As we’re closing in on the end of the second year since we left Bend, some things are starting to seem normal which probably shouldn’t. While many Kenyans in and around Nairobi or other large cities lead lives similar to people in the US or Europe, far more live in rural areas with little access to health care. As a result, we see things at Kijabe that are unimaginable in the western world. And sometimes I forget what a shining star, what a ray of hope, Kijabe represents. There are times when I feel overwhelmed by the need, and feel hopeless myself. But what always brings me back to enthusiasm are meeting patients whose lives are changed by this little hospital.
Yesterday, we operated on one patient, all day. The main road to Kijabe is called the Nairobi-Nakuru highway. It was recently listed by a British firm as one of the 22 deadliest stretches of road in the world.
Poor road conditions, insane passing maneuvers, huge trucks, overcrowded buses, motorcycles, pedestrians, goats, cattle, donkeys, and the occasional baboon all combine for an experience that would be comical if it weren’t so deadly.
There’s a surprisingly sharp turn on this highway, near the city of Nakuru, about 80 miles north of here. About two years ago, a large fuel tanker lost its breaks, slammed into oncoming traffic, killing many. The truck then began leaking fuel. As local villagers rushed to gather the valuable fuel, it burst into flame, incinerating many more. Unbelievably, this just happened again. This time the truck exploded immediately, so no crowd had gathered, so I guess that’s a horrible silver lining. Fewer people were burned this time. The local hospitals were quickly overwhelmed, both by the number and seriousness of the injuries, so Kijabe received some of the most severely injured.
The first patient we treated was a 46 year old woman, Jane, who’s legs were severely crushed. She was awake and alert, but in incredible pain. Examination of her legs showed they were both dead, and her crashing vital signs showed that the acid and potassium leaking into her body from the dead legs was quickly causing her heart and other organs to fail. As she was on a ventilator, with a breathing tube, she couldn’t give informed consent for surgery. I phoned her brother on his mobile, letting him know the gravity of the situation. We rushed her to surgery for emergency amputation of both legs, but to no avail. She succumbed to her overwhelming injuries a few hours later in our humble intensive care unit.
Another victim, Jacob, had injuries which seemed incompatible with life. He had shattered all four of his limbs, including both femurs (thigh bones).
His forearm bones on the right were sticking out through the skin. His left wrist was broken. His right ankle was dislocated and crushed, and most of the bones in both feet were crushed. He had second degree burns from the mid-shin down to the toes. His rib cage had been crushed, with fractured ribs on both sides and a chest xray that showed his lungs were bruised and filling with fluid.
Keeping Jacob alive would be a challenge at the best university hospital in the US or Europe. And this is where Kijabe is beyond belief. Using patched together instruments, donated ventilators and surgical equipment, patients like Jacob are routinely given state of the art trauma care. We were allowed a brief surgery to stabilize the most urgent problems, and the patient was then whisked to the ICU to support his breathing, blood pressure, receive transfusions, and pain control. Several days later, we were given the go-ahead to complete his trauma surgery. He entered the operating room at 8 am as a shattered person, and was wheeled out at five pm, ready to get out of bed.
The amount of teamwork this requires is beyond description. I’ve seen shows on TV where surgical teams rehearse complicated surgeries ahead of time. None of that happens here. When the situation calls for it, everyone just shows up, does her or his job without fanfare, and gives the patient hope for a decent life.
Today in clinic, one of the clinical officers from the outpatient department came in with an xray, to ask us about a child she was seeing. Eight year old Samuel and his mother had been sent to Kijabe to have his leg amputated. He’d been seen at a large national hospital a few months ago with leg pain, and sent away with pain killers. A few weeks later, the main bone between the knee and ankle protruded out of his skin. He’d been living like this for several months, before being seen at another hospital, which referred him to Kijabe for amputation.
I reviewed the xray with a junior orthopaedic resident,
who I asked to describe the findings and make the diagnosis from the xray. He did well, answering correctly that this was chronic osteomyelitis, a deep infection of the bone frequently seen in malnourished children. As the infection worsens, parts of the bone die, and then migrate out of the skin until they fall out.
I was grinning from ear to ear, both because the resident was doing well, and because I knew that Samuel did not need an amputation. We rushed over to the outpatient department to meet Samuel and his mother. As we entered the room, we were greeted by the familiar stench of infected, dead tissue.
I carefully explained to Samuel and his mother that, though he would not need an amputation, he had a long road ahead of him. With good nutrition, several surgeries, and months of antibiotics, this can almost always be cured or brought under excellent control. Children who have been ostracized and unable to attend school can have a decent life, can have hope.
I then asked the resident to perform a “sequestrectomy”, or remove the dead bone. This is usually a large surgery, done under general anesthetic. However, with Samuel’s bone sticking out through the skin, there was no reason not to remove this part of it immediately. As the tissue is dead, there is no sensation. With some hesitation, the resident put on gloves, and tentatively gave the exposed bone a pull and a twist.
To his, and Samuel’s amazement, the dead bone eased out of the infected leg. It took a bit of convincing, but Samuel eventually understood that he was going to keep his leg!
For Jane and her family, we failed. But they know, and they told us, that we did everything we could for her. In Kenya, that means a lot. They know we really cared about her, talked to her before surgery, suffered a little with her. They are grateful for what we did, even though we feel we failed. I guess that gives me hope. For Jacob and Samuel, conditions which would frequently be crippling or fatal can be treated. They can both have hope for a good life. And all of these people come to Kijabe because this rather small, nondescript building on the side of a muddy escarpment means hope. Probably the hardest part of living and working here, both for Ann and myself, is swinging between despair at the overwhelming suffering, and gratefulness to be a part of something so amazing. As always, thank you for being here with us, supporting us and praying for us.