Grace Chew’s Blog

5/3/2009: Day 22, Kapuna Hospital

Sometimes some things just come in waves – in one
ward round I’d see all the ones with enlarged
lymph nodes, then in the next I’d see all the
ones with urinary troubles. Deliveries come in
waves too, as well as some special cases. Periods
of busy-ness also come in waves, and there was
one of those waves these two days.

I’d had planned on going for TB ward round
Wednesday morning, but when I arrived the nurses
told me a snakebite victim had come in with signs
of invenomation, so Dr Valerie went to get the
antivenom. Luckily for the guy, who didn’t see
what snake it was, there’s only one poisonous
snake in the Gulf province, which is the death
adder. So he got death adder antivenom. The only
problem was that he was bitten at 3 pm the day
before, and the antivenom was leftover from
another case of snakebite, so it was only the
next day before he lost his sluggishness and slurring of speech fully.

1 hour after we gave him the antivenom, Suzie,
the CHW in the delivery room, came to tell me
that there was a primiparous lady who was just
about fully dilated and was ready to deliver.
When I heard that it was her first baby I was a
bit hesitant, not willing to put myself into a
problematic long-drawn delivery again. But she
was a great pusher, and although she needed an
episiotomy, we delivered her baby girl in due
time. I got the opportunity to sew up the
perineum as well. Ah, the sweet success of a problem-free delivery!

The next day the adult’s ward round that I went
to was quiet, but that was only in preparation
for the guy who came in the afternoon from
Baimuru saw mill. He’d put his hand through the
saw and it had cut through the base of his left
thumb, leaving it attached by only a bit of
thenar muscle and skin at the dorsal side. One
dose of IM pethidine knocked him right out for
the whole 2 ½ hours it took to figure out how to
fix him, and there wasn’t even a twitch of pain
from him! Ruth and Dr Valerie fished around for
tendons (again) and nerves (which they couldn’t
find) and blood vessels (we could see the radial
artery pulsating, thankfully, so they tied off
the severed blood vessels). There were fragments
of bone as well, and we couldn’t make out whether
it was the scaphoid, trapezium, or the phalange,
so it was just tied in place near the radius,
hopefully to act as some kind of stable structure
for what was then a floppy thumb.

After inserting a makeshift drain, I was given
the opportunity to loosely suture the wound,
jagged edges and all, and then we splinted his
wrist to allow the tendons and bones to heal in
what we hoped would be a satisfactory manner.

As of now, his thumb is nice and pink, but he has
no feeling in it, and perhaps slight movement. 2
out of 3 isn’t that bad, and at least he’ll have
a thumb for grasping things with. We’ll see how he progresses.