Going to the Mother of the Chief's Funeral

Last Saturday, a cattle truck was filled to the brim transporting a hundred Savelagu villagers to the mother of the chief's funeral.  In Tamale, funerals are accompanied by traditional dancing and music and they are both a diversion for the people and an important social event.  As the truck was attempting to pass another vehicle, it tilted causing some passengers to fall off.  The truck then fell into a deep cement gutter resulting in the immediate death of 15 or 20.  The dead, body parts and sixty others were brought to our hospital twenty minutes away.  The emergency room was chaotic with blood, patients, family and staff.   I triaged - directing the young doctors and nurses to care for the seriously injured and for the administrators and orderlies to move the walking wounded to a nearby location.  A dozen patients were sent to the operating room where four had abdominal operations for internal bleeding, eight had chest tubes inserted for collapsed lungs, two had limb amputations and many had suturing of open fractured skulls, multiple facial and head lacerations.  One experienced nurse suggested where to place the dead and these were laid out adjacent to the emergency room.   Twice the patients were checked hoping to find some life.  There were twenty-five dead patients laid side by side and head to foot.  Two thirds of them may have arrived dead.  Their families were twenty feet away anxiously watching the doctors and nurses work.  It resembled a war scene.  A photo did not seem appropriate but newsmen and others were taking pictures.  The death toll three days later is thirty-one.  Twenty-hour work days resulted but we saved many who would have died.

Today is a a national holiday, the birthday of Kwame Nkrumah, the first president of Ghana and it is allowing the staff to catch up.  Order has returned although life will never be the same for some families.   A man with an amputated arm, whose face and nose I sutured and with whom I cannot communicate, thanks me in his distress for caring for him.  It touches me.  Universally we are all the same.

Terrible twos

Terrible Twos

A referring doctor from Bolgatanga Hospital telephoned asking if he could send a two year old child in respiratory distress from a coin stuck in his esophagus. The boy arrived in Tamale alive after a three hour trip. He had had a cough for one month, was repeatedly treated at a local clinic without improvement and finally at the Bolgatanga hospital, an x-ray was taken showing the coin. The parents had no knowledge that the child had ingested it. With some difficulty, the coin was removed from the boy’s esophagus with equipment donated by Robert J. Fieldman, MD and partners and the Karl Storz Company. In the recovery room, the child had severe upper airway obstruction for two hours before returning to normal. The respiratory difficulty may have been caused by irritation from the halothane anesthetic gas which was used. Subsequently, he did well and was discharged. No time to get a photo as the cattle truck accident victims began arriving.
In the midst of the chaos resulting from the cattle truck accident, a little girl presented with a twelve inch wire sticking out her mouth. No one seemed to know how the toddler came to have such an object stuck inside of her but Mr. Mamonie, the senior nurse anesthetist believes this was an example of witchcraft as only the father brought the child in. The mother was not present. Under sedation, the long wire was removed from the toddler’s soft palate and anterior tonsillar pillar and she was sent home. Because I was overwhelmed caring for the numerous accident victims, a history was not obtained. I just removed the wire and returned to the critical patients.

Terrible Twos

A referring doctor from Bolgatanga Hospital telephoned asking if he could send a two year old child in respiratory distress from a coin stuck in his esophagus. The boy arrived in Tamale alive after a three hour trip. He had had a cough for one month, was repeatedly treated at a local clinic without improvement and finally at the Bolgatanga hospital, an x-ray was taken showing the coin. The parents had no knowledge that the child had ingested it. With some difficulty, the coin was removed from the boy’s esophagus with equipment donated by Robert J. Fieldman, MD and partners and the Karl Storz Company. In the recovery room, the child had severe upper airway obstruction for two hours before returning to normal. The respiratory difficulty may have been caused by irritation from the halothane anesthetic gas which was used. Subsequently, he did well and was discharged. No time to get a photo as the cattle truck accident victims began arriving.
In the midst of the chaos resulting from the cattle truck accident, a little girl presented with a twelve inch wire sticking out her mouth. No one seemed to know how the toddler came to have such an object stuck inside of her but Mr. Mamonie, the senior nurse anesthetist believes this was an example of witchcraft as only the father brought the child in. The mother was not present. Under sedation, the long wire was removed from the toddler’s soft palate and anterior tonsillar pillar and the she was sent home. Because I was overwhelmed caring for the numerous accident victims, a history was not obtained. I just removed the wire and returned to the critical patients.

Learning to work with limited resources

Learning to work with limited resources.

The patients come to the hospital so sick. Besides the medical problem at hand, they usually have malaria and malnutrition and in this condition their diseases overwhelm them. Even after entering the hospital, the laboratory and radiology capabilities are limited.
For example, a twenty-seven year old female student presented to a local clinic and then a hospital where she was treated for malaria, which is the knee jerk therapy as everyone has malaria. However, she had more than malaria. When her symptoms progressed, she presented to Tamale Teaching Hospital where I missed the diagnosis for a week because of an incomplete history and physical examination, the difficulty with language and communication, and the lack of laboratory and radiology capability. Since Tamale Teaching Hospital does not have a CAT scan she has to go by ambulance four hundred miles to rule out a brain abscess. She had a middle ear infection which spread into the neck and medially along her temporal bone and possible into her brain.
Poverty is a huge problem. A twenty year old young man, an orphan with no family, has a parotid tumor. He refused the advice of the village elders to go to the traditional healer and came to our hospital instead. His ten dollars is short of the forty dollars necessary for the biopsy and there is no government program to help financially. I will pay with donated money for the biopsy. Another example of poverty is a seventy-five year old woman who has thyroid cancer and hyperthyroidism and was placed on anti-thyroid medication to reduce her rapid heart rate prior to a thyroidectomy. Although she started on the medication she did not continue because she does not have money for more.
The new hospital construction is underway and the ground floor has now been completed. Dedicated doctors and technicians are here and working hard.