Today is Wednesday, July 23, 2014

Emergency in Africa

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By GEORGE ROBERTSON, M.D.

Monday morning we woke up to a breakfast of scrambled eggs and toast. At the hospital we started with morning devotional and followed up with several surgeries. Henry wanted to do surgery on the chief so I helped him with a large inguinal hernia. I dropped out to help Bob with a lady who had an umbilical hernia who had been waiting on the Ward 5 for six days. We followed up with a dilation and curettage.

A young man was brought into the operating room from an automobile accident. His right leg was crushed severely. We gave him IV fluids, antibiotics and irrigated the wound. We had no orthopedic equipment but probably should have done an amputation of his badly traumatized leg. If I had known that it would take three hours just to get him on the road toward the hospital, I would have gone ahead with the amputation that he surely would need after dealing with the delay of transportation. The hold up in his transport seemed several-fold. First, the family was contacted and actually paid for his emergency room care before he was released. Then the family had to arrange for his transportation the 30 miles down the pot-holed, crowded road to the orthopedic hospital. They arrived in an old, beat up automobile in which the right front seat had been removed. I was afraid that the damaged right left which was now supported by a long metal splint would not go into the automobile. By some miracle, they were able to get the poor bleeding, bandaged, splinted, leg into the car.

What followed next I could not believe. Several people tried various positions to ride with him and one person actually made him sit forward so that she could sit behind him, her toes barely clearing the door closure. I could not stand it any longer. With all the manipulation and not having it elevated to prevent the swelling, the leg was beginning to bleed through the bandages.

I shouted at the top of my voice, “Get the man out of here before he bleeds to death. Get in the car and get going.” There were still several back-and-forth conversations with the driver and passers-by going on before he casually started the car rolling out of the hospital gates. One can only imagine the snarled traffic, potholes and other hurdles he would need to pass before getting the 30 miles down the road to the hospital. As I leaned into the window to tell the driver to get a police escort for him down the road, I noticed the flat, complete empty intravenous fluid bag lying below the passenger in the front seat. This site would be another source of blood loss while the patient was en route.

I felt so frustrated by the whole affair I wanted to just quit and go home. We had no extremity splints. We had no Plaster of Paris. We had no pins to hold the bones in place, and everything we wanted to do seemed to go in slow motion. I only hope that young man did not die of sepsis from the leg that will surely need an amputation.

Editor’s Note: Robertson is a physician with Family Medical Associates, PC, in Lebanon.

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