The Kindest Cut - Spear's Magazine

The Kindest Cut

Penelope Bennett meets the Swiss plastic surgeon who is transforming the face of medicine in Ivory Coast at the hospital he built

Penelope Bennett meets the Swiss plastic surgeon who is transforming the face of medicine in Ivory Coast at the hospital he built 
 
 
COSMETIC SURGERY IN Switzerland is big business. By his own admission, Dr Patrick Meredith, an expert plastic- and hand-surgeon who lives and works in the country, could easily ‘do only that — pure cosmetics. There is a huge demand for it,’ he says.

As it stands, however, facelifts and eye-lifts and the like make up only a third of his practice, supplementing the pure reconstructive (for breast cancers and burns) and specialised hand surgeries that he typically carries out in any one of four locations around the country: the two general hospitals whose surgery departments he heads, the private Clinique de Genolier, where he consults, and his own practice in Nyon, above the northern shores of Lake Geneva.

He operates every day, working on small to large cases (carpal tunnel syndrome in the hand, ‘a fifteen- to twenty-minute all-in-all operation’, versus breast reconstruction with a free microvascular flap, which can take up to six hours), weighing in at twenty-odd operations a week.

As with most busy people, he manages to find time for other pursuits. That he chooses to spend it with ill folk in the Ivory Coast, a country that currently has a buffer zone patrolled by UN peacekeeping troops, is perhaps less ordinary. Naturally, he doesn’t see it that way. Meredith sees his work in Abidjan, the largest city in the country and its commercial and banking centre, as a hugely positive endeavour, which it undeniably is. But to the outsider it’s distinctly unglamorous and as far removed from the trappings of a highly successful plastic surgeon’s lifestyle as one could get.

It all started in 1986 when Meredith, then 32, met Dr Louis Haller on the back of an army truck in Switzerland. Both had been called up for military service, with Haller less than pleased to miss out on his only month’s holiday in the year. ‘So he was sitting there, pissed off because he wanted to be in the mountains,’ recalls Meredith. The pair started talking and realised they knew of each other’s work: Haller as director of the Fondation Roche pour l’Afrique, Meredith as consultant on leprosy cases at the Raoul Follereau Leprosy Centre in Ivory Coast.

Buoyed by Haller’s example, Meredith went on to found the Fondation Meredith for the development of plastic and reconstructive surgery in Western Africa. He built its hospital with his own funds (‘the price of two beautiful swimming pools in Switzerland,’ he says. ‘It’s 350,000 Swiss francs, which is a lot of money but it’s not millions’) and went about equipping it in necessarily frugal fashion. ‘I went to France, Switzerland and Germany to get materials, respirators, beds. I was buying them from hospitals that were closing, and buying second-hand.

‘Some of it was given. Some of it — the important equipment like the sterilisation machines — was new. Then we put them into containers and had companies bring the containers down.’ The donors — he gives thanks to two in particular, private individuals who have regularly given to the Fondation — came on board once he had got the ball rolling.

Meredith goes out to Ivory Coast two to three times a year for a week at a time and spends a day catching up on administrative matters and future developments (the Fondation will, in time, build a children’s wing, ‘so we can look after the little ones,’ he says) followed by four solid days operating on more difficult cases, teaching (‘Western Africa has a lack of surgeons, so if we can train some it can only help’), and ‘racking our brains to see how we go around some tough problems.’
 
 
THREE RESIDENTS WORK together with Professor Henri Assé, Meredith’s star trainee, taking care of acute cases — hand trauma, some burns, facial lacerations — and sequela of the above and of cancers (skin, breast reconstruction), as well as some congenital work (cleft lip, deformed ears) and endemic diseases, such as the violent and disfiguring buruli ulcer: this has plagued the country and the FM works together with the World Health Organization to combat and raise awareness of it.

As Meredith explains it, ‘The WHO is a political body that influences health issues at the government level. We are effectively working at the human level because we are manual workers with special skills. Our role is to use these and to teach them as well. There is no conflict with the WHO, just different goals.’

The tricky cases are not pleasant for anyone at the FM, but they are ultimately beneficial to the cause: the trickier the case, the more fuel for recognition. ‘If we are known as an area of expertise and can establish a pole of competence then we will get difficult cases and can show that to potential donors,’ he explains in a telephone interview between operations. They also publicise their work through academia, with presentations at the yearly Swiss Society of Plastic Surgery conference and the MEGA (Multidisciplinary European Group for Aesthetics) hand conference, to name two, and publish papers on a yearly basis.

Beyond performing surgery himself, Meredith ensures the FM trains as many surgeons as it can. As Meredith says, ‘For the medical doctor it’s an act of life. For me it’s also a political statement, a north-south exchange: helping people take care of themselves.’ Professor Assé, senior registrar in orthopaedics when Haller introduced him to Meredith, went on to become a fully fledged reconstructive surgeon under Meredith’s stewardship after spending three and a half years training at the very best specialised centres in France, Switzerland and Scotland, having never before left Ivory Coast in his life (Glasgow must have been a shock).

‘This guy is good,’ says Dr Meredith, delivering the line with emphasis. So good he is entrusted with the day-to-day running of Fondation Meredith, now it its tenth year. ‘We thought we’d do something small and then it went bigger,’ says Meredith. ‘It’s really a question of circumstance.’

Ivory Coast was once conspicuous for its stability, religious and ethnic harmony and well-developed economy, due in large part to Felix Houphouet-Boigny, the country’s first president and father of independence, and also the first African to become a minister in a European government.

After a successful 30-year stretch, violence and xenophobia took hold of those in power and, in 2002, an armed rebellion split the nation in two, sending it spiralling into ‘the kind of internal strife that has plagued many African countries’, as the BBC tells it. Despite signing a peace agreement in 2007, its two warring factions — the government and the rebels, or New Forces — have yet to reconcile fully, and the country today remains tense and divided.  

But that’s the big picture: the politics. Zoom in to better acquaint yourself with the people of Ivory Coast, and it’s a different sight altogether: intelligent men and women, educated minds, an optimistic attitude.

‘Education, education, education. That’s what I think helps. The notion that Africans or Western Africans are lazy is not true at all. If they wish to have an education, and most do, they can get it.’ That the country’s schooling system hinders success is, however, an issue. In Ghana, the British allow the educated to go right to the top, while in Ivory Coast, ‘Top jobs are kept for the French. It’s a political thing.’ Nevertheless, we are right to hope in its people. ‘They’re very intelligent — they’re just not materialistic. There isn’t this craving for having to get something. For most, it’s easy go lucky. They live for today.’

In his book, Africa: Altered States, Ordinary Miracles, lifelong observer of the continent Richard Dowden calls for a re-examination of the perception of Africa as ‘the dark continent,’ and argues that it can only be developed by its own people.

All the more reason, then, to help them help themselves. 
 
 
DUTCH COURAGE: A DISPATCH FROM THE FRONT

In the heart of the Sierra Leonian jungle, a seven-year-old girl lies prostrate on a hospital bed struggling for her life. Unconscious and fighting to breathe, Efi convulses from fever. In Europe she would be rushed to a paediatric intensive care unit, plumbed in with tubes and wires that can measure every conceivable parameter, and surrounded by machines that can do the work of her tiring lungs, heart and kidneys. Here, at the Panguma Mission Hospital, things are necessarily a little different.

To begin with, the hospital has only one doctor — Rutger Anten, a 40-year-old Dutchman who has made a career out of working in remote hospitals like this. A decade working in Africa has left him ruggedly weather-beaten, though still looking younger than his years. It’s likely that Efi has cerebral malaria, but so far she hasn’t improved on her anti-malarials and Dr Anten is keen not to miss a chest infection.

Unfortunately Panguma Hospital’s X-ray machine was irreparably damaged during the civil war and funds aren’t available to repair it. It is difficult to over-emphasise the contrast with Western medicine. Patients are routinely anaesthetised with ketamine, a drug more commonly known in Europe for its role in tranquillising horses and hippies.

Medicine in the developed world is becoming more and more the preserve of super-specialists, but at Panguma the doctor must be all things to all men, women and children spread over the hospital’s 130 beds. In a typical week he may be required to perform tasks as diverse as the repair of a hernia and an emergency delivery of a baby by Caesarian section.

Panguma’s situation is replicated in another ten mission hospitals in Sierra Leone, providing between them around 30 per cent of the medical care nationally, and hundreds more across Sub-Saharan Africa. Increasingly, though, these mission hospitals are being seen as political as well as medical anachronism. In the aftermath of the rebel war, aid flooded into Sierra Leone and the hospital was rebuilt with the support of a Dutch NGO. Now, six years later, that same NGO has decided to re-focus its credit-crunched budget, and as of 2011 the Panguma Hospital will again be without a doctor and the overseas subsidy that covers 80 per cent of its running costs.

Efi’s fate, however, hangs more immediately in the balance. Dr Anten prescribes intravenous Arthemether, the anti-malarial of last resort here in Panguma, and turns to leave the noisy chaos of the ward for a few moments’ respite. If he’s lucky he’ll sleep through the night, but with no other doctor available he’s on call 24 hours a day.

Dr Will Muirhead

Information on supporting Panguma Hospital is available at pangumahospital.org



 

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