Since September 1st, I
have been rotating through General Surgery here at Tenwek. 6 am rounds have
never been my idea of fun, but given the option of this or all-day rounds with
Internal Medicine—I, like most future Emergency Medicine doctors, would prefer
the quick, efficient rounds of the Surgeon. Plus, the Theatre has offered
plenty of opportunity for procedures and I have had opportunity to evaluate
acute abdomen cases.
My first two call-nights on surgery
started out with a bang—literally. Mutatoos
are the local public transport buses, and both casualties were the result of mutatoo road traffic accidents (RTA). Over the
weekend, I experienced the mutatoo
first hand—as I rode in one on our travel back from Uganda. Our bus was packed—with over fifteen Kenyans packed into a twelve person ride. On stops, there always seemed to be
one or two guys hanging out the side door who had to jump in as the bus drives
away. Fortunately, we arrived safely in Bomet on our bus ride. The individuals
below sadly did not reach their destination.
The first mass casualty was on
Thursday night last week. We got a call at 8PM that there had been an RTA in
Naruk, and that they were coming to Tenwek. A bus of six people had hit a donkey and crashed. The
injuries were catastrophic and the morbidity high. They arrived at 10PM. At
first I focused on A., a lady who had severe wounds all over her right arm,
cold extremities, no pulse she would require amputation that night. The saddest
cases, however, were the children. One 5 year old boy (I.) presented having had a
traumatic amputation in the field of his whole right arm. When we explored I.
arm in Theatre-- glass, dirt, and blood gushed from where his arm should have
been. Next a 4 year old girl (L.) lost the right side of her face, sustained a
skull fracture, and right arm avulsion, all the while she was crying for daddy.
Three more—a baby with open tib/fib fracture and avulsion of ankles bilaterally
and two ladies—all required surgery that night. The team was up all night
dealing with the tragedy. Dr. Carol Spears, a missionary General Surgeon who trained at
University of Kentucky, led the team through the night. Tragedies like this are
hard to put in to words; I found my heart broken for I., who will survive but
must live through live without an arm.
The second mass casualty occurred
two days later when twenty-three patients arrived to the hospital without
warning from a nearby RTA. One patient was dead on arrival, another died
shortly after our resuscitation efforts were started. Another patient I
evaluated sustained a C-spine fracture, and before she had transferred to the
regional neurosurgeon, she had lost all sensation and strength below her chest.
Multiple dislocations and fractures were noted among the victims.
When tragedies like these occur, it
may seem like God is not present. We may cry to Him as the Psalmist does in
Psalm 10:1—“Why, O Lord, do you stand
afar off? Why do you hide yourself in times of trouble?” or as Habakkuk
pleads when Judah is oppressed—Hab. 1:2—“O Lord, how long shall I cry for help, and
you will not hear me?” Sometimes there are no easy answers. We ultimately
live in a sinful, fallen world, and the beauty of Christianity is the hope
found in the redemptive work of Christ. God doesn’t promise all the answers
now, but He does allow enough of Himself to be known that we can trust in Him
through tragedy, as Habakkuk does in Hab 2:4—“…the righteous shall live by his faith.” Also God can use a
tragedy to speak to us, as C.S. Lewis rightly notes, “God whispers to us in our pleasures, speaks to us in our conscience, but shouts in our pains: It is His megaphone to rouse a deaf world."
Tragedy opens our eyes up to real life; we are forced to focus on things we
would rather not think about in the routine day—life, death, our past, our
future. If the Church is present during the tragedy, we can be Christ to the hurting. Our presence in the midst of tragedy is often more meaningful than any grand comments we can come up with.
