Saturday, June 18, 2011

Dangories Injuries

This unfortunate young was going to marry in two weeks time. The wedding had been planned and prepared since long. Now she came to the hospital with severe soft tissue injuries of the face after an awful event that could spoil her bright future.
She is a victim of attempted “forced marriage” as people call it here. A rejected man whom she knows well decided to abduct her with the help of three other men. If he manages to keep her in his house for the night, she will have no other choice than to marry him according to the local culture and tradition.
This lady was however not easy to subdue. In the end the four perpetrators had to bring her to the nearby health center with severe soft tissue injuries of the face, claiming that she fell from a horse. That could be true, but they forgot to tell that it happened while they were trying to abduct her.
After her version of the event became known the police was called, and the men were imprisoned.
I sincerely hope that her fiancé will have the courage not to abandon her. She only reached grade four at school, but she is very bright and determined. A wonderful girl – the best wife you could get.
Abduction is an old tradition which is forbidden by law since long. A lot of posters informing about this issue are spread all over in the countryside. It is however still practiced, but more often as a way for two young people in love to get each other in spite of the families’ resistance. If the families for some reason do not approve a marriage between two young people, the couple can get around by arranging an abduction with the help of some friends. After that the families are facing a “fait a complit” and have no other options than to accept the “forced marriage”.
A nine years old girl from Mendi was operated yesterday for a cleft lip.
In the first place her father and uncle had taken her to the regional hospital in the provincial capital, Nekamte. From there she was referred to Addis Abeba. As simple farmers they couldn’t afford to stay in the capital city waiting for her chance to be operated – usually a matter of several months or sometimes even a year.
Finally they took her to our hospital in Aira where she was operated the day after arrival at a cost of 300 birr (25 €).
The uncle is 30 years older than his brother. Their father, the girl’s grandfather, had 14 children. The uncle has 9 children and the father two. An interesting picture of family planning being gradually accepted.
The father has promised to send the girl to school after returning back home from their long Odyssey.
The last picture is of a lady from Asosa who suffered from a fistula (se FISTULA) since 8 years.
The fistula was easily repaired and she is dry and clean as she has not been for all these years.
In Begi, which is situated at the same distance from Aira as Asosa, the Norwegian mission has an ongoing “woman’s project”. One of the activities of that project is to collect and shuffle fistula patients all the way to Addis Abeba, where the famous Fistula Hospital is situated.


Thursday, January 29th, 2009
Patients usually present late to the hospital, sometimes even too late. That a newborn baby was brought to the hospital with congenital anal atresia (absence of the anal opening) in the middle of the night - only two days after delivery - was an unusual and encouraging event.
Otherwise babies with this abnormality are brought only when the abdomen is extremely distended with undelivered stool and gas causing respiratory depression.
Then a life saving emergency colostomy is made, an the reconstructive surgery will be performed done
This baby was admitted as “24 hours emergency” without the obligatory deposit of 500 birr (35 €). This routine is used for all life threatening emergencies when money is not available on the spot. After life saving treatment the relatives are supposed to bring money - unless they are obviously very poor.
The baby was operated successfully in the morning after arrival. Everything went according to the book with professional intubation anesthesia, atraumatic reconstruction of the anal opening and postoperative surveillance.

The staff was instructed to let the child breast feed as soon as it was awake to minimize the use of i.v. infusion which can be a risk for a newborn if not followed very strict and carefully - not exactly the most outstanding of our existing nursing care.
To my great surprise the baby was still on i.v. infusion at the round the morning after surgery. It turned out that the woman who was with the baby was not his mother although that was what she claimed to be on admission.
I never manage to figure out exactly what relation she had to the baby – grandmother? She claimed that the mother was at home in the countryside, a bit far from Aira. To bring her seemed not possible for obscure reasons. The best option was to discharge her with the baby so that he could get breastfed as soon as possible. She disappeared with lightening speed, without settling the bill.
I still wonder who she was and why the baby was left without his mother. I only hope that he will be given proper attention and breast milk.


Tuesday, January 27th, 2009
Injection needles are dangerous weapons. That’s why used needles are disposed of in containers dispersed all over the hospital, in the wards and the operating theater.
Unfortunately not all medical staff is pedantic enough in this issue. After a vaccination campaign in a neighboring province needles were thrown and left on the ground. A small boy found the used needles and started to play with them. Accidentally he injured his left eye with a terrible infection as a result. He came one week after the injury to our hospital with a furious infection in a blind eye. The only option was to do an evisceration of the eye (see page EVISCERATION OF THE EYE).
In this case the eye was filled with pus under pressure, and after evacuating the eye it was packed with gauze for 24 hours. He lost an eye but saved his life.
Monday, January 26th, 2009
The vast majority of the Ethiopians, Christians as well as Moslems, do not eat pig meat. However some tribes around the border to Sudan hunt wild pig for the meat. Unfortunately the meat is often consumed not well cocked or even raw, and occasionally we see patients with severe trichinosis. The condition is serious since there is now efficient treatment, and some cases are fatal.
Now and then a hunter visits our house and offers us to buy a piece of fresh pig meat.
If only the meat is prepared carefully and cocked long there is no danger, and the meat is soft and delicious.
Yesterday we received a farmer who was attacked by a wild pig as he was trying to protect his harvest. Maybe as revenge from being hunted previously? Anyhow the animal attacked the buttocks of the unfortunate patient. Luckily enough the wounds didn’t penetrate to the rectum and the sphincter was intact. So it was only to clean and leave the wounds open to heal under antibiotic cover (never close a wound caused by animal or human bite!)
Everything brakes down these days. Now it is our electrical suction machine, which we bought when I came to Aira 5 years ago. It has already undergone a couple of repairs. I think we can manage to fix it again. Otherwise we will have to use the mop and wring technique as before – that always works!


Tuesday, January 20th, 2009
Now when I have retrieved my collection of pictures from the crashed hard disc I can build on the pages of this site again. Take a look of the new pages – and some refurbished older ones.
I can also show some more interesting and rewarding surgical cases.
For some mysterious reasons curative health care - in particular surgery - has been declared pariah by the crowd of aid organizations. What is generally not understood is that surgery is an extremely cost efficient treatment with a very low cost-benefit rate (low cost/great benefit).
A lot of surgery is even done as a preventive measure – as true preventive medicine. Just as we vaccinate to prevent whooping cough, we operate hernias to prevent incarceration, morbidity and death.
The prerequisite for successful surgery is a correct diagnosis. Look at this 6 weeks old baby who was admitted in the pediatric ward as a case of severe Marasmus (malnutrition).
One clever staff member noticed that he was one of a twin couple and his twin brother looked very well fed.
When questioned, the mother disclosed that the small patient had a vigorous appetite, but vomited explosively after each breast feeding. So the diagnosis became clear - PYLORIC STENOSIS (see that page)
He was operated successfully. Three months after surgery the parents returned with the twins and now you could not tell the difference except from the inconspicuous scar
As a “reward” for taking the effort and expenses for showing up the babies got some nice cloths and blankets. The hand knitted blankets are a gift from the women’s sewing circle at the Löten Church in Uppsala, Sweden.

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