I made the mistake last weekend of thinking that surgery here at Kiwoko Hospital, Uganda, was becoming somewhat routine. However I’m not sure if it was because of a full moon, but I was on-call all weekend and admitted three different people who had been attacked by their fellow-Ugandans wielding pangas (a large jungle knife). I’m fairly used to seeing the results of human disagreements, with plenty of stab wounds of various degrees occurring most weekends back in Edinburgh, and I’ve even had to take someone to theatre with lead in their abdomen after being shot with a sawn-off shotgun. I’ve even seen the results of panga-injuries before, having put back together half a face that had been taken off.
The weekend’s collection involved head injuries. The first on Friday evening, someone who had managed to open the front of their skull into the sinuses causing significant bleeding; he had been out drinking the night before, and by the next evening managed to get himself to hospital, unsure of what had happened! Then I was woken at 5.30 am on Sunday morning with a teenager who had been attacked by her husband the previous evening – she had deep injuries to the muscles of her back and forearm, a near-complete amputation of half of her hand, and a slash to her scalp which had managed to slice open the top of her skull like a tin. I was able to close all her wounds, but unfortunately the hand could not be saved, other than her thumb.
In the early afternoon, panga-casualty number three arrived having been attacked by his friend on the way back from the pub the night before. He had attended a local health centre who had noticed a large slab of bone sticking through his scalp and referred him for further management. I ended up doing open brain surgery as I removed blood clot and traumatised grey matter from where the panga had sliced straight into his frontal lobe, before stitching the edges of his dura (the brain’s cover) back together, replacing some bone, and closing his scalp! I’m not sure I recall ever before even seeing the inside of someone’s skull while they were alive, let alone performing brain surgery, but the patient made a great recovery and went home two days later! Whether his personality is changed at all by the loss of some of his frontal lobe will probably never be known by anyone here at the hospital!
These two patients on Sunday proved to be only a part of a full day in theatre which saw me operating on various emergency patients almost constantly between 8am and 2.30 the following morning. There was a baby with a neck abscess, a 3yr old with an open finger tip fracture and nail bed injury, a man with necrotic small bowel and sigmoid colon following an internal hernia who required two resections and bowel anastomoses, a Caesarean section for obstructed labour in a poor teenager who had been raped nine months earlier, an obstructed groin hernia, and a foot which had been injured with an axe. Then I was up again with an ectopic pregnancy early the next morning. All in a day’s work – neurosurgery, orthopaedics, paediatric surgery, plastic surgery, obstetrics, general surgery, colorectal surgery and gynaecology, in most of which I have limited training if any! But then that’s why I’m here – helping those who would otherwise not have any access to healthcare.
On Thursday afternoon, there was another major injury – this time accidental as a woman who had dropped a mirror attended with a laceration to her forearm. On closer examination in theatre it became apparent that she had sliced the entire contents of the palm side of her arm. I ended up rejoining three nerves, two arteries and about eleven tendons in a three and a half hour operation. I had concerns that the blood supply wouldn’t be good enough, but the next morning she had a warm pink hand, so what I repaired had obviously worked. The challenge for this patient is getting the hand moving again over the next few months. I put the arm in a plaster splint to limit finger extension, and made some cunningly-placed rubber bands passively flex her fingers, allowing my repaired tendons to move without tension. She came back for review again today, and I hope will return for regular physiotherapy. Unfortunately the aftercare of patients is very haphazard here, and we regularly see patients returning pieces of metal such as external-fixators which they have removed themselves, and they often ignore advice about the length of time a plaster cast should remain in place. We’ll have to see how this lady allows us to help with her hand.
After all that, I needed to get away for the weekend – so I went to Jinja, the source of the Nile, and spent Saturday white-water kayaking on Grade 2 rapids. As I’ve not canoed for years, that was quite scary enough for me, and great fun. The major coincidence of the day was meeting the person in charge of the kayaking operation, and discovering he was the younger brother of someone I was at medical school with! It’s a small world. I can heartily recommend “Kayak-The-Nile” to anyone interested in a great day out, run by Jamie Simpson, brother of fellow doctor, Gavin!
And so it’s been back to work again today – with some mostly straightforward stuff to counteract the adrenaline-inducing activities of the last two weekends. But still the memory and story to dine-out on for a while yet – I’ve been doing Open Brain Surgery!
Steve
No comments:
Post a Comment