Gunshot wound is something totally rare in our city and it seems to be something very serious. But for me I saw and treated half a hundred of these already; in South Sudan, Yemen, Papua New Guinea & now in Central African Republic.
Unlike in our city where the medical and supporting services are so good, the severely injured patient would be in the hospital within 20 to 30 minutes and treatment for him started right away. Here in most developing countries, people need to travel a long distance to access the hospital with surgical activities, usually by themselves or with the help of their families or neighours. So all those wounded seriously and in unstable condition, usually they are not even able to arrive at the hospital. And for those that arrived, they may have delayed for a few days already with serious infection of the wound or sometimes with worms in there after they were hiding in the bush! So handling this kind of wound is always challenging.
There were times I needed to take bullets out from the abdomen to save the patients’ lives and of course repaired everything that were destroyed but most of the wounds were in the limbs and for that I needed to remove all dead & dirty tissues to control the infection and after everything is clean then I need to think of how to save the limb and give back the best function of the limb to the patient. For that it may involve fixing the fractures, repair the tendons, muscles and nerves then doing skin graft to cover the final wound. It is always a difficult and challenging job but when the patient went home happily with a functioning limb, I know all those difficult and hard works are worthy.
Sorry for all these complicated medical details. But I will tell you all two stories about gunshot wound here in Bossangoa, Central African Republic. One sad one and one happy one. Last week I received a 68 years old man got shot at his right thigh, the wound itself was not serious and there is no bone involvement. So if he arrived early, say within 2-4 days after injury, he should be home after 10-14 days with minimal disability. But he arrived 12 days after the injury and the infection spreading through the whole thigh despite the initial small wound and he died of infection within 2 days before I could do an amputation to save his life.
Then there is a 21 years old man with gunshot wound at the left leg also came in with lots of infection. When I arrived Bossangoa, he was already in our hospital and because of the infected wound with exposed leg bone, we were thinking of amputation already. I did my best to cut away all infected tissues and clean up the wound, then performed a muscle flap to cover the exposed bone which he refused initially and required lots of explanation to persuade him, because without this operation, he may end up having an amputation. Anyway the operation is successful and his leg is now already covered with skin graft and he will soon be going home with a healthy leg in the coming week.
So that’s it! Ups & downs in the field, with lots of satisfaction but frustrations at times!