I was still in campus, about 15 years ago, I got the usual Kenyan street news, a rogue driver hit an old lady, back in my rural area. X rays report showed she sustained fracture to the pelvis, multiple others on the left femur and superficial, partial and deep soft tissue injuries-all over.
She got admitted in the provincial hospital's orthopedic ward. The old lady had to undergo a total hip replacement, a modified exofix on the same femur and a lot of screws on plates to hold her pelvis together, a surgery that took nearly 5 plus hours. She was mummified with gauze roll soaked in iodine, head to toe, as dressing to the multiple injuries she sustained all over the body.
She appeared delicate, something which scared the nursing students who were assigned responsibilities to dress her daily since the government health workers were on strike. Her dressing changes would take like 2 hours, she was in great pain and the exofix was used as the handles to turn her to the sides. At times they could just change the rolls without cleaning her wounds, use hydrogen peroxide which would foam and cause excruciating pain, or pour a lot of saline solution on her wounds wetting her all the way, creating a swimming pool on the sunken 1 inch mackintosh mattress. They could leave her lying in one position for long hours, fear going close to her because of the odor from unchanged bandages, no medical review and antibiotics administration, a million and one cascades which are ingredients for sepsis and pressure ulcers formation.
All this happened, I did not have a clue of what to do or even notice if the right thing is being done. Probably I would have just done the same.
I remember this particular Saturday morning, the only doctor covering decided to do the unthinkable. He removed the green bandages from the weak grandma. Damn it, she was dark!, no, black, other portions green, maggots cat-walking down isle. I heard him use the term "septicemia".
I lost her, she was my grandma, It was not due to negligence, but lack of trained personnel, no appropriate measures, techniques and materials to manage her status. I took it deep and sought to find solutions so that no one else would have to go through what she did under my watch, and yes, I found the solution.
Specialization made me understand what was happening and it explained everything she went through (the bolded texts above). I was able to learn the science behind healing wounds, I was subjected to technology and gained a wealth of knowledge to understand all wound status, I now know measures to prevent and manage all the wound etiologies.
Lessons to learn: Proper assessment and objectives oriented management yields positive wound healing results. It is not necessary to admit a patient just for wound care. There are different materials available scientifically engineered for dressing all wound status, they reduce the frequency of dressing changes, manage exudate, prevent infection and reduce the healing time. Despite the medical knowledge, advanced and multidisciplinary approach management is absolutely necessary. Health workers need to update their knowledge and practice frequently, things change. Lastly, early referral to the relevant specialists is part of treatment.
Kennedy Omondi
Advanced Wound Care Specialist