No borders for orthopod

Cate Swannell
Med J Aust || doi: 10.5694/mja15.1005C1
Published online: 5 October 2015

While living temporarily in Australia, American hand surgeon Dr Mohana Amirtharajah is making the most of her sabbatical from her US practice, volunteering with Médicins Sans Frontières in Jordan and Haiti.

IT will be hard to forget the images from Europe of Syrian refugees pouring out of their homeland, desperately seeking safety and help, but according to a doctor who’s been there, what we’re seeing on our television screens and social media is just a fraction of the reality.

Dr Mohana Amirtharajah, a hand and general orthopaedic surgeon, has just returned to Sydney from the border between Syria and Jordan where she worked for Médicins Sans Frontières (MSF) in a Jordanian hospital in the city of Ramtha.

“Our project there was to treat war wounded”, Dr Amirtharajah tells the MJA.

“All our patients were Syrian refugees injured in the conflict.

“It absolutely is horrific on the ground, and what we’re seeing is just a small percentage of what’s going on.

“Just to get to the hospital, the injured have to first survive the trip to the Jordanian border.”

About 90% of the patients Dr Amirtharajah treated in the Ramtha Hospital had already received some treatment at a Syrian field hospital, and the caseload could be anything from two to six cases a day, but it “depends on how bad the fighting is across the border”.

“We were close enough that we could hear the bombing”, she says. “It was like distant thunder.

“The really horrible feeling was hearing the bombing for a couple of days but then not seeing any patients. That’s when you begin to wonder just what has happened to them and where they are.”

Dr Amirtharajah is US-trained, completing her undergraduate degree at Brown University, her medical degree at New York University, and her orthopaedics training at the University of Iowa, followed by a year’s hand surgery fellowship at New York’s Hospital for Special Surgery.

When her husband’s company transferred him to its Asia-Pacific headquarters in Sydney, she came along for the ride, and opted to join forces with MSF for the duration of the family’s stay in Australia.

“I’d always wanted to work for MSF”, she says. “I heard about them first when I was an undergraduate and thought they would be a terrific organisation to work with.

“Then when the opportunity here came up it was just perfect.”

With no reciprocity between Australia and the US, Dr Amirtharajah opted to work with MSF on a 2-month on, 2-month off basis, rather than training to work in Australian hospitals.

“When you’re building up your own practice in the US, it’s very hard to take time off. Here in Australia, I have time on my hands so working with MSF is a great way to keep up my skills.”

She has completed one mission to Jordan and two to Haiti, which presented a different set of problems.

“In Haiti, the work is much more about road traffic accidents. The infrastructure there is terrible and they haven’t recovered from the earthquake 5 years ago”, Dr Amirtharajah says.

“There’s also a baseline level of gang violence so we saw some gunshot wounds. Industrial accidents were also part of the job.”

Working for MSF, she says, has made her a better surgeon.

“Definitely. You learn to do things with limited resources, but also, you’re working with people from all over the world.

“You get exposed to techniques which you probably wouldn’t do otherwise.”

While MSF provides solid infrastructure on the ground for its surgeons — the Ramtha unit, for example, while housed in a hospital run by the Jordanian government, was completely staffed and equipped by MSF — the support doesn’t end there.

“We come back and are debriefed in Sydney where we talk to multiple people”, says Dr Amirtharajah. “But when you’re doing repeat missions like I am, you’re basically in constant touch. I’ve always felt very well supported.”

She has treated many patients but two, in particular, will stick in her mind, she says.

“In Jordan, there were two adolescent girls, maybe 13 or 14. Both had very bad injuries — one had to have an arm amputated and the other had a spinal injury as well as abdominal injuries that meant she couldn’t work properly.

“What impressed me about them was how much they took care of the other kids on the ward. They were always smiling and happy to see you — they became part of our community. I’ll always have a special affection for them.”

In Haiti, too, she met someone extraordinary.

“During my first mission to Haiti, one of my patients had a badly injured hand from an industrial accident”, she told MSF newsletter, The Pulse.

“After several surgeries and some creative use of skin grafting, I was able to save all but one digit. After some time, he was able to return to work. I got to see him during my second placement in Haiti, about 5 months after my last treatment and, although the hand is far from normal, it is functional, which was great to see.”

The Syrian crisis remains a puzzle to most people in the West, but Dr Amirtharajah has come away with a better understanding of the nuances than most.

“I certainly understand the major players in the southern part of Syria, at least, better than I did”, she says.

“It’s really complex. So much of it is driven by local issues. We in the West, we talk about the big names — ISIS, the Free Syrian Army, the al-Nusra [Front] — but the fighting is very much tribe versus tribe, town versus town.

“There’s always hope [that things will get better]. As the international community becomes more aware and more energised, that will help I think, but it is very complicated.”

Dr Amirtharajah is certainly playing her part. Her next mission will come in about 8 weeks, but she doesn’t yet know where she will be posted. She’s more than content to keep working with MSF in the world’s hotspots.

“A lot of US expats say you come to Australia planning to stay for a year or 2 and end up staying 3 or 4”, she laughs. “If our plans change and become more permanent, then I’ll certainly apply to the [Royal Australasian College of Surgeons] but otherwise I’ll stick with MSF.

“It’s been a great opportunity for me and I’m just grateful to be able to work with such a terrific organisation.”

MSF runs regular recruitment information evenings. Visit for details.

  • Cate Swannell



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