As I sat down to write this, my phone rang. It was the excellent resident I’m currently working with, calling with bad news. He had brought our patient from Sunday, the one with the terrible leg infection, back to theatre to wash out the infection again. Instead of finding the leg improving, he found toes turning black, and the muscles dying. We got to Kamau too late. The infection had gone too far. This young man is going to need an amputation.
I can feel the resentment build: why did this have to happen? It wasn’t a complex problem: with some basic surgical care from the outset, he could be planning his recovery, this episode soon relegated to a painful memory and tales to tell his children and grandchildren. Instead, he will be an amputee, in a country which doesn’t look kindly on disability. Here we have no “Kenyans with Disabilities Act” to put in sidewalk ramps, require accessible public transport, or prevent employment discrimination. Disability is sometimes viewed as a curse, creating fear, suspicion. He will have some difficulty finding and affording a good prosthesis. This is a huge setback for his life.
If this were an isolated instance, it would be simply frustrating. But it is a regular occurrence, even here in Kenya, one of the more developed countries in sub-Saharan Africa. I’ve been to countries where things are much worse, where there is simply no hope for patients with significant injuries. The suffering across this continent is unimaginable.
There’s a lot of people working on this problem. My Notre Dame classmate and roommate from medical school, John Meara, has risen to the highest echelons of the academic world, and is spearheading the Lancet Commission. The Lancet, one of the oldest and most prestigious medical journals in the world, has decided to undertake a major project, looking at the effect of this severe lack of surgical capacity in the developing world. The governing body of the World Health Organization meets in May and will pass a resolution declaring basic surgical care a right, much like access to clean water, food, security, and vaccines. This is a watershed moment for the billions of people suffering worldwide from lack of access to adequate surgical care.
In our lifetimes, this problem will be reversed, and severe lack of surgical capacity will go the way of smallpox and polio. But that doesn’t help Kamau today.
Our first patient for the day, a young man in a car wreck, was due to have his hip socket reconstructed after a fracture-dislocation of his hip. Unfortunately, due to a scheduling error, we had to re-schedule his surgery for Thursday.
Our next patient was due for wrist reconstruction after a mangling injury a year ago when his van rolled over as his arm was out the window. As we were preparing him for surgery, I pressed gently on a little opening in his arm. To my surprise, a 3/4 inch seed pod popped out, followed by pus. Apparently, despite multiple surgeries at two excellent hospitals in Tanzania and Nairobi, this remnant from his roadside injury had hidden inside his arm for a year. It decided to work its way out on the day this patient was finally scheduled for his reconstructive surgery. We cleaned out the infection and took him to the ward for intravenous antibiotics.
The third patient today was a middle aged lady who had fallen down some stairs, shattering her wrist. She was scheduled for a combination of plating and external fixation today. Though she has a history of hypertension (high blood pressure), she has been well controlled by medications. Until she got onto the operating table. Her blood pressure shot up to a dangerous 200/100, and persisted despite intravenous anxiety and blood pressure medications. Surgery cancelled.
Next up, a two year old boy who fell down some stairs, hyper-extending his elbow to the point where the elbow broke just above the joint. Jane had this same injury just last November. The treatment is a surgery where the bones are manipulated back into position, and then held there with two pins introduced through the skin into the bone using video xray. This went flawlessly, all the equipment worked perfectly, and he should be fine. Finally, we accomplished something for the day.
Our last patient was the disastrous Kamau, wrapping up an all-too-typical day in the battle against trauma in Africa. When he wakes up, we’ll need to give him the bad news and obtain consent for amputation.
In the big picture, I know progress is being made, systems are being formed, surgeons are being trained, the John Meara’s of the world are pushing global organizations to wake up to this unseen epidemic. But day to day, my picture isn’t that big. My picture is the men, women, and children in my clinics and theatres who suffer agony and disability from lack of safe roads, safe drivers, and access to safe surgical care. Though we’re too late for Kamau, my prayer is that his children will live in a world with less suffering.