Eldoret, Kenya: "The machete wounds have caused near amputations"

In early January, Dr. Gary Myers, a surgeon from Oklahoma, was dispatched to Eldoret, in western Kenya, to support the Doctors Without Borders/Médecins Sans Frontières (MSF) team responding to post-election violence. He describes his experience working in the surgical department of Eldoret Hospital.

“What’s been really dramatic to me is the intensity of some of the violence. On at least three of the patients I’ve seen, the machete wounds that they’ve had have caused near amputations. In my experience working with MSF it’s been unusual to see fractures caused by knife wounds, but at least half of the patients I’ve seen here have been injured in this way. If they didn’t have surgery they would most likely lose their limbs.

The hospital here in Eldoret is very sophisticated. It’s a 600 bed hospital and when it’s running at full capacity there are four operating rooms and a staff of around seven surgeons, as well as several specialists, anesthetists and nurses. But the recent clashes slightly overwhelmed them; this is primarily a teaching hospital so they were not fully prepared to deal with so many wounded people. In the early days following the clashes they were also hampered by a lack of staff. A lot of the people who work here, particularly the nurses, live outside the city centre and weren’t able to get back to work for a few days because of the roadblocks.

One of MSF’s first responses in Eldoret was to ensure that the hospital had enough supplies. We donated some materials and after an assessment realized that the surgical ward could probably benefit from some support, so I flew over from Geneva. But my role is very much a support one; the doctors here are extremely experienced.

At this point, roughly 15 days after the worst of the violence in Eldoret, most of the lifesaving surgery has been done. So what we’re dealing with is a kind of ‘backlog’ of patients that need care, they’ve been operated on but need further operations and ongoing wound care. We have about 110 to 120 patients to see, 10 to 15 of those are burns patients and the remainder are people with fractures from machetes or gunshot wounds.

Part of my work here has been operating on patients with bone fractures, using a method called external fixation. External fixation is a way of immobilizing bones to allow a fracture to heal. It aims to fix the injury, reduce pain and restore function. One of the benefits of this technique is that the risk of infection, which could cause serious problems, is minimal. The surgery involves placing a number of pins or screws into the bone on both sides of the fracture. The clamps and rods are known as the “external frame.” Although the bone is immobilized, external fixation means that the patient can still move their limb, something that is not possible if a cast is used.

My Kenyan colleagues here already had some supplies of the pins and screws needed to do this type of surgery, but when I arrived I realized that with the number of wounded patients we had to see the hospital would probably need more. I put an order in with headquarters and the equipment arrived 24 hours later. We’re using up the existing supplies and then should be able to treat another 20 or so patients with the additional equipment, which should meet the needs here, since not everyone needs this method of surgery.

So far I’ve been involved in performing external fixation surgery on six patients. One of my patients this morning was a 29-year-old man, who’d been shot in the leg twice. He was brought to the hospital straight away and operated on. He’s been here for seven days now and as the bullets had fractured his thighbone we decided to operate again. The surgery took about an hour and a half and was very successful. We should be able to discharge him on crutches within a few days and then he’ll just need to come back to have his dressings changed and undergo some rehabilitation.

It’s clear to me that this hospital was slightly overwhelmed after the clashes, so MSF injecting some support at this time has helped care for these patients. If things do resolve, then the hospital will quickly revert back to normal and MSF’s support will not be needed.”