An update to our healthcare community website, has collapsed the system, I keep following up with the hosting team to help correct the error. It is Thursday night, the 13th of April around 10pm. I am a doctor in a Level V hospital, Kenya, working in the Surgery and Orthopedics department where I have been 2nd on call this week since Monday morning. Being a long holiday weekend, people tend to imbibe a little more and we tend to be busier due to the resulting injuries. I anticipate nothing less.

It is now around 04:00am, Friday 14th April. In the hospital, a patient has come with a swelling on his groin, a condition known as incarcerated inguinal hernia. This occurs when a loop of gut is trapped in an internal opening towards the scrotum. He is in a lot of pain. Attempts to manually reduce it fail and we plan to take him to theater.

At 10am, the doctor in the ward calls to inform about the patient with the inguinal hernia. The problem has subsided temporarily. The hernia has reduced spontaneously, we strike him off our emergency list. He will continue staying in the ward until we operate on him on a later date electively. But there are two other cases that arrived in the morning; one of them is an elderly man who has multiple fractures following a motorcycle road traffic accident. He has a fracture of the thigh bone and another one around the elbow and a bad wound. He will require emergency surgery. The other case is of a young man, in his twenties, who has been chopped off his right hand by thugs in wee hours of morning. He also needs to go to theater for emergency surgery. Both are hemodynamically stable.

I am still following up with the website hosting team and finally, good news arrive around 10 am Friday the 14th that the problem has been resolved. Unfortunately we end up losing some recently stored data from our website.

At lunch hour, sited in a local restaurant devouring my lunch, I receive a phone call from the doctor 1st on call, theater space is available and the patients are ready for the operations. I finish my lunch hurriedly and head to the hospital.

At the hospital we perform the surgeries on our two patients, an ordeal which takes a better part of our afternoon. For the elderly man, we clean the bad elbow wound, repair it and splint his arm. He will still require undergoing more surgeries to fix the fractures. For the young man, we clean the stump thoroughly, fashion it a little and close it. He will have to live with the new disability.

In the evening, darkness creeps fast with the highway buzz of lorries, cars, buses pass by and passengers board as they hurry their way home. It will fade as the night wears on. I think of dinner and engage myself with activities here and there. I talk to my wife and son over the phone and they are doing well except for the persistent refusal to feed by the 2 year old.

It is now an hour past midnight on Saturday 15th. I am still awake, surfing the net, I receive a call from the doctor 1st on call, I am informed that there is a gentleman who has just been brought in, where he was in a bar and fell from the seat sustaining an injury to his abdomen. The abdomen is distended and very tender. His blood pressures and pulse are fine. The patient has blunt abdominal injuries and he may have ruptured either the gut or his bladder. “Continue resuscitating the patient and prepare an emergency theater list,” I advise. We will operate on him.

An hour later around 03:00am the hospital calls to inform that theater space is available. On conversing with the doctor 1st on call, it occurs that the patient is not well prepared for theater yet. We need some more time to prepare him so we adjourn his surgery.  

I doze off, and wake up somewhere around seven thirty. During the morning hours I have my house cleaned and the laundry done. Just as the afternoon is creeping in, the hospital calls to inform that theater space is available and I head off to the hospital.

We receive the man in theater. A urinary catheter inserted drains about 4 liters of a bloody fluid.  We open the abdomen to find a ruptured bladder of which we repair and clean the abdomen of numerous blood clots that had accumulated. His other organs are normal. He reverses well from anesthesia. By the end of surgery, the catheter is draining very clear urine. It is now past 5:00 pm, I head to my house.

At around 10:00 pm, the hospital calls again, there has been another road traffic accident. A man and his pregnant wife, both of them on a motorcycle were hit by a public service minivan. Fortunately both are stable but will need to be operated on sooner. She has a bad knee wound with fractures of the associated bones. The man also has a wound but not as bad though he still will need some emergency surgery. There is still another breastfeeding lady with a breast abscess and she requires emergency surgery. The rest of the night is relatively calm. I slip off to slumber past midnight to wake up at 7:00 am on Sunday the 16th.

This issue of road traffic accidents is a big deal. Most of them involve motorcycles. Since their introduction to the Kenyan society approximately 10 years ago to create jobs for the youth and provide alternative means of transport, they have claimed thousands and thousands of young productive lives, left families and the society in tears and turmoil. Brothers and sisters have lost their loved ones, working husbands and wives have become maimed, children have lost their parents and vice versa. The cost to the individuals and economy at large as a result of these motorcycle injuries has been humongous. There has been unprecedented rise in the burden of disease as a result of these injuries. Unfortunately, it seems there are no aggressive efforts that are ongoing to mitigate the situation yet.

Sunday is quite calm, no phone calls from the hospital. I spend most of my time browsing the web, working on the community website and reading materials. Evening creeps in, with no phone calls yet from the hospital. I doze off past midnight to wake up on Monday 17th at 6:30am morning. My weekly call shift ends at 8:00am. I drive off to be with my family at least on Easter Monday. Happy Easter Holidays.