The past few days have turned out to be rather hectic. Almost immediately after I got my last post uploaded we were called to the Casualty because of a Road Traffic Collision. Dr. Brown arrived a few minutes before I did. When I walked in I'm not sure it was even controlled chaos. There were three men sprawled on the floor of the very small casualty ward, there was also a sick child and her mother on one of the beds and a sick woman on another bed. Envision the following scene - a room approximately 5m by 6m square. There are four large old fashioned hospital beds, a wardrobe, a small sink and table, a cabinet on the wall, and a trolley with various equipment on it. There are two doors, one to the outside, and one to a small triage room. As well as the three men on the floor there was a doctor, three nurses, two orderlies, several onlookers, an anesthetist, and myself. There was also various staff members coming and going. Lets just say it was chaos. To compound the difficulties the most severely injured patient was lying in the swing radius of the door going to the triage room. Thus, anytime someone needed to go to this room for supplies, charting, etc, they had to step over and squeeze through the door.
When I arrived the nurses had me put a line into one of the men and then we began fluid resuscitation. When the patients were stabilized - at least as much as you can tell when you have only portable blood pressure cuffs and your clinical acumen for tools a secondary survey was performed. The one of the patients was pretty badly injured but stable, the second had a compound fracture of the tibia and fibula, and the third was only shocked with muscle strain and bruising. The severely injured patient was sent to X-Ray to try and figure out for sure what was going on. On the way back they noticed that he had a small arterial bleed on his leg so that had to be tied off. The X-rays showed that he'd been pretty beat up - four broken ribs, an avulsion fracture to the right ilium, fractures on both sides of the left pubic ramus, closed fracture of the left radius and ulna, and a dislocated right patella. This isn't considering the soft tissue damage that was underneath all the bloody dressings. However, with the patients stabilized we called it a night.
Saturday morning after rounds Natalie and I went to Casualty to see what was going on with the patients. The severe patient - from here on in Bob - had dressings on his feet, right lower leg, left knee region, and also on his face where his lip had been sliced through. As the dressings were removed the extent of the damage to his legs was revealed. There were deep lacerations on the lateral side of the left knee, the 'meat' of his left heel was literally hanging by a few strands and part of the bone had also been cut off. Then we unwrapped his right leg. The collision or getting out of the vehicle had sliced his shin from top to bottom, essentially peeling the skin layer off, splitting the fascia, and revealing the muscle below. His right heel was also lacerated deeply. We began by suturing the lacerations on the left leg, and reattaching the heel. Unfortunately the lacerations at the knee had severed the nerves and Bob had no motor control or sensation from the knee down as best we could tell. After quite a few sutures the heel was reattached and the two lacerations around the knee closed we began on the other leg. First the wound was washed to remove all the gravel from it, then it was sutured closed, as high as possible. The problem was that the accumulation of fluid in the muscle had caused the tissue to swell so that the skin could not stretch enough to cover it. Thus the wound would require secondary suturing. With that the patients were done. The Bob and his friend Bill with the compound fracture were referred to one of the teaching hospitals with orthopedic surgeons while the third patient was discharged and that was another day.
Sunday we were looking forward to a day of rest. However, one of the Doctors was opening a new clinic in a small community about 1 hour away from Donkorkrom and requested we come. After a truly marvelous example of 'African Time' (e.g. Instructed time of arrival - 8am, instructors time of arrival - 8:40am; time of departure - 10am; time of arrival at clinic - 11am; time of first doing something 1pm) we began seeing patients in a free screening/advertising set up at the local market. About 80 patients later (40 each) we headed back to the clinic for a bite to eat and some relaxing. So by the time we got back to Donkorkrom our Sunday was gone.
Monday proved to be especially hectic in the Out Patient Department. Some of the staff that usually help are on leave and as a result there was a massive line up of people speaking at least three different languages with a variety of complaints. After an exhausting day we finished and started getting a few things lined up for our departure. For lunch one of the ladies here in Donkorkrom invited us for a delicious Ghanian meal. She prepared Red-Red. The closest Canadian food would be a chili except with a bit of fish instead of ground beef. It is served with fried ripe plantain and is very delicious. It was cool to eat some more traditional food as opposed to the rice and fish we have been eating.
Our final day was topped off by a delicious meal prepared by another of the ladies who works at the hospital. We had rice balls and two kinds of soup - ground nut soup with goat and light soup (tomato base and fish). It was a gorgeous African evening with the frogs croaking, good food, and good company. A splendid way to say goodbye.
Tomorrow we will travel to the town of Cape Coast via Accra where we will drop our luggage. I'm sure that there will be more adventures but this is goodbye from the Afram Plains and will likely be my last post from Africa.
Farewell
