Aira Hospital

Still fighting with a hopeless internet connection. That’s why the news on the blog are short and scarce.

This young girl was happy to survive one of the common car accidents on the roads around. High speed, overload and chat are the common factors behind the accidents.

She lost one eye and got severe fractures of the mandible and the maxillary complex, known as Le Fort III fracture system.

The maxillary complex is loose and the nose severely fractured as well

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A difficult case even in the first world.

We managed to get good alignments and fixation with our standard external fixation device made out of bicycle wires and Plaster of Paris

To lose a leg is catastrophic. There is no supply of prosthesis around and without a leg you cannot do the farming which is the only way to survive for 95% of the rural population.

It is an old dream of mine to be able to supply our amputees with an artificial leg. Readymade prosthesis in different sizes left and right are available and can be purchased from abroad if only we had the money. Made of out of plastic they need only some heating to be adjusted to an amputation stump. No need of high tech equipment or trained staff - only money is needed.

Recently during the Swedish election campaign the country’s infamous Marxist-feminist nr 1 burned 100 000 Swedish crowns in public to get the attention of the media. She got it with the same success as when she urinated on the red carpet among dignitaries during a gala in Stockholm. This time however she was sober.

In the same election campaign various car companies pay 8 million crowns for free champagne to everyone.

One of our patients made an artificial leg for himself. A bit clumsy, but it works.

Others do not have that capacity and therefore we always do our outmost to save a limb.

This unfortunate man was as drunk as the Swedish Marxist-feminist NR 1 when she urinated on the red carpet. He fell asleep outside his hut and woke up in the middle of the night as a hyena was having a good meal on his leg.

In the operating theater all dead muscles and other soft tissues were cut away and the wound cleaned thoroughly (wound debridement and revision).

Not much was left. However the anterior muscles kept the foot in (dorsal) extension so there is a substantial chance of getting the patient walking on two feet

After some days the large defect was covered with skin graft.

It looked promising on the latest picture.

The patients disappeared although he was told to return for follow up.

Maybe a lucky hyena got a full and undisturbed meal later?

100 000 Swedish Crowns would pay for 500 cesareans saving 1000 human lives.

The free champagne could keep Aira Hospital going for 100 years.

Priorities are indeed different in this world.

Elephantiasis is a disease which can be treated conservatively with good result (see page “ELEPHANTIASIS”)

We know all too well that the result of surgical treatment is not promising in the long run – something which I am being reminded repeatedly by people engaged in the podoconiosis programs around.

But what do you do when a young man turns up at the OPD with a huge deformed leg asking for an amputation? Just chop it off?

I personally cannot resist helping and trying to save his leg. The surgical treatment is rather simple but time consuming.

The principle behind the surgery is very simple:  if there is no subcutaneous tissue there will be no subcutaneous edema. So cut away all subcutaneous tissue! The method was described by Dr Thompson and the procedure carries his name.

Start to harvest skin from the leg with a handheld dermatome.

Excise all the affected subcutaneous tissue from the leg down to the fascia.

Then transplant the skin back on the bare fascia and elevate the leg in traction with a pin through the calcaneus

The result might not be cosmetically the best, but the patient is happy and relieved.

The special form of elephantiasis called podoconiosis which represents almost all of the cases seen here in Ethiopia is caused by small mineral particles from the red soil which penetrates the skin and blocks the lymphatic system in people walking barefooted. It could be easily and simply be prevented by protecting the feet with shoes. Poverty prevents that.

The problem caused by podoconiosis is enormous. There are a lot of patients suffering from the disease, but except the beggars in the street you do not see them easily. They usually hide as it is considered a shameful condition - a curse. 

One researcher has calculated that the overall financial lost in Ethiopia from this disease widely overshadows that caused by HIV/AIDS!

What is the biggest killer in the third world? 

AIDS? 

Malaria?  

Tuberculosis? 

Snake bites?  

NO- NO - NO!

The single biggest killer in the developing world is trauma – in particular road accidents.

More than 5 million people every year die from trauma in the developing world. That is near to the same number of death caused by AIDS, TBC and malaria together.

Many more millions of people are permanently disabled after trauma. It is one of the most frequent causes for hospital admission and outpatient treatment – a major strain to the health budget and health facilities.

Why is it then that practically no NGOs are interested in supporting treatment and prevention of death and disability caused by trauma? I personally know of only one NGO in the whole world which is engaged in this important issue.

All other aid organizations are only interested in projects dealing with HIV/AIDS, mother and child health care, preventive health, human rights, women’s right etc..

Incredible amount of money is poured into HIV/AIDS project 80 % of which is wasted on workshops, meetings, conferences, travelling, hotel expenses, daily allowances etc. A lot of money which is derived from other important sectors of health care.

Here is today’s harvest of trauma patients

Did you know that Ethiopia has the highest rate of traffic death per vehicle?

No ambulance service, no trauma service, no awareness and lack of curative health care quantitatively and qualitatively are the explanation to that high figure.

The lesson to learn from this blog is:

If you wish to save lives and limbs in the third world then spend your money on treatment and prevention of trauma related diseases!

An elderly lady sustained a fracture of the femur in a car accident and was taken to a nearby hospital. There she was treated with the time honored method of traction. Unfortunately the fracture never healed after 3 months traction in bed and the patient was therefore referred to Aira Hospital.

The x-ray showed abundant with callus, but non-union in malposition (a lot of extra bone but no healing and bone ends out of line)

The fracture was approached surgically

The bone ends were refreshed

A heavy Rush Pin was bended to give good three point fixation when inserted in the bone marrow

The pin was hammered into the bone marrow giving stable fixation to the reduced fracture

Bone chips were transplanted around the fracture to promote healing

Finally the wound was closed

The patient could mobilize with full weight bearing immediately after the surgery

After six months the fracture had healed soundly

We all experience complications, setbacks and failures. There is no reason in exposing specific hospitals or individual doctors in the public on the web. The medical professionals who live and work here know that too well. Fortunately we have good relationship and cooperation in between us. No one here would be the one to through the first stone!