Tuesday, May 22, 2007

Gunshot Injury: Nigerian Doctors Dilemma

Our patient with Gun shot injury is anything but unlucky. Though at this time it’s still too early to say whether or not his limb will recover fully, you might still be interested in knowing how he’s doing. Well like I last said, we finally were able to take him into the theatre at about 12.30am. It was a long night for an operation that lasted till 5.30am. No member of the unit had a wink of sleep the whole night. If you are reading this you might to tempted to think I’m lying but it’s true. Nigerian doctors are not what you have always heard. They are dedicated. As a fact they a over worked and under paid. If you have ever had a bad encounter with any, it is definitely this frustration that sometimes is expressed as poor doctor-patient relationship.

My indefatigable Chief headed the team that explored our patient’s grin to ascertain the extent f damage and salvage the limb if possible. By the time we went in, we found that the femoral artery at the level of the inguinal ligament was totally severed by the bullet. Our major task then was to arrest the bleeding that had started gushing out from the proximal end of the artery.

Next task was to repair the artery. The surgeon had to take a graft from the other leg to repair the blood vessel. This failed because; in the process of handling the graft it became traumatized. This is a situation that would have been avoided if the hospital had microscopes for microscopic surgeries. The suture material is not meant to touch the intimae of the vessel as it predisposes to embolization with its own dire consequences.

So we had to make do with prosthetic device made from tetrafluroethylene, a material that is made to have the same properties as an artery. Note that this material was not provided by the hospital but by my chief-According to him, he’s not going to ask the patient to pay as they patient can never finish paying him. The usual charity medicine we practice in Nigeria.

Now back to the surgery! We replace the destroyed section of the artery with this device and at about 5.30am we were through and all won out. Hoping that what has been done show positive result. The result was drastic, better that what we expected. As at yesterday, power in the affected limb has increased. The limb getting warm, except the ankle and the foot. But so far we happy it didn’t get as bad as we thought. Now in order to save him, he has to be on heparin (an anti-coagulant). But guess what there no single drop of heparin in the hospital is. In fact not even a single drop is available in town. We need to make special arrangement for someone to get it out of town and by then our fear would have already happened. Besides, the patient can’t even afford blood transfusion how much more, sending for drugs out of town. We have to settle for a not so good alternative- Clexane. I’ll keep you updated on what happens next. This is just a tip of the iceberg the things people go through in a totally bastardized system.

What could have otherwise been an easy ride for everyone has become complicated situation due to bad laws and neglect of the health system. Doctors do have their short comings, but the season Nigerians are going abroad for treatment of malaria is due to things like this. Heparin is a drug a hospital shouldn’t lack. But our teaching hospital has no heparin

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