Grapic Images, once again!
Back to the hospital! The day began in major theatre observing a surgery on a 15 month old boy with hypospadias. This is a birth defect in the opening of the urethra. The surgery was kind of hard to see from where we were standing, but its always amazing to see a broken body opened up and put back together again.
Going into surgery
Things were beginning to pick up in minor, but there were a lot of us down there which sometimes makes things more complicated than they should be. Trisha and I decided to go take a look at casualty. As we got closer to the gate we saw quite a bit of commotion. There were probably six people yelling from the outside of the gate which I’ve never seen closed, and two police officers guarding it from the inside. Once the officers saw us the immediately opened it to let us in. Inside on the male half of the room we saw three patients and another five police officers. It’s not uncommon for police to escort prisoners in who need medical attention, but this was different. These patients weren’t prisoners—well at least not yet. We saw Dr. Abdulhussein, one of our favorite doctors because he involves us in patient care and asks us questions to challenge our knowledge. We made eye contact and he motioned for us to follow him. Upon squeezing through the officers and onlookers, we arrived at the bedside of a male in his mid-twenties, severely beaten. Dr. Abdulhussein explained he was going to do a full body exam basically to check for DCAP-BTLS (deformities, contusions, abrasions, punctures, bruises, tenderness, lacerations, swelling). His way of performing this was somewhat similar to what we do in the American world of EMS—but not quite. I was surprised he did not expose his body and at how rough he was with the patient. They guy would be screaming out in pain yet the doctor would keep poking, prodding, and yanking. The officer in charge of him was also being very aggressive, slapping him hard in the face and yelling at him to scoot up in the bed. Upon completion of the exam the doctor concluded he did not have any broken bones, but without an x-ray I wasn’t convinced. The patient had a large laceration on the back of his head deep enough to indicate a possible occipital fracture. I was most worried about internal bleeding, and they said he was going to go for an ultrasound as soon as it was available. After finishing up at the bedside, Dr. Abdulhussein began to explain “mob justice” to Trisha and I. The patient we had just seen had stolen something earlier that day. When that happens in Kenya the people who witness the offense are allowed to chase after the theft and beat him until the police come and take him somewhere. This is legal here! No one gets persecuted for beating someone to death in the street.
I then overheard the doctor tell someone the patient had been struck by a tuktuk, even though minutes earlier he had told us about the mob justice scenario. Learning this switched on a light bulb in my head. We have seen a lot of people involved in some sort of motor vehicle accident, but how many of those were actually mob justice victims? It seems like every day new horrifying evidence of abuse is brought out into the light.
Trisha and I decided to go help out in minor while we waited for the mob justice patient to come back from medical imaging. Dr. Abdulhussein was going to teach us how to suture so we definitely wanted to wait around for that. As we were at a low point in number of patients, Jeff came in and told us if we wanted to see a really cool wound to come in the exam room. I followed him in and this is what I found:
This patient had been cut by an iron sheet used for roofing. His open, unclean cut had turned into this in a matter of weeks! The foul, sour smell of rotting flesh filled the room making it almost unbearable to stand. Jeff assisted an intern doctor in the cleaning of the room which included scrapping out the white infectious part of the wound. After spending some time in there it was almost time to go if we wanted our free ride in the van. I decided to call it a day, while Trisha wanted to hang out for an extra half hour to see if our mob patient would come in for sutures. I saw her an hour later and she said he had never gone up for ultrasound; he was still lying on the gurney where we had last seen him. After going to have a closer look at him, he appeared deceased. I cannot express how angry I am with how this case played out. I have gotten a thorough insight of Kenyan healthcare, but I don’t know if I’ll ever completely understand it. It makes me want to stay longer because things seem to get done and move faster when we are there. Even if our only contribution is pestering the staff or changing dressings, I still feel as though we are helping improve the wellbeing of patients at Coast General.
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