Posted by Tanya Shah
A young boy was recently brought to the Nyaya Health clinic from one of the outlying communities of Achham. The day before, he had fallen out of a tree while playing with other children. He developed pain in his left arm and a large cut in the skin with muscle, tendon, and blood seen within the wound. His family placed the injured arm in a home-made sling to bring him to our clinic, which included a full day of walking from where they lived. While such injuries are relatively common in all countries around the world, they can be particularly life-threatening and/or crippling in areas like rural Nepal.
When he arrived at our clinic, our auxiliary nurse midwife (ANM) working in the triage area immediately brought him into the treatment area for evaluation based on his distress and the large bloody bandage. This bandage was carefully removed and the wound and arm were examined by our health staff. Although no bone was visible in the cut, it was clear that there was an underlying fracture. This type of open fracture can quickly lead to infection and major permanent damage to the arm if correct treatment is not given immediately.
Kamala Sharma, one of our ANMs, and Aditya Sharma dressing the wound before stabilizing the fracture with a sling.
Our staff provided him with pain medication, a tetanus immunization, and antibiotics. We also stabilized his presumed fracture with a splint. Ideally, the immediate next steps would be for the patient to get an x-ray and have an orthopedic surgeon evaluate his condition. Unfortunately, these are currently unavailable in Achham and the nearest facility with such resources is nearly 15 hours away by bus. One of Nyaya’s key priorities during the upcoming year, as we open Bayalpata Hospital, is to acquire an X-ray machine through donation and subsidized cost from the manufacturer. Using our telemedicine applications, a designated orthopedic surgeon in the US would provide us with free consultations for complicated cases.
In this case, because of the current lack of the necessary resources in Achham, we had to refer the boy to the distant medical facility so he could get the tests and possible surgery that he needed. Unfortunately, the 15-hour bus trip would be nothing short of a harrowing experience because the poor road conditions will greatly increase the pain in his broken and only partially-treated arm. The financial cost to the patient’s family for this travel and treatment is also significant.