Grace Chew’s Blog

14/2/2009: Day 3, Kapuna Hospital

We’re now going to macro mode and take a closer
look at an emergency that took place today. It
was probably the hottest day so far, the
temperature rising fast and early, and the wind
hardly picking up in the morning. Thankfully
there was only going to be one round, it being
Saturday, or so we thought. Ruth and I saw some
interesting patients, and another delivery,
during first rounds. We were to go back to see
several other patients after breakfast, but there
was an emergency – a lady had taken a swing had
her left arm with her machete (unintentionally of
course, she was going after bananas on the tree)
and had severed her extensor digitorum tendons,
that straightens up the fingers. When we arrived
at the outpatients examination room, Dr. Archer
was fishing around in the rather deep cut, trying
to find the ends of the severed tendons. She
eventually found the ends connected to the
fingers, but then couldn’t find the ends attached
to the muscles towards the elbow, so she decided
to extend the wound upwards. All this while, the
lady had only local anaesthetic put in and around
the wound, and I can’t imagine whether she was
bearing the pain wonderfully or she just didn’t feel any pain.

Dr. Archer did a zigzag incision up the hand, and
with more blind (or rather, with educated
guesses) fishing around, and thanks to the sharp
eyes of her assistant, found the tendon ends! We
had to go find some suitable suture material from
the operating theatre storeroom (which still had
boxes of catgut) and she stitched the two bundles
together with some PDS monofilament we’d found,
then closed the wound and incisions she’d made
with silk mattress stitches on a rethreadable
(old school!) suture needle. Then her hand was
put in a plaster of Paris backslab, with the
wrist extended, so that the tendons, hopefully, will reunite in time.

All this took just over 2 hours, with the sun
turning the room into a veritable oven, and the
wind cruelly refusing to blow. Even the medical
student enthusiasm of seeing a tendon repair in
the bush couldn’t keep me from wilting a bit. And
not one shout or even whimper of pain from the
lady, although all she had was local anaesthetic
+ adrenaline on her arm, no nerve block, no
nothing. As I held her arm up while the plaster
set, she told us her story, and how her
confidence in Dr. Archer’s expertise (who’d just
seen tendon repairs so far) and her faith in God
made her certain that she’d get back her hand function again, at least in part.

I wonder what I’d had done in Dr. Archer’s shoes.
She’d carried on, with an open mind and a prayer
on her lips, with the knowledge that the only
next option for this lady would be the long trip
to Port Moresby. Would I just give up, or would I
continue on like she did, trusting that the
results of my handiwork would not be worse than
if I’d just left it alone, but better? I wonder.
As of now, I’d be hard-pressed to do anything,
this being the first tendon repair I’ve seen, and
the medical-student feeling of helplessness
strikes again. What’s certain is that little
miracles are constantly happening in this place,
with each emergency, and each patient.

(Update on 19/2/2009: The incision is healing
nicely [the PNGians have amazing healing times!]
and she can twitch her fingers towards extension, albeit with a little pain.)