I have tried to forget the events of Monday but I guess I have been so infected by them that I must seek a cure. Monday started like every other beautiful, hopeful and optimistic day with bright faces at work and anticipated patient load. But this was to take a drastic turn. At about 10.30am when we were done with the ward rounds and settled in for other activities, the sirens of the FRSCN ambulance commandeered through the gate towards the A&E. They had unusually filled the ambulance with the rear and side doors wide open. Legs, dangling hands, blood, dirt and wailing all found expression from within the bus. Without saying a word, they began pouring out their contents into the bosom of the hospital. Two buses, all filled to capacity, one heading to Bayelsa from Maiduguri and another heading to Maiduguri from Abuja, had had accidents separately almost simultaneously. My nursing and other staff (God bless them) swung into action. Luckily, Faith and a couple of CHEW, who were around to pay me a visit subconsciously gloved up and made themselves useful unbidden. A 3-year-old child, yes she had to be, was gasping, thick blood ran from her nostrils and mouth to the outside. Her head was swollen. I immediately pick her up and put on the bare ground. We commenced CPR, cleared the airway and continue for over 30min, she stop responding, eyes fixed and dilated, pulse absent. Gone. I dashed to the latent phase labour room where 3 patients were lying on the ground and one on the couch. The one on the couch had her scalp shoved aside like a toupee askew, only this time, the skull was exposed with blood pouring out. I quickly grabbed a suture and attempted to close the scalp and arrest the bleeders, while screaming instructions out. IV Normal saline! large bore carnula Stat! Get us blood in here! Where is the lab tech?! As soon as I was done with the last stitch, she started gasping, I commenced CPR, I asked for more NS, while waiting for the blood, it didn't come. She died after 40min. While I was with the woman on the couch, the one below kept screaming for help, same orders saturated the air. Nurses caught them and gave them life. The woman had her ankle rotated, the flesh and the muscle was peeled from the leg up to the knee. The other leg saw the skin and the medial maleolus removed. She was bleeding uncontrollably. I flew over to her side. Commence trying to cover the skin over the bones and stop the bleeding, she commenced gasping.. Luckily we got a unit of blood group O positive initially meant for the first woman, crossmatched it, it was a match and we commenced transfusion. She was not to make... My gloves and apron all soaked with blood, I stood up with a hiss. She was silent. All spontaneous vitals disappeared. I walked away to the A and E again. My doctor had taken care of some of those in the OPD on the ground. The dead woman was the mother of the dead child. Both are now dead. The father, a Muslim, was watching me all the time. He folded his hands across his chest and walked away when I hissed. He also had cuts and bruises. He buried his dead here and continued his journey. A child, 6year old, kept screaming in the A and E, her left shin bleeding and abnormally rotated. The right had its ankle turn around and displaced. She had been given pain killers earlier but that expired and the cries started again... I walked towards her, looked down and saw "the" man. His case will be for last. I tried to calm her but it was all to no avail. Well, we got to save her. I reduced the tibial fracture and immobilized it, then grabbed the ankle dislocation, did the same. Don't ask me if she cried. Her brother, about 8, laid still under the influence of analgesic. He had cut his jaw and head. The nurses had taken care of him. To the OPD, an obese lady had dislocated both ankes. Careful maneuvering ensured proper reduction and subsequent immobilization. She was been taken to Jos by the Frsc as her husband kept in touch before I thought to intervene. A young lady laid on the ground unable to move her leg. There were two sticks supporting the left leg. They had been tied there as first aid by the Frsc. I passed her. A military man had a deep laceration on his right gastrocnemius muscle. He writhe uncontrollably. My staff took care of it. The mother to the child with bilateral leg fracture laid motionless on the ground. Her legs twisted at the ankle and she breathe laboriously. I fixed the ankle and realized she had fractured some ribs. She made it. Back to the man in the A and E on the ground close to the girl with the broken legs, he was restless. I scream for the FRSCN ask if he could be identified but they couldn't. I ask the man and he told me his name, he was coming from Jos. He had no numbers by memeroy he could recall, his phone was missing. I noticed a sign of blood pooling by his left side under his skin. Turner Grey's sign. I immediately knew he was bleeding profusely inside. I ordered for fluid and blood. Fluid came, blood didn't. I told the Frsc that he needed immediate emegercy care that we couldn't offer here. His best bet would be Jos, 2hrs from here because of the bad road. The Frsc claimed since they didnt know where he was coming from or any contact of his, it would be difficult, besides there were other critically ill at the site of the accident that were yet to be evacuated. I knew from experience that a blunt injury as this would have had something to do with the spleen. I couldn't do a splencetomy. I was handicapped. I had tons of patients to stabilize. I thought to take him in my car to JUTH but again I thought about other patients yet to be attended to. I had no ambulance nor an ambulance driver. The man spent another 3-4hours before he gave up the ghost. His, is the part of this horrific event that haunts me. I felt I could have done more but I didn't. I feel a sense of guilt. We had no mortuary here so his corpse stayed overnight until we pleaded with a certain ambulance driver in a far off village to take the corpse with him to the hospital in Kafanchan pending the arrival of his relatives. The Frsc had their hands full and didnt come back after several calls.
Every hospital needs an ambulance and every doctor practising in the rural area needs to improve their skills to save more people within their rural community and those that may, by accident, happen upon their care. Again, the rural doctor initiative and, especially the kateri medical services who have continually ensured we are employed here, are doing their best to see that everyone deserves good health and they must get it. May the soul of the departed rest in peace and may we and the government that have failed them, continue to learn to do better next time.
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