My mobile rings. It is a nurse from the Emergency Room (ER):

“Dr Sophie, we have a boy whose legs have come off. Please could you come to help?”

I shout “I’m coming!” before hanging up and starting the laborious task of correctly putting on my hijab, along with pulling on my shalwar kameez, making sure that I don’t need an umbrella for an erratic hail storm, and run over to the ER in my flip flops.

This is far removed from anything I’ve experienced in the UK, and it is exactly why I wanted to work for MSF (Médecins Sans Frontières or Doctors Without Borders). To provide care for people in extremis, regardless of race, religion, colour, creed, or political persuasion—mostly the same reasons that we become doctors in the first place.

The case above is one of many, unfortunately. Is there anything worse than going out to play and having your legs blown off?  I’ve been faced with this question on an almost weekly basis since arriving in the rural Khyber Pakhtunkhwa (KPK) province in Pakistan six weeks ago and I’m struggling to find something worse than losing your dignity, childhood, and innocence, all with one regrettable footstep. I am of course referring to IEDs (improvised explosive devices) and the collateral damage they cause to their (often unwitting) victims—curious little boys who go out to play.

The injuries are severe, and disgusting. We unravel the homemade bandages that someone has wrapped around this boy’s legs, and reveal severed bones surrounded by a mangled twisted carnage of unrecognisable muscles, tendons, and blood vessels all hanging limply from where the knees should be. The boy himself is awake and stunned as the IEDs are often designed to injure rather than kill—forcing further logistical and medical burden on the enemy combatant—it’s hard to accept this “rationale” when you are faced with a child who is unlikely to ever walk again.

What we are able do for these boys is to ease their pain and tidy them up in the operating room as best we can. I do not yet have a grasp on what types of rehabilitation services there are available in rural Pakistan, but I’m guessing the options are limited. People here are dirt poor and expensive things like prostheses and rehabilitation are usually the reserve of the rich. So who knows what life is like after they leave our facility?

I have seen many young boys in this ER, with all the naughty injuries that little boys get up to in any setting—swallowing coins, trying to catch pigeons, falling off bicycles, and many more—and what they all have in common is that they cry like babies and they all want their mothers.  The exception to this rule is the case above, and those like him. Surrounded by their hysterical relatives, these BBI (bomb blast injury) boys are grim-faced and stoic. They simply watch, as the bandages are unravelled, noting which parts of them are missing, and they do not shed a tear or ask for any help.  They keep their heads while all about them are losing theirs…and never breathe a word about their loss.

Kipling’s “If” may be reminiscent here…..but there is nothing poetic about this injustice.

Sophie Reshamwalla worked in London as a surgical registrar before completing a Master’s degree and the DTM&H at the London School of Hygiene and Tropical Medicine. She has worked for THET (Tropical Health and Education Trust) and Lifebox Foundation and currently works as the ER supervisor for one of the MSF projects in Pakistan.