The rural area where I practice is bedeviled with social vices ranging from armed robbery to fulani herdsmen attack to rape to assault etc. On this fateful day as I had just had lunch(at 6pm) after a hectic day, the phone rang. It was the hospital calling. I picked the phone and answered rather shruggingly, "hello". The voice at the other end was that of Emma, the afternoon shift nurse. "Sir they have just rushed in an emergency. The person's intestine is outside, they said he was stabbed". Well, I knew the hospital bed spaces were all occupied and whatever the case, the patient would need to be operated upon. "Please ask them to take the person to Kafanchan general hospital, we do not have any bed space left". I replied. One hour later I thought to take a stroll to the hospital to check on the patients on admission. Upon arrival, the whole place was rowdy, I made to the A&E and met a distraught young man applying pressure on the abdomen of another young man groaning in pain looking frightened. I asked whether they weren't asked to rush to General hospital kafanchan for immediate attention, but they replied that they were waiting for their friend who had gone in search of a car to convey them(we do not have an ambulance). Well , I waited for another 20min, and there was no sign of the young man. I dove into action cursing under my breathe my reflexes and unreasonable idea of taking this patient and wondering what I was going to do with him if nobody came in the next hour. I dished out orders as though we were in some combat ground. "2 large bore canulae! IVF normal saline 1L fast! Irrigate gut with warm saline 3L now! Pass NG tube! Iv ceftriaxone 1g, Iv flagyl 1g fast! Im TT! Pass catheter!!!" My nurses at some point were confused and almost bumped into one another as I kept the orders coming."Bandage! gauze!!" And within few minutes to an hour, he was stabilized. As I was about to document, the next victim was wheeled in! This one was worse off. His guts were almost completely exterirorized. He was vomiting. He was lethargic and weak. I could identify the stomach with a linear cut that was bleeding on the greater curvature. He had been stabbed as well. I shouted, "I need an ambulance!!!!!!!!" "This one needs to be operated now or he dies!" Everybody stood motionless as though a scene out of a movie. Then they started moving again after it might have dealt them a blow jerking them back to reality. I quickly grabbed a suture, chromic, we hadn't vicryl(they are usually very expensive) in the hospital. I repaired the stomach cut to prevent the bleeding. My hope was to stabilize and have the patient rushed to the next level of care. The transporting vehicle never came. 3L of IVF saline had gone down! I ordered, "I need blood for transfusion!" Friends rushed to the lab and commenced screening and matching. "Prepare the theatre" (I didn't know when I said that). It was already 11pm. The generator was running as though to urge me on. My nurses surprised me as they worked like they had previously worked in a teaching hospital, mostly extension workers, midwives and diploma nurses. This was their first experience with a case like this. Though scared, they concealed their fears and worked with every instruction I dished out. I passed an NG tube, passed a catheter, covered the guts with sterile saline soaked drape, ordered for antibiotics, pain killers, TT. Ordered for blood investigations to check the kidneys, didn't wait for result before we lifted him to the theater. I scrubbed. Got draped, probably the fastest I had ever done. Got my doctor ready and before long we were cutting open the young man. We found the guts intact and were all too happy to irrigate and close up when as I lifted the descending colon to flip over to irrigate, my heart skipped a beat. There it was, a collection of boiling blood. It was boiling like hot water at its boiling point. I said, "we have a punctured vein!" At first we thought it was the inferior venae cava, then I realized it was a mesenteric vein. It was bleeding non-stop. Onyeka applied pressure while we thought about how to go about it. You know what? God took charge, we repaired it. Whooof! Phew!! That was more than a scare! We transfused the dude while on the table and waited to see if the vein was still bleeding. It wasn't. We further irrigated with warm saline then closed up! (I just let out the air I inhaled while writing that part of the story. I still feel uneasy writing it here. It appears I am still operating the patient now). We left the theatre after a successful surgery at about 4am. Post operatively, we battled very high blood pressures for over 72hrs before it normalized. He was discharged after 10days. Suture removed and oral feeding commenced. This is one experience that only a doctor can handle. Now imagine if there were no doctors in this rural community. Imagine if the rural doctor was not available. Imagine when they would get a transporting vehicle, when it would get to Plateau state, a 2-3hrs journey because of the bad roads, just imagine. The role of rural doctors can not be overemphasized.
There is a need to continue to advocate for more rural experienced doctors in communities where the poor are largely located. I do not know how long I would be here, but as long as I am here, I would continue to do my best to ensure the availability, accessibility and affordability of quality health care for the rural dweller. The rural doctor initiative cares.
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