Note: The following post has graphic content
The call came into Dilidai, our ambulance driver. A man from a village about six hours away had been bitten by a bear while collecting wood. Members of his village had carried down to Sanfebagar, where he was now awaiting the ambulance. His leg had a large gaping wound. Bayalpata Hospital Dr. Bikash Gauchan drove down with Dilidai to assess. When they arrived, they found the patient to be stable clinically, and they transported him to the hospital. Dr. Bikash and Bayalpata physician Dr. Amir Bista assessed the situation, and, together with health assistant Udayji and nurse midwife Urmila sister went about repairing his leg. Using the sedative diazepam, the pain medicine tramadol, and local numbing medicine, they cleaned and sutured the leg over the course of a few hours. I met the patient a few days into his admission. By this time, his wound was healing well though he did have a lot of swelling of his leg from all the inflammation caused by the bite. He also had severe foot drop (inability to raise the foot), caused by damage to a nerve that wraps around the fibula (one of the lower leg bones). It is likely that, over time, with physical therapy, he will improve. Dr. Bikash taught the man’s uncle, who was serving as his attendant at the hospital, how to provide gentle physical therapy. Meanwhile, our team in Kathmandu is looking for an ankle-foot orthotic device to prevent contractures (scarring of the muscle and tendons that prevent movement). Dr. Bikash is keeping the patient as in the hospital until his wounds heal. Today is his eighteenth day, and he mentioned how much he misses his six-year-old daughter. She will be visiting shortly, and he will be able to go home soon. We will need to follow-up with his foot drop to decide whether it will be worth the several months’ income to travel down south to get an orthopedic evaluation for a surgical correction. For the moment, we will allow for the inflammation in his leg to calm down. Unfortunately, we do not have a female community health volunteer in his home village yet who could follow him more regularly and provide support. He will make the six hour trip back to the hospital in a few weeks. Here, I provide a slide show showing the repair of the wound performed by our team and the time course of the healing process over the subsequent two weeks.
Duncan Maru, MD, PhD is a co-founder and President of Nyaya Health. He is currently a resident in the Internal Medicine – Pediatrics program and fellow in Global Health Equity at Brigham and Women’s Hospital and Children’s Hospital of Boston.