Scalpel for Hire: An Interview with Anna Kerola

Anna is a veteran surgeon who has extensive experience working in conflict zones across the globe. She has worked at Bara on four occasions, and has subsequently gone on to work in Mali, Ukraine, Gaza, South Sudan, and the Democratic Republic of the Congo. I crossed paths with Anna at Bara in 2023 and I've been eager to hear what she has been up to since then. Some sections have been edited for clarity, length, or patient confidentiality.

Can you tell us a bit about your background - where you trained, and what led you to trauma

surgery?

I come from Finland and I am a surgeon with dual specialisation in general surgery and

orthopedics/traumatology. I completed both specialties at the University of Helsinki (it's not possible to specialise in trauma surgery specifically in Finland). I chose to pursue both because working in trauma surgery and humanitarian settings has been my goal for almost a decade, and I believed that this dual specialisation would be valuable for the patients I treat – and it has proven to be so.

During the early years of my surgical residency, I became enthusiastic about managing polytrauma after participating in the European Trauma Course, and my passion for trauma surgery truly began when I first worked in Bara. My interest in working in humanitarian settings and in areas affected by armed conflict then grew further during my assignment in Mali with the UN the following year. To strengthen this skillset, I also completed an MSc in Disaster Medicine.

How did you first come to work at Bara, and how many times have you been there now?

My first time at Bara was in February 2017. At that time, I was still a surgical resident in Finland. There is a program for Finnish surgeons and surgical residents to go to Bara, and a consultant surgeon at the hospital I was working in had already completed a rotation there, which truly sparked my interest. Initially, I wondered if I was too early in my career to go, but looking back, I believe the timing was ideal. My first stay was for six weeks, and later that same year in the fall I had the chance to return for three months. Since then, I have been back to Bara twice more, in 2019 and 2023, each time for another three-month rotation. In total, I have visited Bara four times, and I am certain that I will go back again one day.

My first rotation at Bara was also in 2017, but I don't think we crossed paths then. Other than Bara, where else has your career in trauma surgery taken you?

In 2018, I worked as a surgeon for the UN peacekeeping operation MINUSMA in Mali, which was a three-month assignment. There, I served as a trauma leader during several multiple-casualty incidents, gaining first-hand experience of working as a trauma surgeon in an armed conflict setting. Following this, I began applying to humanitarian organizations and was accepted after completing an interview processes. In 2023, I worked with MSF (Médecins Sans Frontières; Doctors Without Borders) in North Kivu, Democratic Republic of Congo (DRC), and later that year I went to Ukraine with the NGO UK-Med for almost six months. In 2024, I worked with UK-Med again in Gaza for two months, followed by a two-month assignment with the ICRC (the International Committee of the Red Cross) in Juba, South Sudan. In 2025, I spent six months working with the ICRC again in Goma, DRC.

It was only a few months ago that M23 rebels managed to take control of Goma - what was it like working against the backdrop of that conflict?

While working there the armed conflict in North Kivu escalated, and in late

January 2025 we faced an overwhelming influx of war-wounded patients. Reading about mass casualties is very different from experiencing them firsthand, especially when multiple recurring and consecutive mass-casualty incidents occur over an extended period and with minimal resources compared to high-income countries. The workload was the most intense I have experienced to date – we worked around the clock with little sleep or breaks, striving to save as many lives as possible. Nevertheless, the team spirit among the hospital staff was exceptional, and I believe this was a key reason we were able to treat patients as effectively as we did under such circumstances. This is a lesson I will always carry with me: when you work as team, you can overcome even the most challenging situations.

How did you find the security situation in Goma? Did the instability affect work inside the hospital?

During the active phase of the conflict in Goma, security was well managed by the organization I was working with (the ICRC). For this reason, I didn't feel that the instability significantly affected the work inside the hospital - apart from, of course, the massive influx of wounded patients and the looting of the medical warehouse, which impacted our resources. Despite this, I felt that the strong team spirit and our shared commitment to helping the patients kept us motivated to work effectively even during those challenging times.

What skills or lessons did working at Bara provide that set you up for success on these sorts of missions elsewhere in the world?

First and foremost, working in Bara taught me to trust and rely on my clinical skills. In many situations in the humanitarian context, you don’t have access to the latest imaging technology or specialised surgical instruments, yet you can still make timely and accurate decisions based on clinical examination and often ultrasound and treat the patient appropriately. The technical skills, tips, and tricks I learned at Bara from some of the world’s best trauma surgeons have been invaluable during my missions in areas affected by armed conflict, making Bara an exceptionally important place for my professional growth. Bara also taught me the principles of managing mass-casualty situations: even when the situation is overwhelming, it is essential to stay calm, trust your skills, and rely on your colleagues.

What are the biggest lessons or takeaways for trauma systems in high-income countries that came from your time at Bara?

For me, one of the most valuable aspects of working in Bara was the extensive exposure to penetrating trauma. In high-income countries, the vast majority of trauma is blunt, so having the opportunity to gain hands-on experience – and to learn diagnostic and treatment strategies directly from some of the best trauma surgeons in the world – has given me the confidence and competence to manage especially penetrating trauma patients, a skill not all surgeons in high-income settings possess. The ATLS primary survey principles apply universally to all trauma patients, but while trauma care in high-income countries often relies on a specialized trauma team with clearly defined roles, such teams always have a leader who makes the final diagnostic and treatment decisions. In these moments, the ability to trust and rely on one’s clinical skills becomes truly invaluable.

Are there any patients that have stuck with you in particular?

From Bara, I vividly remember one night when we received 34 seriously injured trauma patients within just a couple of hours in the middle of the night. It was during my first rotation, and I was working alongside local surgical residents and emergency medicine colleagues in the Resuscitation Room. It was my first mass-casualty experience, and despite the chaos, the teamwork left me with positive memories of that night and further strengthened my skills.

During one of my missions in an armed conflict I operated on a seriously injured patient in the middle of the night who had sustained gunshot wounds to the aorta, inferior vena cava, and bowel. Despite his critical condition, he survived with minimal complications. During and after that operation, I thought a lot about Bara – the lessons I had learned from senior surgeons there and how my time in Bara had prepared me to manage such a difficult patient independently.

Incredible that the patient with the aortic and caval injury didnt just immediately exsanguinate. That actually brings to mind another penetrating aortic injury we had on one of our on calls together in 2023 - particularly memorable because I can picture the image of the knife still in stuck in the patient's back. How did you go about repairing the vascular injuries for your patient? Was primary repair feasible or did you shunt for damage control and revise a few days later?

I definitely remember the patient you mentioned in Bara! [I later realised this particular patient had been written this up as a case report, which can be found here].

For this patient, primary repair of the vascular injuries was feasible, but due to the patient's overall condition, I applied damage control principles to the bowel injuries and performed a relook once he had stabilised.

Incredible work. To wrap up, do you have any words of wisdom for doctors aspiring to become involved in trauma surgery or global health?

I believe that for some people, trauma surgery becomes a passion – it chooses you rather than the other way around. If that happens, I would simply say: go for it, if at all possible. Working as a trauma surgeon in a humanitarian context requires long-term dedication to learning, proactivity, open-mindedness, flexibility, and the courage to step into the unknown. Although the work can be extremely challenging, both mentally and physically, it ultimately gives far more than it takes. My advice is to follow your dreams, because they really can come true.

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Dr Anna Kerola is a dual trained general and orthopaedic surgeon from Finland. She has a particular interest in trauma surgery and disaster medicine, and has extensive experience working for a range of humanitarian organisations across a number of armed conflicts - including Mali, Ukraine, Gaza, South Sudan, and most recently in the Democratic Republic of the Congo.

Dr Nick Chapman is a senior emergency medicine registrar, and has recently passed his written fellowship exams for the Australasian College of Emergency Medicine. He has a strong interest in both trauma and retrieval medicine, and completed his Postgraduate Diploma in Aeromedical Retrieval in 2021. He has previously worked at The Alfred Hospital's Emergency & Trauma Centre, but is hanging up his scrubs in favour of overalls as he heads to the Royal Flying Doctor Service.

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References

[1] Thousands flee fighting in Congo as rebels claim they’ve captured the key city of Goma. CNN [internet]. January 26th, 2025. [accessed September 12th, 2025]. Available from: https://edition.cnn.com/2025/01/26/africa/congo-severs-ties-rwanda-rebels-goma-intl

[2] Naicker D, Pswarayi R. Stab injury to the spine with retained knife blade and aortic injury: a case report and review of the literature. Indian Spine J. 2024;7(1):104-7.