It was around 7pm on a weekday at Bayalpata when our nightguard, Naresh dai, came running to fetch the doctor on call, “Bullit, bullit! Dr. Saab.” At first, we all thought someone with a bullet injury had come to the hospital. On further clarification, we learned that a woman who had been hit by a bull had been brought to the Emergency Room and needed immediate attention. Naresh, who had previously worked as a waiter at a fancy restaurant in Bombay and had picked up a fair bit of English, was actually trying to say “Bull Hit!”
Dr. Amir and the health assistant on call, Taraman, immediately left for the ER. Thankfully, the woman was in stable condition—her blood pressure and pulse were stable and she was conscious and able to converse. She had no signs of an acute abdomen or internal bleeding. Her urine was clear without blood. X-rays of her pelvis revealed no bony injuries.
She had been grazing her animals about four hours ago and was about to tie up her bull. As she was putting the noose around its neck, it went wild and attacked her with its horns, injuring her pelvis and causing a large wound. Her daughter-in-law who was at her side in the ER chimed in, “One should never tie a bull from the front, particularly this bull. It has attacked other people before.”
The pelvic wound was massive—about 20 cm in length and deep with subcutaneous tissue and fat clearly visible. It was shaped like a “V” with a large flap of skin and soft tissue in the middle. Once sutured, it would look like a botched-up C-section.
Dr. Amir, an aspiring surgeon, immediately prescribed some broad spectrum antibiotics, a tetanus booster and pain medications and then, proceeded to clean the wound with normal saline and betadine. After injecting sufficient local lidocaine, he placed catgut sutures and expertly aligned the deeper muscle tissue. As he was about to start suturing the skin, we lost electricity due to a power outage—a frequent occurrence in Achham. Naresh dai quickly brought in a lamp with rechargeable batteries and the suturing continued.
Once the mini-operation was over, the patient was able to slowly lower herself from the procedure table and walk over to her bed in the ER. Her wound was cleaned and dressed daily to avoid infection. She went home in a few days on oral antibiotics and returned in a week to have her sutures removed.
Ruma Rajbhandari is a physician at Brigham and Women’s Hospital, Harvard Medical School, Boston. She volunteers with NSI and Nyaya Health