I am, at the strong encouragement of one of my sons, who says that there are some stories in my life worth recording, reviewing and extending a brief autobiography I wrote years ago. Going through a bit of it yesterday I came across this brief event of one day in my journey. This occured while I was briefly attached to a large teaching hospital in Addis Ababa.
I was on call one night on the eve of a large Muslim holiday. The next morning I left to go to the hospital surprised that I hadn’t had a single call over night. As usual we did a round of the whole surgical wards and early in the round I came across a poor lady lying in bed with most of her small bowel and a bit of her large bowel mixed in with a lot of dirt and gravel lying on the bed next to her. She had a large hole in her right side where all the tissues down to and including portion of the right iliac crest (part of her pelvis) had been torn off in a car accident.
Later I discovered the story. She had been hit by a car driven, by a nun, about four hundred kilometres south of Addis Ababa. The driver had taken her to the local hospital who stated, correctly, that they had no surgeon and the nearest hospital with a surgeon was one hundred and fifty kilometres up the road towards Addis. So the nun took her to that hospital, where she was told that they did have an appointed surgeon but he was away and they had no idea when he would return. They came to Addis, where the first three hospitals said that they had no empty beds. She was eventually admitted into St. Pauls – but nothing had been done for her. No IV fluids, no antibiotics, no dressings – in fact nothing at all except that she had been put in a bed.
I have learnt to be pretty patient but this stretched me to the limit. Why had nothing been done? The hospital was without water so the operating theatres were out of action and definitive treatment could not therefore be undertaken. I think it was planned to leave everything to the undertaker! So I organized for a drip and antibiotics and a clean moist dressing over the exposed entrails and planned to look into the water situation later. I had already noted a tap being used down the street by the general public.
Soon we came across another young man who had been stabbed in the back. He was as white as an Ethiopian can be. As he was of a higher social class he at least had a drip up but the blood bank was closed for the holiday. My wife had arrived in the country by this time and I arranged for her and a missionary nurse Jean Sokvitne to donate blood. With some difficulty we were able to collect it and cross match using Eldon cards.
I organized a group of workers and I worked with them. Between us, we carried water from the afore-mentioned tap and collected maybe a hundred litres in a large container outside the operating rooms. Grudgingly the staff agreed to operate. The young man when stabbed had had his renal artery and vein divided and fortunately the knife, avoiding the duodenum, opened into the peritoneum but not causing any bowel injury. He thus had a peritoneal cavity filled with blood but uncontaminated by intestinal content. We gave him two units of foreign blood and I showed the doctors how to filter the blood from inside his abdomen through gauze and we auto-transfused the patient. He survived and did very well.
Next we worked on the lady. It was difficult but we cleaned her intestines, cleaned the edges of her wound and after returning the bowel to its proper place closed the wound with considerable difficulty. She also recovered, although much more slowly than the young man. In addition to her physical disease she had underlying mental problems which added to her initial poor management and which made things difficult during her recovery.
The day after the holiday we had, as usual on working days, a morning meeting at which all admissions over the past couple of days were discussed. I was, surprisingly to me, severely chastised. Two motions were passed:
- Never again would doctors be involved in carrying water to the hospital or in arranging for it to be carried as this was a government responsibility.
- No auto transfusion would be used unless a modern cell saver were used (of course there were none in Ethiopia!) as the country was not a ‘banana republic’.