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When it takes a village to nurse patient back to health

Patient care: When it takes a village

A hippo sank its long canines into her left thigh

I always had a problem wrapping my head around a hippo’s bad reputation. Reports show this fresh water mammal is the leading killer of man in Africa among the large animals. As a Kenyan, I had reserved such a reputation for lions, elephants, leopards and crocodiles. In 2005, I changed my mind.
One hot February morning in 2005, I boarded a bus to Ngao in Tana River County. My friend was reporting to the hospital as a medical officer and I was riding along for adventure. The countryside was wildly beautiful and relatively untouched by destructive human civilisation. Transport was difficult, but that added to the spirit of adventure.
We arrived at Ngao sub-district hospital to a warm welcome. The hospital was small and mainly staffed by healthcare workers from the local community. The hospital tour took 30 minutes as there wasn’t much to see besides the two wards (paediatric and male) and the maternity unit, which encompassed the female ward.

I was stuck at the maternity ward where the radio call unit was housed. The incessant chatter over the radio constituted communication along the entire Kenyan coastal trip. Far flung facilities without access to telephone or mobile phone network were able to communicate with the referral hospitals to coordinate patient care. I was fascinated. We were shown to our accommodation facilities and as a vegetarian, my first challenge was finding food. Despite the Tana River basin being a major supplier of fresh vegetables, residents thrive mainly on fish from the river and export the green produce. We left the village to look for food. The residents are either farmers or herders culturally. Back then, the farming communities farmed along the river bank and lived in cluster villages. The herders lived further away from the river.

Tana is the largest river in Kenya, inhabited by crocodiles and hippos. Along the river, there were defined crossing points. These connected people from both sides of the river for daily interaction. Some of these points had bridges while others employed a boat with an oarsman to ferry the people back and forth.
Generally, the people have figured out how to coexist with the river animals, but at a price. Incidents of human-wildlife conflict abound, and this gets worse during the dry season when resources are scarce. While crocodiles may attack humans for food, hippos do so for defence. The territorial males will mark their space while females mainly attack to defend their young.
We arrived at the hospital after a late lunch, to find a major commotion. A young woman had been brought in, having suffered major traumatic injuries from a hippo attack. The dry spell that had persisted the previous three months had seen the water levels in the river drop drastically. The hippos felt exposed and irritable. The crossing boat carrying this woman had glided over a hippo that attacked and flipped it over and she landed right on top of the irate animal.
The hippo attacked her, sinking its long canines into her left thigh, leaving gaping puncture wounds that were bleeding profusely. She was extremely lucky the injury had spared major nerves and the femoral blood vessels, otherwise she would have died within minutes. She was rescued and rushed to the hospital. Word had spread like wildfire that the hospital now had its own resident doctor and the community expected miracles. There were at least 50 people in the compound accompanying the patient.

In the failing light of day, without electricity and a generator that was not in use due to the unsustainable nature of the fuel consumption, the doctor did his best to clean the wounds and arrest the infection that would stem out of the bite. Yes, a hippo bite is one of the dirtiest wounds that can be inflicted. I got a glimpse of village medicine and improvisation to keep the patient alive.
The nearest hospital was three hours away in the ambulance with a huge risk of insecurity on the road. All vehicles plying the route were usually accompanied by the police. We were stuck with the young woman until 5am the next morning before she could be safely evacuated. Meanwhile, it was a race against time to prevent her from developing sepsis.
With limited resources, the doctor did a thorough job of cleaning the wound. Being a medical student, I could only help with monitoring the anaesthesia we set up to sedate her in order to tolerate the procedure. We did not have an operating theatre and had to do with a make shift one in the isolation ward. It was a gruelling three hours.
The whole night, the family and friends camped outside the ward on the grass keeping watch. At midnight, the young woman came to and was able to communicate with her family. The mood suddenly changed from fear and anxiety, to hope. By morning, they were adamant that they did not want her to be referred. They had faith in their doctor and their hospital. The nursing team had done a sterling job.

An hour of counselling and explanations fell on deaf ears. They did not believe there was anything more the referral hospital would do for their patient. As far as drugs were concerned, they would travel to bring them. A long prescription was written and without any reference to the woman’s immediate family, a young man was dispatched in the first matatu out to Malindi to buy the drugs.
The most heartwarming observation was how the entire community stood with the woman and her family. Her husband and parents were spared the financial burden. They were tasked with providing her with emotional support and catering to her personal needs. The men dealt with medical costs while the women cooked and fed everyone present.
The culture displayed by the people of Tana River County is critical to patient well-being. While the medical team may struggle with the clinical care, the social support structure goes a long way in ensuring the best outcome for the patient. It is inherently African and should be preserved at all costs.