Abdullah is a nine yo boy who had been bitten on the arm by a snake some
time back. The exact story is is unclear
and seems to change depending on the translator. One iteration is Abdullah was
treated by a local witch doctor with herbs ( or “erbes” as they say here).
Another was a toriquet was left on his arm for too long and too tight and he developed gangrene after
his brachial artery clotted off. Sort of like a heart attack of his arm.
Whatever the story, he he got screwed. Maybe he would have died with out the
lousy care he got. Maybe the snake was a
Black Momba and since he is only 30 kg it would have finished him off quickly.But
I bet if I asked him the day I met him if he wished he had rather died he would have
said “ndyio” (yes).
I
had been asked to see him the 1st wk I was at the hospital but when I went to
find him on the pedi ward ( aka bedlam) his parents had taken him home. I have
been thru that before. Many patients just “abscond” with their kids never to be seen again. This
seems particularly true of bad limbs that will never heal. The idea of amputaion
doesn’t sit well here in Kagera. You can’t
blame them really. The chance of a
prosthesis is next to zero. And if you’re a growing kid in need of several
prosthesis over your growing years…well that’s impossible. Facing a life of
being crippled, the village “gimp”, the incomplete man or women, the stigma of
imperfection, well its impossible. You can write off a big chunk of you life including
facing the fact that you may never find a mate, a job, friends…. Well, you can
see this can go on and on.
To stay
on track, Adullah’s parents brought him back. And when I did find him in
the crowded, 2 or 3 kids to a bed, pedi ward Abdullah was in a bed by himself! He had been placed in a relatively quiet room at the end of the
ward. Later I realized the reason why
and thought to myself “ these nurses really do know whats going
on”. Abdullah was put in relative isolation not
b/c he was infectious ( which he prob was) but b/c the nurses knew he was
trying to hide his hideous arm from anyone looking his way. When I first met
him he wore 2 kangas. One wrapped his lower body and a second one wrapped his
right arm. I almost lost my professional cool when I peeled the stinky pussy
kanka back and saw his mummified necrotic
arm. It looked like something from a 1950’s bad horror film. But this
was real.
From his wrist to his elbow was just skeleton,
no muscle, like parana had attacked his arm and eaten all the tissue off the
two bones of his forearm. From his wrist to his fingers was dried gangrene
mummified tissue. Above his elbow was 2 to 3 inches of stinky infected tissue. Abdullah cried when I got near but never
looked up at me. I am sure I terrrified him; a tall white man. Maybe the first
to touch him or see his wound. I have a
love and facination for pathology and usually the grossier the better but this
one made me mad. Sure he was going to
loose his arm and be crippled and stignmatized for the rest of his life.
But this was cruel torture and psychologically damageing to this little
kid. Why hadn’t this arm been removed before and who is so insensitive to leave
this dead limb on this little kid for so long.?
If this was in the U.S. Abdullah would be on the front page of the
Boston Herald and the N.Y. Daily News. “Boy Mummy Back From Dead” His parents
would be arrested for cruelty to children. Social Workers would go nuts!
But quess what? This is not the US. This is
Kagera. There is no money for medicine or surgery. There is just passive
acceptance of bad things happening to innocent people.
We finally got Abdullah to the OR. My guess
this surgery should have been done 3 months ago…at least. The first thing I did
after we draped him was take the dull saw and cut through the the 2 bones ( radius and ulna) of his
forearm just distal to his elbow. His bones, completely stripped of tissue and
muscle,along with his leather gangenous wrist and hand dropped off into a
bucket. I asked the runner to “ get that arm out of the room”. Next, we found a
suitable clean level on his upper arm, cut down to his humerus, cut that in
half and removed his distal upper arm and elbow. Then we created a nice round
wrap of tissue to cover the bone and sewed his arm up to create a stump. Time
of operation, skin to skin: 60 mins. Timing of operation: very late.
I followed up with Abdullah every morning
in the hospital. He never complained of pain . His dad, a muslim, was there
every day at the bedside. We got more comfortable in time even though we had
few words in common between us. Forget about words, we had nothing in common
except that he came to believe that this mzungu was helping his son. I brought Abdullah a pad and pen on post op day
2. I’m pretty sure he use to be right
handed. I wrote the alphabet out and then he did the same with his only ( left)
hand. Then I tried to write the alphabet out with my left hand. That was the first time I ever saw him or his
dad laugh. Then I wrote “ practice makes
perfect” I hope they get that translated
someday. The next day he was up and
about and his wound looked clean. Against the better wishes of the nurses, I
sent him home. I’m betting his house is cleaner then the hospital and I know his dad will be at his side.
Abdullah, with any luck and no signifigant
complications will have an upper arm that is about 7 inches long. It won’t be
beautiful but it won’t stink and he doesn’t look like a walking horror movie.
His chance of a prosthesis…next to zero.
His chance of
enjoying his life as a handicapped but otherwise possibly normal person…much
improved.
No comments:
Post a Comment