Dr Tanga Audi, a plastic and hand surgeon at Kenyatta National Hospital

The hospital is now seeing up to 20 people every week from five cases previously with either thumbs, the four fingers or the whole hand nearly or totally amputated through what doctors describe as an increase in assaults and industrial accidents.

Going by what is being reported at Kenyatta National Hospital (KNH), there fears that the cases might be higher across the country, especially in the rural areas, where access to health facilities is a tall order.

“This rising trend is very worrying to us who see patients on a daily basis. Initially most of the cases we saw were due to industrial accidents, but now more people are coming with injuries arising from assaults,” says Dr Omondi Afulo, a doctor at KNH hospital.

Most of those who present with injuries due to assault say they have been attacked by thugs or in other cases, blame it on domestic violence.

“The problem is patients do not tell the truth especially if the hand or fingers have been partly or completely amputated during domestic violence,” adds Dr Tanga Audi, a plastic and hand surgeon at KNH.

“They will tell you it was a thief or an accident that caused the problem.”

Nevertheless, the high assault cases maybe a reflection of the rising wave of crime in the country as well as falling standards of living.

Social scientists are now linking increase in domestic violence to high poverty levels and unfaithfulness within relationships, among other things, that end up being manifested in physical violence.

The rise in hand and arm injuries can also be explained by the fact that majority of the people use them as a defence when someone wants to slash their head or other sensitive parts of the body.

In the case of industrial accidents, lack of proper protective gear or measures in many industries maybe the reason behind an increase in the accidents, according to Dr Audi.

His counterpart, Dr Afulo, says they are now filling many compensation forms for industrial workers, an indication that industrial accidents are on the rise.

Unfortunately, some of them are not being compensated as employees are said to be using other strategies to avoid paying compensation that may run into hundreds of thousands or millions of shillings.

Such employers are either dismissing them, especially the casual workers or relieving them of their duties even before the compensation process has began.

Many of those affected have been rushing back to KNH doctors in tears, requesting for help as they are too poor to hire a lawyer to intervene on their behalf.

“Patients come to us crying, having been relieved of their duties even before the injured part has healed,” says Dr Audi.

Afulo and Audi, who are the only hand specialists in the country, say this is happening at time when hand injuries at the casualty are overwhelming both them and the theatres where surgery is supposed to be done.

Because of this, cases that would otherwise have been treated may end up with disabilities as loss of a limb needs immediate attention.

Reconstruction of a single finger or hand that is severely injured takes not less than six hours in the theatre.

But doctors say for better outcomes, the person who has been injured needs to present himself or herself in hospital within six hours from the time the injury happens.

Otherwise, it may be too late to save the affected part as the viability of the hand is less than eight hours. In such cases doctors are forced to amputate the affected fingers or hands before infection spreads to other parts of the body.

Charges for such injuries are another area of concern for the poor people. Those who are admitted at KNH in the public and private wings for the reconstruction process pay between Sh20,000 and Sh 50,000, and Sh 50,000 and Sh 150,000, respectively, depending on the severity of the injuries.

In private hospitals, the minimum charges are Sh 250,000 as the treatment depends on the number of doctors attending to the patient and their individual rates.

While KNH remains the saviour of many poor people, the institution does not have a hand unit and the equipments necessary to undertake specialised surgery such as replanting the part that has been chopped of to its initial place in line with the anatomy of the affected location.

This means most of those who present with amputated hand or arms cannot be replanted.

One of the key equipments required for this purpose, the Micro Surgery Set, costs between two and five million shillings.

Besides the equipments, Dr Audi says they also require more personnel to assist in the re-plantation process. In an ideal situation, putting back a hand that has been completely amputated requires three teams of medical personnel.

One team headed by two surgeons is tasked with cleaning, packing and dressing the amputated part while another team, also headed by two surgeons, prepares the place where the amputated piece will be replanted. The third, with two surgeons, is a stand-by team.

Likewise, proper preservation procedures of the amputated parts will have to be followed by medical personnel and patients, especially by those in far flung areas, who have to transport the amputated piece to the hospital for re-plantation to take place.

This is critical as any delays leads to blockage or death of blood vessels of the amputated piece, making the re-plantation process unnecessary.

Dr Afulo, who studied and worked in South Africa, says when doctors there realised they were seeing an increase in industrial cases, they managed to negotiate with companies to contribute to the setting up of a hands unit and equipping it.

At the same time, there were discussions on the measures the companies need to put in place to reduce such accidents.

Says Afulo: “The only challenge we have in Kenya is most people have not appreciated the importance of having a hands unit, and we hope slowly we can approach companies to make contribution towards such a unit.”

Already, discussions are going-on at KNH hospital on the possibility of establishing such a unit that would provide specialised treatment to those with hand injuries.