicine or whether it was a symptom of Lassa fever itself.
"Before we knew the answer, the patient's swollen face when he died haunted me like a nightmare. This was the first time I felt so close to death, and I became terrified of dying," says Soong. Fortunately for him the ten long days of observation finally passed, and everyone breathed a sigh of relief.
Amid a hail of bullets
On October 29, 2004, civil war broke out once again in Liberia. This was the first time Soong heard the actual sound of gunfire. Again, the horror of death assaulted him, but the resolute DWB assignment leader nevertheless decided to organize a "vanguard team" to cross the front lines and practice medicine at Redemption Hospital, where patients were piling up.
Soong still remembers how at one point he was in a car, surrounded by a perilous atmosphere. The streets were covered with sticks and stones, the doors of all the shops were locked up. His driver was so nervous when going through a checkpoint that he gunned the engine and sped away amid the clatter of rocks being hurled by a surrounding mob. All of this terrified Soong.
After the perilous journey he arrived at the hospital to find a continuous flow of wounded patients filing into the hospital. The medical team worked from noon to two in the morning, by which time Soong's blood sugar level was too low due to lack of food. He grabbed some rock-hard emergency rations and began munching feverishly. He also opened a can of corn that was years beyond its expiration date as a side dish and gulped down this memorable meal.
Yet at this very time, he finally experienced the true spirit of DWB: "Although I could clearly feel my deep fear of death every second in the process, I was a doctor without borders. I wanted to go places others couldn't go, helping those who need help. This is not heroism; it's a simple decision to devote and contribute my life to others."
Preparing for the next venture
Two years ago, Soong finally returned to Taiwan from his DWB duty, becoming an ordinary resident surgeon at Chang Gung Memorial Hospital in Linkou where he has been strengthening his professional medical skills. After his five years of training is over, he plans to continue his studies overseas so he can carry on serving patients around the world.
Soong states that his medical practice in Taiwan is quite a luxury: doctors can easily perform X-rays or MRI scans for patients. "We pretty much forget about the acuteness of a doctor's eyes and hands, and neglect real interaction between people." In his blog, it is difficult for Soong to hide his weariness in being caught up in the current of Taiwan's hospitals, especially when he listens to colleagues complaining about advancement and salaries, gossiping and spreading rumors about hospital affairs. The apprehensive feeling that he will lose his dream and passion for medicine is especially hard to bear.
"Honestly, I am panic, because I found I am not belonging to any group in the main trend group," Soong wrote in English in his blog a year and a half after returning to Taiwan, revealing his thoughts. After passing DWB's baptism of fire, this proud free spirit of a doctor has gained self-control. But where will his inner turmoil bring him next? What kind of inspiration and change will he bring to Taiwan's medical circles? These are yet to be seen.
Intro to Doctors Without Borders
Doctors Without Borders, which won the 1999 Nobel Peace Prize, is an international humanitarian medical aid organization. Since its founding in 1971, it has been dedicated to providing emergency medical aid to victims of war, natural disasters and epidemics, and also furnishes medical care to areas with insufficient provision, helping them build self-sufficient medical systems.
Currently, DWB serves over 70 countries. Each year, more than 3,000 volunteer medical staff from over 60 countries, including doctors, nurses, logistics specialists, food and water hygiene engineers and management personnel are assigned to different locations to take part in humanitarian work.
In the last several years, DWB has been cooperating with various NGOs to promote the Campaign for Access to Essential Medicines, providing medical treatment to sufferers of AIDS, malaria and other diseases, and hopes to pressure pharmaceutical companies in developed countries through a sense of moral duty to freely license their patents so that developing countries can produce medicine, decreasing the costs of drugs so patients can receive medical care.
(compiled by Kuo Li-chuan/tr. by Chris Nelson)
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