The Adventure of Living in the Kingdom of God

Saturday, March 2, 2013

Kenya - part 4

My first night on call! We arrived at the hospital a couple days before New Years having landed in Nairobi a few days earlier to spend time with precious friends and celebrate the birth of the their new daughter. I received a tour of the hospital by Mrs Patsy Gaw, a retired RN from Nashville who has been to Tenwek several times with her husband David Gaw - a retired orthopedic surgeon from Nashville. Seeing firsthand the hospital campus and the many patient wards left me with a deep sense of respect for the work going on at Tenwek and the sense of calling upon the people who call Tenwek home.

Tenwek is one of the few hospitals in the area with emergency services 24 / 7 / 365. There are several government hospitals that many people will go to first but if it is too complicated for them to handle (which is most things), they refer them to Tenwek. Orthopedics has been a strong point of Tenwek for many years even before the arrival of Dr Galat because of Dr Chupp, a general surgeon who because of the immense orthopedic need started doing orthopedic cases with the help of his Campbell's Orthopedics textbook and delivered fantastic care for a decade or more prior to Dr Galat's arrival. Needless to say, Tenwek has built a reputation of offering excellent orthopedic care for many years and the people of western Kenya know it.

My first call night was somewhat busy, not so much because of the number of patients that came in but the severity of the injuries seen. New Years Day during the day with remarkably quiet but the evening brought work. I received a call from the general surgery intern Liz (by the way, she is absolutely awesome!) who said " I have three patients to run by you. You should probably come see them." I walked up the hill to Casualty (we call it the Emergency Room), a medium-sized room with curtains to divide patients' beds from each other.

#1: 50 year old male involved in a RTC (Road Traffic Crash) with bilateral lower extremity fractures - a Left severely comminuted distal femur fracture. A right comminuted tibial plateau fracture. Both injuries were thankfully closed (no bones sticking out).

 --- We placed his right leg (tibial plateau frx) in a long leg plaster splint and placed a  tibial traction pin in his left leg (femur frx). He was fixed a few days later with a left retrograde femoral SIGN nail and a right tibial hybrid ring external fixator. Will show pics of that later.

#2: 35 year old male involved in a RTC 2 days prior with a dislocated left hip in immense pain. He went to the government hospital who said he should really go to Tenwek.

Xray - Left Hip Dislocation with Posterior Wall Acetabular fracture
Wonderful Team in OR - Liz & Daniel
Tenwek is blessed to have a CT scanner that worked most of the time I was there.  It cost $100 for a CT Scan in a region where the average income for most families is around $750/year! Oh, and its powered by 50 car batteries linked in series to provide the power for it (no joke!)
CT Scan: You can see the large divot in the femoral head and the large piece inside the joint. No bueno!

--- He dislocated his hip two days prior in a RTC and no attempt had been made to reduce it (put it back in the hip socket). We took him to the OR and under sedation worked to reduce his hip. While reducing it, we never got the satisfying 'clunk' we hope for when the hip goes into the joint. It was very unstable and continued to pop back out as soon as we felt it was in. Above, you can see the team there that night in the OR placing a tibial traction pin in his affected leg. As you can see from the CT scan image above, the reason for the hip's instability was a piece from his broken hip socket was pulled into the joint keeping the hip from reducing. He was taken the OR where we extracted the piece of bone from the joint and plated the back wall of the hip. Fixation pics later.

#3: 3 year old girl with a right elbow injury with a displaced and 180 degree rotated lateral condyle fracture after falling out of a tree. She was pinned the next day. Sorry I don't have xrays of her elbow. 

Needless to say, there wasn't alot of sleep that night.

More to come...

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