At the end of the day – I’m happy with the result for young Abe!
If a kid is in hospital under your care for a year you get to know him well! I got to know young Abraham very well. I did a number of operations on him, and my wife brought him and his father to Australia for some very delicate surgery, which we couldn’t do there. A church here in Australia paid the airfares and an ex-Ethiopian Australian gave them a house to live in, while in Australia. Two colleagues of mine did surgery on him. They did it free and paid the hospital bill as well.
He was a little boy; he didn’t go to school; he played on the roadside. He was knocked over by a car, fell under a cotton picking machine and was mangled from his lower abdomen down to his knees. His father stayed with him all the time he was in hospital. We saw the mother and rest of the family occasionally.
His injuries were extensive; a fractured right femur; the skin and fat sheared from all of his left thigh down to muscle; his penile and scrotal skin were torn from their normal position but survived and could later be re-used; he had a cut running right between his legs taking out part of his urethra and splitting his anal canal in two. He was obviously in severe shock. Continue reading “Abraham”→
Monkeys – we didn’t see a lot of monkey bites. There are of course many different types of monkey. In one place where we lived there were dozens of them. We had a lot of bananas but, against what we expected, they rarely ate them. They loved our guavas. There was a large tree abutting the back of our house. They would steal as many as they thought they could hold, run along the roof ridge and, no doubt accidentally, dropped some as they ran. Those dropped would clatter down the tin roof into the gutters; which was annoying, particularly at night! They would sit on the window looking through the bars, and you wondered who was looking at whom!
Who’s watching who? -At our kitchen window.
Guereza monkeys, brilliant with their black and white colours, leaping from tree to tree were gorgeous to watch. Staying for a break at the one of the Rift Valley lakes we saw lots of those monkeys with ‘painted’ backsides. They were thieves, watching carefully and awaiting the moment, they’d jump down and steal food from your table or even your hand.
Hyenas – people think that these are only scavengers, but they are prepared to attack living animals or humans. They can cause rabies. At night time our workers would not walk alone. There were always at least 2 or preferably more of them and armed with dullahs (heavy sticks) when walking outside..
The two cases which stand out in my mind are of two boys who came in (at separate times) both having been scalped. (photos below the ‘more’ line) The bone on the top of their heads was laid bare over many sq cms. You cannot graft onto bare bone. We had to drill multiple holes through the outer table of the skull, being very careful to not go right through the inner table of bone. The tissue in the centre of the bone (the marrow or medulla) granulated out through these holes and when it had covered the bare bone totally we could skin graft it. Both boys eventually did well even if they were prematurely bald, and needed to wear protection to protect their grafted skin from trauma and the sun. Thin (split) skin grafts don’t become normal skin again.
Wild boars (called kekero there). With their long tusks and bites they could tear skin and do a lot of damage. We had some that visited us daily in our garden. They learned how to turn on the tap in our back yard using their tusks – in order to get a drink. I wouldn’t have minded if they had only thought to turn them off. The locals told us when we arrived at that University that rhinoceroses came every afternoon. They got it wrong. We never saw a rhino but daily had boars visit us.
Crocodiles are very common in the Rift Valley lakes. Crocodile teeth tear the skin and shatter the bones. We saw a lot of their bites as the people fished from very flimsy balsa wood boats.
Hippopotamuses- I clearly remember a number of hippopotamus bites, all very dramatic. The story of one boy is fascinating. The villagers were short of meat and decided a hippo would be good meat. Half the village got behind him and half on the other side; many with spears. Those at the back began to drive it forward. It began to move. The others were ready. The hippo saw them; didn’t like what he saw; began to charge at full and frightening speed. The villagers fled but this boy slipped and fell; the hippo was on him. The villagers killed the hippo and probably enjoyed the meat. The boy was brought to the hospital. He had a big gash on his chest, exposing but not breaking his ribs and a cut slicing his left buttock in two and the cut extending to the back of the knee. It was deep enough to expose the sciatic nerve, over a long segment, but did not divide the nerve.
We didn’t like getting too near hippos – they charged at you.
Another hippo bite that comes to mind is when a woman was leaning over near the edge of a lake doing her washing. A hippo came up behind her and bit her buttocks from top down laying them as if it they were an open purse. Fortunately it was mainly skin and fat and was repaired fairly easily.
These are some of the ones which came into our back garden and who could turn on taps!
We all get bites at some time or other.
Insects bite are probably the commonest and they cause lots of problems. There are thousands around the world who die every year from malaria. The enlarged spleens which they often get make them more prone to getting ruptured spleens from traumatic episodes. There are also other nasty mosquito spread diseases. Ticks also bite and they can cause a variety of diseases. Scorpions – their stings cause severe pain but usually not much else. Young children may get worse reactions as a few varieties are venomous. Injecting directly around the site with morphia gave the quickest and best results. You quickly had very happy customers. The above almost always cause medical diseases although there can be complications requiring surgery, and I’m a surgeon – so I tended to deal with bigger mouths and more traumatic bites.
Snakes – Their bites are not consistent in how they behave; that is they are either venomous or non- venomous, and there are a variety of venoms. The non-venomous just give you a nip without poison – scary but these are really a fairly minor issue. The venomous ones have a variety of ways of causing major problems. Among them are neurological problems, bleeding diatheses, tissue death, allergic reactions, kidney failure. It is nice if you have specific antivenins available depending on the type of snake, but our patients tended to arrive late, and antivenins are much better if given early. The polyvalent antivenoms which we held in stock were not as good at any rate. The major problems we saw were of tissue damage with massive swelling needing splitting of the skin to relieve pressure, and often cutting away the dead tissue. Amputations were occasionally necessary, but more often we could cover the dead areas with skin grafting. Continue reading “Bites 1 – garden and domestic”→
My joints don’t like getting down or getting up these days, so picnics on the ground are no longer fun. But here in Australia there are so many parks with excellent facilities that we can sit at shaded tables with gas BBQs even in most country towns. There are roadside toilets along the roads, and in many parts of Australia many stretches of road, with so little traffic that you can safely just go behind a tree!
Not so in most parts of Africa. Without going into details there were a number of amusing/trying situations.
We built two new toilets at the Leprosy hospital – septic systems. An introduction to Life in Africa We had to employ guards outside them. If we put toilet paper rolls inside they were stolen. If we didn’t people used banana leaves or corn, neither of which septic systems are made to deal with. So we had guards posted on 24 hour duty, exchanging whatever for a generous issue of TP. (Maybe of interest is that the majority of Africans eating their normal diet, which is very high in fibre, have 2-4 bowel motions per day – hence the 24 hour duty roster for the guards!) Continue reading “The joys of the simple life”→
The Rift Valley has many large lakes. The leprosarium was on the Eastern side of the Rift Valley
Well, young Yacob* isn’t young any longer. He has seven children and two grandchildren; he lives in Australia and holds a significant government appointment. He was offered an ambassador post in an African country but refused it. But he was just a school kid when I met him.
He was a mid-teen at that time. He was going to school, I think, in grade 3. After that He did 2 grades each year and eventually had to leave our area to do grades 11 and 12 in a bigger school. He was bright. Then he was forced into military service and eventually got to Australia with a bit of help. He had hoped to become a doctor but wasn’t allowed into medical school here.
But I didn’t meet him because of his studies. In the evenings and during the holidays he worked in the leprosy hospital operating room complex. Working in a leprosarium 1968-74 There were, of course, others working there too. Most of them were treated or being treated leprosy patients. One had no fingers but he looked after the sterilising system. Sterilising was done there for the whole compound – 2 hospitals with an OR each, and 2 outpatient departments. It ran almost 24/7. The nurse from the leprosy hospital came into the operating room when we were operating under a general anaesthetic to watch at the anaesthetic end, after I had put the patient to sleep. (This was at a hospital about 20 years before the time with the 3 teenagers). Follow up on Mesfin of the ‘3 Teenagers’ She didn’t scrub. If Yacob* was there he did. We didn’t have an assistant scrub also, so he had to do both the scrub nurse and the assistant’s duties. Often I didn’t have to ask for an instrument because he was watching, knew what I needed, and put it into my hand. He was good! I only had 2 people scrubbed with me for two types of operations – open prostatectomies and spinal fusions.
Later he did small procedures like suturing and removing dead bones from leper’s feet. One of our sons fell and cut his head while I was away. Yakob sutured it up.
We had a number of kids come in on whom we had to do tracheostomies (ie open into the trachea through the neck) because they had obstructed airways from inhaled foreign bodies – usually corn or beads. We didn’t have all the fancy instruments available to do it through the mouth. The problem was that after surgery they needed intensive watching with frequent aspiration of mucus through the trachy tube before we could remove the tube and let the wound heal. Maybe for 3 or 4 days. There was no other worker apart from him who would watch the patients overnight. So we used to bring a suction machine, an oxygen bottle, and the patient into our home lounge. We had a timer to wake Yacob* up at regular intervals and he slept on our sofa – all 6’3” of him! (For people with head injuries and with regular observations ordered if we happened to go back to the hospital – say at 2am – the obs would be written up until 6am, and the worker asleep.)
He knew 7 languages and in a hospital where they spoke 15 different languages, as the patients came from all the southern parts, he was often used as an interpreter. He was a great kid.
In Australia he became a nurse; did a bachelor and masters’ degrees in medical science; studied admin, and has been CEO of a rehabilitation department for over 30 years.
Surely he must retire soon.
Street scene near the hospital – taken more recently. There were few cars in those days.
Heated Stew 