A night at KNH’s chaotic casualty wing

By DANN OKOTHAn eerie silence hangs over the usually busy emergency unit. The hustle and bustle appears to have died off – albeit momentarily – and so do the often-frightening sights that characterise the receiving area at the referral hospital.As the day wears on, doctors, nurses, and support staff prepare to call it a day with female employees thronging the bursting washrooms to spruce up before leaving.Patients at Kenyatta National Hospital’s Emergency and Accidents Unit. [PHOTO: STAFFORD ONDEGO/STANDARD]The day had been hectic for majority of the staff, a clerk at the records desk tells me as he flips through a pile of papers while signing off. The workers, he says, had grappled with an unusually high number of emergency cases, explaining their eagerness to leave.But they leave behind a scene that is not for the faint-hearted. Stretchers draped in bloodstained linen line the entire length of the corridor.Urine, blood and vomit swamp the entire floor, making movement across the unit a precarious undertaking. The lone cleaner is clearly no match for the mess.At the farthest corner, an abandoned patient groans in pain. He kicks his feet and feebly waves to call for help. Whenever he can, he mumbles a few words asking for a glass of water or milk. He has been lying here since 6pm, I learn. First-hand experience Welcome to Kenyatta National Hospital (KNH) Emergency and Accidents Unit.It is 8pm on a Saturday evening as I arrive at the unit, also known as Casualty, to experience first-hand the operations of the unit and also see what patients and their kin go through.The patients at the unit and their minders left unattended on the benches huddle together to beat the cold. They are victims of the melee and confusion that characterises a changeover from day to night duty staff.The changeover, another staff tells me, should be as smooth as possible to prevent unnecessary patients’ suffering but that is not always the case as it can also be a protracted and acrimonious exercise. Staff simply do not arrive in time to relieve their colleagues – with others not turning up altogether. I learn some of the staff leaving now were supposed to have been relieved by 5pm.At 10.30pm, the chilling cold, which is a common feature at KNH even during the day, gets worse. I regret for forgetting to carry warm clothing. I retreat to a corner near the records office, shielded me from the cold wind breezing from the Upper Hill area.11.15pm: I’m jolted from a brief nap by the screeching sound of worn-out stretcher wheels grinding against the concrete floor. There are chaotic scenes in a room, which a few moments ago was as quiet and forlorn.Hundreds of patients and their handlers have suddenly descended on the emergency unit. Nurses and doctors who had not arrived for duty a few minutes ago are now running up a down in a fervent frenzy to save patients’ lives.Deluge of patientsThe sudden deluge of patients, I’m told, is not an unusual occurrence, especially on a weekend like this. They are mostly victims due of drunken driving, bar brawls, illicit brew consumption, mugging, attempted suicide and domestic violence. But there is the occasional victim of botched abortion, rape, severe diarrhea and heart attack.11.45pm: The hospital staff, including doctors, are overwhelmed. Medical staff, patients and their handlers push, jostle and shove in a dramatic rat race that tilts the balance in disfavour of weak unaccompanied patients.There are few medical equipment and aid to go round so doctors and nurses settle for the most ill – and even these ones would be lucky to secure a drip or have their blood pressure and temperature examined.There are only two doctors – maybe three – to man the whole unit. I learn that they are all general practitioners, meaning they can only do so much for the critically injured patients.Accident victim 12.45pm: A road accident victim identified only as Maina is wheeled into the emergency unit. The man has a deep cut right across his head. A doctor administers first aid to stop the bleeding and a morphine injection to stop the pain. "He needs to see a specialist, maybe a neurosurgeon, because he could be bleeding in his brains," says Fredrik Khamati, who brought him in.There is no neurosurgeon on standby and one has to be called in from home or other engagements. But it would take 45 minutes to one hour before one can arrive. In the meantime, the patient slips in and out of consciousness – his minders stand by his side facing the grim reality of having to watch their kin die before their eyes.1.15pm: By now most of the people who had been jostling for cards and a chance to see the doctor have long given up. They are now sprawled on the benches or on the floor with their patients curled grotesquely on the stretchers – their fate hanging by a thread. A few call taxis to seek treatment elsewhere while others return home to await their fate.Meanwhile, the few doctors and nurses still on duty (about half the number that started), are still battling to save the more critical patients and new ones who keep arriving in droves.Intensive care A few are quickly wheeled to the doctor’s office and then to intensive care unit as the hospital staff battle to attend to arriving casualties.1.45am: A wailing woman is rushed through the main door on a stretcher – she is bleeding profusely and blood is dripping through the stretcher fabric. "She attempted abortion in Huruma estate," says her sister, Akinyi. A backstreet doctor botched the operation, leading to severe bleeding.Her loud wailing stirs the now subdued crowd of patients and their minders in the waiting room. The nurses quickly wheel her away to the labour ward, apparently to divert attention."She would have to see a gynecologist," says Akinyi, as she emerges from the doctor’s room. However, that would have to be in the morning because there is only one in ward who at the moment was performing a caesarian section on another patient.They will need to "flush her", which literally means cleaning her uterus to remove debris left by the botched abortion and stop the bleeding. "That will require several pints of blood and quite a bit of money, none of which we have right now," the sister reports.2.15am: The neurosurgeon arrives three hour after he was called. Maina had been wheeled into an inner room after his condition got worse and he started experiencing seizures. The abandoned patient at the furthest corner stopped kicking and moaning. 2.45am: I laboriously drag myself to the entrance of the emergency unit. Exhausted, frustrated and freezing from the biting cold, I search for a taxi to take me home. The less than 15 minutes drive to Donholm estate appeared like an eternity as events of last night weighed heavily on my mind. I was left wondering what happened to the patients I saw and interacted with –especially the one who disappeared behind the doctor’s office door never to re-emerge. Did they get well? How about the ones that back went home in frustration? Can things get better?

A night at KNH’s chaotic casualty wing

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A night at KNH’s chaotic casualty wing

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