Two Falls From Trees

It is very common to see men climbing high up in trees to cut down the top most branches which they do with a very sharp panga [a long knife]. Unfortunately they do this with absolutely no security what so ever and as a result many serious injuries occur through falls including broken necks that can cause quadriplegia in which all limbs are paralysed.

A man living dangerously at the top of a tall tree

One evening last week a man aged 48 came to the hospital. He had fallen from a tree and a branch had made two holes in his anterior abdominal wall through which bowel was protruding. Incredibly this had happened thirty six hours before he came to our hospital. He had tried to get attention at a government hospital, they suggested he went fifty kilometres to a bigger government hospital but he did not have enough money for the bus fare. He eventually staggered to our hospital. In addition he had a severe wound behind his left knee where a branch had penetrated from one side to the other amazingly without damaging major blood vessels or nerves. I was able to pass four fingers from one side to the other and easily feel the main artery beating.

The man who fell from the tree with two loops of bowel through two separate holes in the abdominal wall

We took him to theatre and dealt with the abdominal trauma. The ragged lacerations behind the knee could only be cleaned and formal closure will have to wait until later when all signs of infection have settled. He was fortunate that the Maua Methodist Hospital was willing to offer treatment, however, it is unlikely that he will be able to pay much towards the cost. The hospital is in considerable financial trouble as people so often cannot afford to pay and nobody whose life is in danger is refused treatment.  Staff wages have had to be increased to compete with government hospitals as we have lost 75% of our nurses to the state side even though their hospitals have few drugs and equipment. In addition the government doctors often spend more time doing private work than attending to their hospital’s patients.

3 days after the surgery awaiting discharge home

 

Having seen the above patient I was called urgently to the trauma room to see a four year old boy who had also fallen from a tree and a branch had penetrated through the scrotum into the abdominal wall and through into the peritoneal cavity. He of course needed urgent surgery. Quite an evenings work extending into the night.

While in the process of writing this I was called to the medical ward to see a patient with a large liver abscess from which we drained a litre of pus.

A large liver abscess

Surgeon Else after it had been drained. One litre was drained but more will slowly drain through the drainage tube we inserted

I also helped our excellent Danish surgeon, Dr Else, regarding her second patient of the weekend admitted with severe post partum haemorrhage. This patient is now stable. The first was an undiagnosed bleeding disorder with a clotting time of 35 minutes, the normal being less than 8 minutes. Mary has been involved too racing around getting various bits of medical material that was needed from the medical store where she spends much of her time. Fortunately the mother survived and is now doing well but sadly the baby had inherited the same bleeding disorder and died of blood loss during the night.

I can assure you that working here can be very rewarding but at times too very sad. There is rarely a dull moment.

Post script regarding the man who fell from the tree.

Since writing about the man who claimed to have fallen from a tree I have learnt he may have deceived me. I have heard a much more likely story. The man is alleged to be a poacher and he was trying to kill a buffalo for his dinner. The buffalo had other ideas and attacked him resulting in his injuries which were certainly compatible. I am pleased to report he has made a quick recovery  from his abdominal injury. As I left Kenya the man was still in hospital as he was unable [or unwilling] to pay his bill. The open wound behind his knee still needs attention. To compound this patient’s difficulties the authorities are said to be taking a keen interest in his welfare.

Do I detect a rather snug look on the face of this buffulo?

 

 

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