Bullet in the brain: Baby Satrine Osinya’s remarkable recovery

For almost two weeks now, Kenya has been keenly following the story of a little boy who shot to the national limelight through a most tragic way.

Baby Satrine Osinya was in the safe hands of his mother Veronicah at the Joy in Jesus Church in Likoni, Mombasa, when hooded gunmen stormed the church and opened fire.

Veronicah, her motherly instincts at full throttle, moved to shield the baby in her arms. The gunmen noticed what she was doing and went straight for her, shooting bullets into her as she protected her child from the madness.

Because of the close-range velocity of the bullets, one tore through Veronicah’s body into little Satrine’s head. But its destructive power had been greatly absorbed by the heroine mum, so it came to a stop inside Satrine’s brain.

The gunmen walked out after their attack, probably bemused by how easy the whole thing had looked, how easy they had rained terror on the church. Inside, on the bloodied floor, Baby Satrine clutched onto the lifeless body of his mother, who had sacrificed her all, her life, to protect him.

Then the news cameras arrived at the scene, followed the injured to hospital, and beamed the little boy’s cries to the world. In an instant, Satrine became the face of the attack, attracting so much attention that the government stepped in to save his life.

Doctors said they would have to observe the baby for a few days as they waited for a swelling in the brain to reduce, then make the final decision on whether or not to remove the bullet.

They finally removed it after a three-hour operation on Tuesday this week, reporting later that Satrine was stable and recovering from the most harrowing ordeal of his young life.

To many people, however, that the option of letting the little boy live with a bullet lodged in his head was on the table was unimaginable. How would he cope with a foreign object in the most delicate part of a human being’s body, they wondered?

But neurosurgeons, led by Dr Gichuru Mwangi, clarified that, because of the attendant risks, they had to establish whether it would be safe for them to operate on Satrine. “We will have to establish the route of the bullet and if we reckon that it would be safe to remove it, we would (do so),” Dr Gichuru said. “The right side of the brain is responsible for visual information and we have to relate our observations on the head and the boy’s vision before we decide the way forward.”

LIST OF UNFORTUNATE PEOPLE

And, with that announcement, the little one became a potential candidate for a list of people who have lived with bullets in their heads for a long time. American William Lawis Pace was one such unfortunate person, and he lived with a bullet in his head for 92 years, a feat that earned him a mention in the Guinness Book of World Records.

William was accidently shot in the face by his elder brother Marvin, who had somehow located their father’s .22-calibre firearm, when he was aged eight.

At the hospital, doctors refused to operate on the young boy, saying the bullet was dangerously close to the brain. It paralysed his right eye and twisted his mouth a bit, but William lived a normal life for 92 years.

In recognising him, editors at the Guinness Book said he was the “person living longest with a bullet in the head” as of 2009. He had been shot in 1917.

Closer home, former Amagoro MP Oduya Oprong was shot by unknown assailants in 1993, just a year after being elected to Parliament. He was rushed to the Nairobi Hospital, where brain scans showed he had shrapnel stuck in his head. He underwent several medical checkups and doctors even anticipated operating on him, but further tests locally and in London revealed that surgery could lead to his death. The option, then, was to live with the shrapnel in his head.

It wasn’t, however, an easy decision for his doctors as a foreign object in the head can be dangerous, depending on its position and the route it followed, which doctors call “the trajectory”.

MAY DEVELOP COMPLICATIONS

A person’s chances of surviving a bullet that hits or passes through the head, according to neurosurgeon Peter Wanyoike, depends on the velocity of the bullet, which part of the brain was hit and the impact made on the nervous system.

According to Dr Wanyoike, people who have foreign objects in their brains may develop complications depending on which lobe has been interfered with.

“The brain has different lobes; the frontal, temporal, occipital and parietal,” he says. “Each of these has specific functions and damaging them results in impairment. For doctors to remove a foreign body in the brain, they have to be sure the surgery will not cause more harm than is already there.”

Individuals who suffer from temporal lobe damage have difficulties recalling visual stimuli and might be blinded or visually impaired. Damage to the frontal lobe, which is mostly caused by stroke, may result in the loss of imagery and difficulty in visualisation of spatial relationships.

If one’s occipital lobe is damaged, one can have constant hallucinations or epileptic characteristics.

Deep brain structures are crucial to consciousness and basic functions such as controlling the heartbeat and breathing. These are the high-risk territories of the brain that when tampered with can cause death instantly. A person thus has a better chance of recovering if the bullet misses major blood vessels in the brain.

In the case of Baby Satrine, the bullet lodged itself on the right side of the brain, and neurosurgeon Gichuru Mwangi said his team would have to be very cautious in theatre so as not to cause more damage.

“We will operate the baby’s head and remove the bullet, but that will only be possible if we establish that during the process we will not tamper with the proper functioning of the brain, especially in neurological responses,” Dr Mwangi said. “If we operate on the baby without conducting thorough checks, we may remove the bullet but cause complications such as impairing his speech, memory, vision and balance, among others.”

Only about one out of 1,000 people hit by a bullet in the head can survive for more than an hour. Most of these have bullets enter one side of the head and exit through the other without damaging the brain or causing death. One such person is Prof Joseph Nyasani of the University of Nairobi, who was shot in the head by gunmen 20 years ago during a robbery incidence.

“I was heading home to Westlands just after reading the 1:00 pm news at the Kenya Broadcasting Corporation,” Prof Nyasani says. “Just before I got home, some three people approached me and asked me to surrender all that I had. One of them drew a gun and forced me out of my car. All along, I thought the gun was a toy pistol, but, after a short argument, the man with the gun pointed it straight at my head and pulled the trigger. The bullet entered through my right eye and exited at the back of my head.”

The robbers then took whatever they could from the car and scampered out, leaving Prof Nyasani, father of broadcaster Nyatichi Nyasani, for dead. A witness rushed him to hospital, where he remained in coma for about three weeks. “Doctors told me I would be okay with time, but I chose to seek a second opinion from Europe, and so I flew to Germany, where I underwent anti-coagulation therapy first before the doctors could operate on me,” he said.

SHOT BY HIS WIFE

Other people who have stayed with bullets in their heads include Jim Saunders from Texas, who accommodated one in his head for 30 years. Jim was shot by his first wife, who put a gun to his forehead while he was asleep and pulled the trigger, in 1981. The .25-caliber bullet lodged three inches deep and although it left Jim virtually blind and without any sense of smell, doctors decided it was too risky to try and remove it.

According to Dr Wanyoike, to remove a bullet from someone’s head costs between Sh115,000 and Sh2 million, depending on the complexity of the operation.

“Sometimes the patient has to be placed under intensive care, and that costs a lot of money,” he explains. “The operation might also send the patient into a coma for a couple of days, meaning the patient will have to be wheeled into a High Dependency Unit, which mean more costs.”