Patients who need hip replacement such as those with arthritis, back surgery, spine operation, or any other major surgery have to wait for up to four months or even longer, before the surgery is done. Reason: the theatres are packed with people with severe road accident and gunshot injuries, who are crowding out these patients.
“The society is generating many fractures than we doctors can cope with, making many other needy patients to suffer as we respond to daily emergencies,” moans Doctor Geoffrey Kibuga, the Head of Orthopedic department and spine and trauma surgeon.
Dr Kibuga says they are receiving eight cases of serious injuries every day up from two a couple of months ago.
“We are finding it difficult to attend to other needy cases as our time and theatre is taken up by the trauma cases, many of which are avoidable road accidents cases.”
Resources that would have been used to manage other patients are now being directed to respond to the road accident and assault patients.
Massive cases of injuries have overwhelmed the orthopedic ward, making it the busiest section at the hospital with bed occupancy of 140 percent. This means the beds in the wards are not enough to handle patients streaming into the hospital, forcing the nurses to put some of them on the floor.
Dr Kibuga says the hospital is spending about Sh 50,000 to correct one case of severe injury from road accident, many of which could be avoided. This money is enough to cater for three years dosage of antiretroviral drugs for an HIV positive person or to treat about 160 people with less severe malaria if the road safety measures are followed and assault cases reduced.
In addition to the money, patients in the orthopedic department are staying on average 30 days in the wards, higher than the hospital average length of stay of 10 days.
“Something is wrong in the society and we need to do something. When the Michuki rules were adhered to, we were receiving only two cases of mild injuries every day. But now the number has risen to eight.”
Road accident cases fell from 7,000 in 2005 to 4,400 in 2007, a drop the hospital attributes observance of road safety measures when Michuki rules were adhered to. But the cases reported at the hospital started to rise again, reaching the 4,800 mark in 2008 and have not tapered since then.
Between January and November 2009, the hospital received 5,089 patients who were involved in Road Traffic Accidents (RTA). In the same period, other cases of trauma were too on the rise, with 2,524 assault cases and 221 gunshots being attended to.
This is an indication that violent crimes and domestic violence might on the steady rise in the country. Doctors at the hospital say they have not had it easy in the past five years with the total number of RTA, assaults and gunshots remaining above 7,000 every year.
Last year, majority of the patients were treated for head injuries (37 percent), knee and lower leg injuries (15 percent), hip and thigh (13 percent), wrist and hand (8 percent), and abdomen, lower back, and spine (7 percent).
Those taking up most of the space in the orthopedic wards are the road accidents victims, assaults and the gunshot patients in that sequence.
Because of this high number of accidents and overcrowded theatres, patients are now being treated using a most expensive method known as traction- a set of mechanisms for straightening broken bones or relieving pressure on the skeletal system
Using this method, the patient’s fractures heal slowly as they lie stationery on the bed and in certain position for several weeks. When costed, such a treatment requires not less than 250,000 to cater for one single patient admitted at the hospital for four months.
Ordinarily, if such cases are operated on, and a plate used to support the fractured bone, the patient is discharged and the rest of the healing takes place at home. Such an approach costs about Sh 40,000. This long stay at hospital when the traction method is used is making it difficult to get a space for new patients as those injured occupy a bed for over four months.
“At the moment, due to lack of theatre space, patients have to be in the hospital for longer, making it difficult for other patients to get space,” says Joel Mwangi, Medical Records Officer, Statistics.
Mwangi notes that while patients in other wards were being discharged frequently, allowing their beds to be utilized by fresh patients, this is not the case in the orthorpaedic department which is experiencing runaway road accident and assault cases.
In the 2008, for instance, while 65 people utilized a single bed in obstetric and gynecology department, only 27 did so in the orthopedic. What this means is patients in the orthoapaedic department are staying longer in their beds than any other ward forcing some patients to lie on the floor or to be put on the waiting list until when a vacant bed is available.
“One of the most effective ways to reduce this pressure on the hospital and create space for other patients is to deal with the high numbers of road traffic accidents and assault in the society,” says Mwangi.
Dr Kibuga thinks a number of interventions have to take place to reverse the current treatment and free-up space in the orthopaedic department. The society needs to follow road safety rules and become less violent. The Ministry of Health and the Treasury needs to provide resources to the hospital to put in place infrastructure and offer incentives to doctors.
While the provincial and district hospitals have surgeons, many of them do not have equipments to operate road accident victims with severe injuries. Without facilities, these surgeons are referring all the cases to KNH causing the clogging in the system.
An AWC-Feature
