Hong Kong doctor volunteering in West Africa can’t forget the children she saved, or the ones she lost

It’s the children who stay uppermost in Jessica Ng Man-sin’s mind. She would visit them in the paediatric ward at the hospital in Freetown, the capital of Sierra Leone. Some were her patients, in with fractures, skull injuries, or because they’d accidentally swallowed caustic soda, used to make soap. She’d take them sweets. Many she saved, but some she couldn’t.

Sitting in the Foreign Correspondents’ Club in Hong Kong, Ng, 34, an orthopaedic surgeon, looked back at the year she has just spent in the West African country, where she was the first Hong Kong doctor to work at a hospital of the Italian medical charity Emergency.

Sierra Leone has been at peace since the end of a civil war in 2002, but the conflict left its scars. Poverty is endemic; two thirds of the population of six million rely on subsistence agriculture.

Ng worked six days a week at the surgical and paediatric centres of the hospital, in the Freetown district of Goderich, where patients are treated free of charge. She had previously worked at Eastern Hospital in Chai Wan, often dealing with sports injuries to knees and toes.

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“I’m an orthopaedic surgeon, but I worked beyond bones and limb injuries [in Sierra Leone] because we had head and maxillofacial injuries [where the facial bones are fractured],” says Ng, so her experience broadened quickly. “Professionally, it was an eye-opening experience. We don’t see such injuries in Hong Kong.”

Many of those injuries were caused by accidents on the country’s notoriously dangerous roads – they accounted for 80 per cent of injuries she treated. No one wears a safety helmet on motorcycle taxis, a major mode of transport, she says. Six months of the year it’s dry, then comes six months of rain, where roads become flooded and blocked off, and conditions even more treacherous.

Three-year-old lbrahim Barrie was admitted to the hospital last August after a road accident. “Half his scalp was detached with the fracture,” says Ng. There were stones and mud in the wound, from which a putrid smell emanated. It had taken his family days to reach the hospital.

“He was alert, he was crying, he could talk,” she says. “On the first day I had to remove this cement debris from inside his skull.” For the next three months the wound was cleaned every two or three days. “In the end we had to rotate part of the scalp to cover up the exposed bone.” Skin was also grafted from the boy’s thigh to cover the scalp.

“He was an extremely stubborn boy,” Ng says, laughing, “He never let me carry him. He would let the local staff, but not me. I love children, they are the most honest. And their bones and soft tissue often make a wonderful recovery.”

She also saw injuries from falls, particularly from mango and palm trees during the harvest season.

Ng says she chose her career “by exclusion”. “I know myself. I cannot do business. I do not want to be in the business world. I love sciences, I love biology, and I love people and the work of humanity,” she says.

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While a medical student, Ng also studied Italian, and came across surgeon Gino Strada, who had founded Emergency in 1994. “I read his book, he’s an icon,” she says. “I dreamt about working for Emergency and waited until I specialised.”

While Sierra Leone is religiously tolerant, Ng says she had to learn quickly about local customs.

“Fudijah, was a 14-year-old girl who had fractured her leg two years previously,” she says. The leg was treated but the wound had become infected and by the time Ng saw it, it needed to be amputated. “Fudijah agreed, her parents agreed,” but the family were Fulah, part of the third largest ethnic group in Sierra Leone, which meant the chief also needed to give permission. And a few days later, Fudijah had her leg amputated.”

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An issue of great sadness for Ng is the families who refused treatment. Sometimes local remedies had been used to try to treat wounds before she saw them. These include cow dung and scalding the wound, so by the time Ng saw the patient something that could have been straightforward to fix was now a complicated, infected injury.

“Sometimes it was just a sprain or simple fracture, but the muscles inside had been burnt. We would explain the treatment, but these were often people who cannot read and they would leave,” Ng says, adding that the infection would only worsen.

The work was demanding, Ng says, so when not working she would often sleep in her home in the hospital compound. Her mainstay was the local food, such as the leaves of the root crop cassava or pepper soup with lots of beans. “They use okra and make it into a spicy sauce.”

However, Ng didn’t need to go without her native cuisine. “There’s a huge Chinese population in Sierra Leone,” she says. Chinese firms have built a railway to export mineral resources to the coast; some export dried seafood.

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Emergency’s hospital has 100 beds and 400 staff, says Ng, of which about 10 are from overseas. Ng worked regularly with Lamine, a local man in his 20s who had been a cleaner in the operating theatre. Lamine, she says, studied hard outside of work and became a scrub nurse. One day, just before they began an operation, Lamine told her matter-of-factly that he saw his father shot in front of him.

“You see these extremely talented people who have personal stories that are more than you can imagine,” says Ng.

At a later date, says Ng, “Lamine came into the [operating theatre] and he said: ‘I’ve found my long-lost sister.’ He found her alive.” Many people went missing during the civil war.

Another key public health crisis for Sierra Leone is children accidentally eating caustic soda. It’s a raw material used for making soap, which is a home industry in Sierra Leone.

Caustic soda looks like milk powder, says Ng. Adults are often busy working and children eat the soda. There is an established surgical programme in hospitals because it happens so often.

“Their oesophagus gets chemical burns, and we need to do some surgical intervention to help them to eat. And we have seen some patients, they die from not having an intact food pipe because they come too late,” says Ng.

“Sometimes we do an endoscopy; sometimes we open the stomach and feed them through the stomach opening. There are children who cannot eat for a week, and if they cannot eat they are not fit enough for surgery to open up the stomach for feeding. More complications come up. And they just die.”

Ng called these young caustic soda burn patients her “friends”. She didn’t conduct surgery on them, but she would visit them.

Morlai Bangura was three years old when he arrived at the hospital. “He had a very severe chemical burn along his food tract. One of our surgeons operated on his stomach and his small intestine,” says Ng. He started eating slowly and was a fighter. When he recovered, he was too weak to walk. “He tried to walk with a small rollator, frowning. For a month he never smiled. When he started to eat, he started to smile.”

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Morlai’s condition would fluctuate. Often when he left the hospital he would eat for two weeks and then worsen, so his mother would bring him back, usually a bit late. When he arrived he couldn’t eat for a week. In the end he had an infection and the paediatrician took over the patient to manage his condition.

“One day I asked the nurse how he was, and she told me he had passed away that day. He was three when he came; he was four when he died. He was a friend, because he always asked for me. I would bring him melted chocolate mixed with a biscuit.”

Emergency operates in five countries, including war zones, and Ng will definitely go back out in the field. Working for a medical charity, says Ng, earns her about a tenth of a surgeon’s salary in Hong Kong, but to her it doesn’t compare.

“I want to equip myself better,” she says. “I want to train more. I’m also keen to work in the public hospitals in Sierra Leone and elsewhere, to teach, to train more people” and to increase public health awareness about road safety and chemicals in the home.

“I don’t want to buy things, I don’t need them,” she says.“The experience is so much more than that. And I would really encourage other Hong Kong doctors and surgeons to do this.”