Trauma is a really big problem here in Juba. I’d say gun-shot wounds and RTA’s make up the bulk of our acute surgical takes most days. (Here surgery and orthopaedics are all one.) In fact, they experience what we would call a “major incident” at least once a month! These usually take the form of mass road accident casualties etc.
Well we had the first one of our trip last night. There was some tribal conflict (cattle raiding I believe) in one of the rural regions three hours out of Juba. This actually occurred three days ago, but the bus load only arrived today to JTH. There were about 20 dead, 50 injured. The majority of these were gunshot wounds and lacerations including, sadly, women and children with bullets lodged in various places. Amazingly, most of the patients were haemodynamically stable (I assume because the sicker ones had already died) but we still took 15 to theatre this afternoon on the trauma list. Generally surgical debridement was the order of the day (wounds three days old were by now horribly infected) along with fishing out the shards of bone shattered by bullets and fixing the fractures. I’ve never seen actual bullet injuries in the UK and I hope I never have to. They’re horrible.
There’s certainly a lot of challenges to meet in the acute care here, (especially given the volume every day and frequent major incidents) but we’re making progress. Obs and drugs charts are being printed by the MoH. The seniors here recognise the need and are supportive of our efforts, which is very encouraging. We’ve been given an office for the link on site. We’ve set out a teaching programme on some of the basics of assessment of the sick patient, which we begin on Saturday. We’ve completed the first cycle of an audit assessing the quality of the acute care. We’ve indentified a suitable ward to setup a rudimentary A&E Resus, and are currently looking at different models of triage.
There’s a lot to do, but there are so many opportunities out here: it’s brilliant. The hospital’s really moving forward and it’s exciting to be a (small) part of it. And the weather here is beautiful!
James
Well we had the first one of our trip last night. There was some tribal conflict (cattle raiding I believe) in one of the rural regions three hours out of Juba. This actually occurred three days ago, but the bus load only arrived today to JTH. There were about 20 dead, 50 injured. The majority of these were gunshot wounds and lacerations including, sadly, women and children with bullets lodged in various places. Amazingly, most of the patients were haemodynamically stable (I assume because the sicker ones had already died) but we still took 15 to theatre this afternoon on the trauma list. Generally surgical debridement was the order of the day (wounds three days old were by now horribly infected) along with fishing out the shards of bone shattered by bullets and fixing the fractures. I’ve never seen actual bullet injuries in the UK and I hope I never have to. They’re horrible.
There’s certainly a lot of challenges to meet in the acute care here, (especially given the volume every day and frequent major incidents) but we’re making progress. Obs and drugs charts are being printed by the MoH. The seniors here recognise the need and are supportive of our efforts, which is very encouraging. We’ve been given an office for the link on site. We’ve set out a teaching programme on some of the basics of assessment of the sick patient, which we begin on Saturday. We’ve completed the first cycle of an audit assessing the quality of the acute care. We’ve indentified a suitable ward to setup a rudimentary A&E Resus, and are currently looking at different models of triage.
There’s a lot to do, but there are so many opportunities out here: it’s brilliant. The hospital’s really moving forward and it’s exciting to be a (small) part of it. And the weather here is beautiful!
James
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