Our First Transport 11/5/10

Friday began as most work days do; a cup of coffee, staff assembly, and then to my office. About 10 minutes after sitting down Julian, one of our nurses, came in and said “there is a child in treatment room, can you come and see him?” His screams could be heard across the compound as I walked toward the clinic. It was at that point that Julian informed me that he had been given Penthidine (a strong sedative) more than 30 minutes earlier. This child should have been fast asleep. Instead he was sitting up on the bed giving everyone including his mother the evil eye. His arm was covered in blood soaked gauze.

As a second attempt to calm him we gave him some IV valium. That just made him angrier, because we had to start an IV. At this point the 45lb 8 year old had enough medicine to make me drowsy, so we couldn’t safely give him any more. Instead his mother held him on her lap, our student held his legs down and I braced the injured arm while Julian numbed and cleaned the gaping 4 inch long laceration. On inspection it became clear that he had severed a tendon in his right forearm. We could see one end of it, but could not find the other. It was clear that the cut would need to be repaired under general anesthesia. So, we made the decision to transfer him.

Matt was nominated to drive, so he got to have his first experience as extreme ambulance driver. I say extreme because the road between Matoso and Migori is little more than a 40km glorified cow path. It is littered with craters and boulders, not to mention cows, donkeys, goats, and children standing in the middle of the road.  All of this while trying to avoid the bicycles and motorcycles that are also careening up and down the hills. Oh, and driving on the right side of the car and left side of the road.

Everyone was very quiet as we piled in and started off for town, an hour away. The boy lay comfortable on his mom’s lap for the portion of the trip, then, the lidocaine began to wear off. One he was no longer numb every bump was painful with his arm sliced open. He cried each time the Land Cruiser hit a hole (which is about every 20 feet on that part of the road). He was trying to be strong, but it was just too much for him. As we pulled into Migori we found that it was market day, so the already busy streets were packed with cars honking and people pushing. So, Matt did what he needed to, and probably the only thing in the world that could have distracted the child. He put on the siren.

The boy’s eyes got wide as he whispered to his mother “what’s that?” “That’s us,” she replied. He sat in awe of the cool sound that was coming out of our vehicle and watched as people dove out of the way (not accustomed to an ambulance screaming down the street). A few moments later we were wheeling him into the operating room with his mom by his side. I’m told by his mother’s friend that he is doing very well and they believe he will have full use of his hand again.  All thanks to our great staff and a pretty cool, tricked out Land Cruiser.