A Harsh Reality

After lunch I returned to work around 2pm. One of the staff told me they were bringing an OPD (Outpatient Department) patient to x-ray for a femur x-ray. Lots of people were standing around in the OPD so I popped my head in to see what was going on. All I could see was a man with a blood stained hospital sheet. Great. I went to the x-ray department, put some latex gloves on and waited.
A 30 year old man named James came in on a stretcher. I pulled back the sheet and cringed. He had split his skin open from his groin to his knee. It was about 14 inches long and 4 inches wide. I could look in the wound and see his muscle and bone which was visibly fractured. Really, there was no need for an x-ray to confirm it but we did one anyway. I slid the cassette underneath his leg on top of a pool of blood, hoping the blood didn’t seep onto the x-ray film. After taking the x-ray I pulled out the cassette and blood streamed off of it. Surprise, the x-ray showed his distal femur split into two pieces! It’s hard to get the full story of what happened with any patient, but apparently James was up in a tree cutting down branches, when a large branch fell on his leg and pinned him. This all happened around 8am, but he didn’t get to the hospital until 2pm. Where was he all that time? Well, this is when you can say, “Sorry, you were born in a third world country. Life isn’t fair.” He was miles away from any kind of road when the accident happened, there is no 911, nobody he knows has a car to come and pick him up. So his friends had to carry him to the nearest road to wait for a ride to the hospital. In this part of the country cars don’t pass by that often. If you’re not on a main route, it could be hours. They first tried to put him on a motorbike (popular form of transportation) but his leg was literally cracked open. So six hours later he finally made it to the hospital by car.
So his leg is split open, broken, and he’s losing lots of blood, now what? He needs surgery as soon as possible to clean out the wound, stop the bleeding, and but his bone back together. We do surgeries here, but this type of orthopedic reconstruction is out of our league. So what hospital can we send him to and how much money does he have for the ambulance ride? It stinks that the amount of money you have determines the level of medical care you receive, but this happens in the US to some extent as well. He doesn’t have the national health insurance either. For 160 Kenyan Shillings ($2USD) a month it covers all medical expenses for your entire family yet most people can’t afford it. When you have to choose between food and insurance, you can’t blame people for not having it.
So it was decided that James was going to Kisii Public Hospital. Kisii is the closest town to us. It’s about 90 km (55 miles) away but it takes a good two hours to get there. We tried to clean out the wound, gave him some antibiotics, and splinted the leg for the car ride to Kisii. Some how it was decided I was going to ride with him the ambulance. Sure, why not send the x-ray tech?!
So in the back of this ambulance is James, me, and 2 of his friends that brought him to the hospital. James speaks no English but one of his friends did which was a big help. The only supplies we have in the ambulance is a shoe box size first aide kit with gauze, syringes, saline, and gloves.

The next two hours were the longest of my life. I prayed that James made it to the hospital alive. The dirt roads here are terrible. They’re full of potholes, bumps, and rocks. It’s like being tossed around like a popcorn kernel in an air popper. Holding on to something is necessary. James’ stretcher bounced off the ground as we tried to go “fast.” I put one hand on his pelvis and the other on his knee, trying to keep his leg attached. With each bump more blood seeped through the gauze, and the white sheet turned red. James cringed in pain with each bump. It was another one of those moments, “Sorry, you were born in a third world country. Life isn’t fair.” By the end of the ride it was a relief for me to see him cringe, at least he was still conscious and feeling the pain. I was afraid with each jolt his femoral artery would burst. His foot was going cold but was still able to wiggle his toes. Along the way his friend wanted to stop and get him a soda because he hadn’t eaten all day. Sorry, no stopping, he desperately needs a blood transfusion not a soda!
At 6pm, 10 hours after the accident we arrived at Kisii Public Hospital. This was my first time seeing a government run hospital. It was disgusting. Think of a hospital from the 1950s and cover it in dirt and dust. That is what this place looked like. I had this idea in my mind that when we arrived medical staff would be eagerly waiting for us. What a silly American idea that was. When I got to the OPD there was nobody that looked like a doctor or a nurse. Everybody was in plain clothes just standing around. I was the only one in hospital scrubs- is this really a hospital? Who is going to help this man? He’s dying. Turns out you have to buy a blank patient chart booklet for 20 KSH (30 cents) before a patient can be seen. It doesn’t matter if you’re dying, you have to go to the other side of the hospital and buy this booklet. So while Duncan, the ambulance driver, went to buy the booklet I was on a mission to find a doctor or a nurse. You would think this was an easy task but it wasn’t. So I got out the x-ray and started showing everybody the femur cracked in half. That kind of received some attention but nothing ever “stat” happens in Kenya. I tried not to be the rude American but his guy has been losing blood since 8am! Finally, with our 20 KSH patient chart we were told to go to Ward 3 to be admitted. But first we had to do other paper work. I pushed James to the ward, while Duncan took care of the politics.
After being at the hospital for 25 minutes I encountered my first doctor and nurse, what a pleasant surprise! They agreed about the blood transfusion but there is a catch. If a patient receives a blood transfusion, a family member or friend of the patient must donate to replenish the blood bank. Sounds simple, but with the HIV rate highest in this part of the country it can be difficult finding a donor. I had another moment of, “Sorry, you were born in a third world country. Life isn’t fair.” So I tried to talk James’ friend into donating but he was hesitant. I would give blood but I donated a few weeks ago. Please, somebody just get him some blood!
I’m not sure what ended up happening. It was time for me to leave, as the doctors took over. Who knows what will happen to James. Will this father of five survive? Will he lose his leg? Will he ever walk again? Sorry, you were born in a third world country. Life isn’t fair.
If you’re at home reading this asking, “What can I do to help?” First off, you can pray for him. Secondly, go donate blood. No, you’re blood isn’t going to save somebody in Africa but it will make a difference. Isn’t a needle stick and 30 minutes of your time worth it when you can save somebody’s life?!