He was referred by his brother. After 3 weeks of festering on a hospital bed in town with a broken neck and paralysis. The hospital kept promising and cancelling plans for operation. He had also started developing bed sores and was in constant pain, bed bound in the same position all day long.
The story was simple. On the way to work he had been involved in road traffic accident. He was not wearing a seat belt and was thrown out of the car. He could not move his arms and legs and a passer-by dragged him off the road to safety. He was initially taken in a pick-up truck to one hospital then to another. He ended up in a hospital full of promises but no action.
Anyway, when he finally arrived, he required immediate emergency operation to fix his broken neck, treatment for the bed sores and nursing care to prevent blood clots in the legs. Now, able to eat and drink in comfort, he manages to survive, living in a wheel chair.
He was referred immediately by his orthopedic surgeon once he arrived at the hospital. The surgeon knew he did not have the wherewithal to manage a patient with spinal cord injury and sent him on his way. He was transported safely with proper neck protection in an ambulance. After adequate resuscitation!
He also needed emergency operation and his broken neck was fixed immediately. The signs of recovery started soon after the operation was performed. He started feeling his legs and then gradually noted increasing power in the arms and legs. A month later, he was able to walk and wondering when he could resume relations with his wife.
Spinal cord injury
A spinal cord injury (SCI) is damage to the spinal cord that causes changes in its function, either temporary or permanent. These changes translate into loss of muscle function, sensation, or autonomic function in parts of the body served by the spinal cord below the level of the lesion. It can lead to temporary or permanent paralysis, temporary or permanent loss of bowel or bladder control and loss of sexual function.
The key determinants of outcome are the initial and then, secondary injury. The secondary injury can be prevented by safe extrication, safe and controlled transfer, early diagnosis and management and eventually, good and effective rehabilitation.
Tales of real life
The International Spinal Cord Injury Society has designated 5th September as the SPINAL CORD INJURY DAY. A day to create awareness about the plight of patients and carers, inform and educate about spinal cord injury and finally discuss with everyone concerned about removing the obstacles in the life of those who are unfortunate to be so affected. This is very important because road traffic accidents, assaults and falls leading to spinal cord injury can happen to anyone.
The more you know the better.
The patients described above were managed by different people and one was lucky: the other very unlucky. Let me tell you why. Number 1 was transported to hospital in an unsafe way. Secondly, the hospital was not capable of managing the case but continued to lie and make promises.
The family eventually cottoned on to the shoddy management and the false promises of the doctors. The brother then went shopping around for other hospitals where the patient could be managed more appropriately. This does not auger well for the particular hospital and for all of us as healthcare practitioners.
This is critical.
Hospitals should owe allegiance only to the patient. We are advocating for patient centered care where the patient in king and the most important denominator. In this way, the patients’ interests are protected and so a good outcome is almost guaranteed.
Patient number 2 was referred early and transported safely for definitive surgery and so ‘luckily’ had a good outcome. This is the crux of the matter: good management equals good outcomes.
Where are we in Nigeria?
Poor public service and lack of an efficient ambulance or emergency services is a major obstacle for spinal cord injured patients. Therefore, first respondents have a critical role and need to be properly educated. At the scene, do not just drag people anyhow. Ask questions first.
Ask the following important questions:
1: Are you okay?
2: Are you hurt?
3: Any neck pain or back pain?
4: Can you move your arms and legs?
The answers will allow you to know if they are at risk of spinal cord injury or have already suffered an injury. If they have pains in the neck/back or are paralyzed, be very careful and treat gently. Transport safely to hospital and inform them that the patient has suffered a possible spinal cord injury.
For more information, join us on the 5th September as we ramp up the advocacy. We will be having an open day to share information and advice. Call Emmanuel on 08122221616 for more information.