Traditional surgery that saves lives and money

By Kevin Tunoi

KENYA: Under the shades of a mango tree in Marakwet District, two men restrain a man seated on a locally made stool while the third, armed with a scalpel, slices open his forehead, exposing the skull.

Bystanders, including his relatives, watch in revulsion, as the scene is reminiscent of a horror movie, robbery with violence or even murder.

A small stream separates curious onlookers and the men under the tree; on one side old men seated on traditional stools murmur inaudible words as they lit dry grass round a cooking pan filled with water.

The octogenarians momentarily dip the burning grass into the water but the flames do not go out and the exercise is repeated again. It is an exercise meant to ward off evil spirits lest the traditional operation goes awry. The patient’s forehead is cut open, drilled and treated while he is fully conscious, his agonising pain visible from his bodily reactions.

In under an hour, the man who had been restrained resiliently gets on his feet, his clothes soaked with blood. “It went on smoothly, and it is a success,” states the scalpel holding man as he pulls off his blood stained surgical gloves.

A motorcycle rider revs his engine and the man who has just had his forehead cut open puts on a cap and hops onto the bike, and off they zoom to the nearby Endo Mission Hospital for the necessary tetanus shots.

Local anaesthesia

“Welcome to my theatre, you are just in time to witness how we do surgery back here in the village. I am Daktari Kichwa and this is my son and protégé, Nixon,” said Mr Wilson Belione as he washes his tools of trade.

Moments later, another patient walks in hand in hand with his wife as the ’doctor’ explains to me that he is expecting a visit from professional neurosurgeons and other medical practitioners who want to observe his procedures.

Daktari together with his son prepare the patient and using fingers they feel the section of the patient’s dented forehead; then proceed to shave off his hair and inject local anaesthesia. Before they start the surgery a group of trained doctors from Eldoret arrive and are ushered into the ‘theatre’ to observe the exercise.

“When you are ready inform me so that we can perform the operation,” says Daktari, and Eldoret based Neurosurgeon Florentius Koech together with Anaesthetist Kituyi Werunga nod in the affirmative. Two hours later the patient is stitched up and walks away from the mango tree to the health centre for a tetanus jab, as Daktari disinfects and put away his ‘theatre equipment’.

Belione brags that he is better off than most doctors since he can operate on patients better and has a record of no mortality at the operating table. “These skills that I have are passed down through generations, it is from my forefathers and I am passing it down to my son,” he said.

His patients walk the villages, and lead normal lives after their operations by Belione: they are living testimonies. “Way back in 1993, a tree fell on me and the impact cracked my skull; I got very sick and I could not speak. Quick intervention and 21 stitches by the then local doctor saved my life,” noted Mr Johnstone Kiprop.

He added that though the procedure was painful, family members restrained him as the surgery was being performed to remove the broken part of the skull that was applying pressure on the brain. Kiprop explained that locals in the area prefer their own because they believe it is a God-given gift that has been passed down through family lineage.

“Theirs is a gift from heaven, from their fore-fathers and with the over 30 years of experience he is a very safe pair of hands and his son is now also perfecting his skills,” he says.

Eighty-year-old Mr Cheserek Arap Yano, Daktari’s elder brother says he was saved by a two-day long surgery after his son assaulted him.

He takes off his hat and shows scars of his broken skull: the pulse movement is noticeable and the octogenarian explains that he is all right and experiences no pain. “When my son hit me, I was unconscious for a week and later when I came to I realised I was injured and was taken to Daktari for an operation,” states Yano. Mr Philemon Kanda, a graduate, recalls how while in primary school he was hit by a rock thrown by a schoolmate while playing 13 years ago. “I had a tough time being in class because I could not see the black board clearly and I had headaches. I was referred to the Daktari immediately he finished the operation; my sight went back to normal instantly,” he adds. Many more patients around the village show off their scars and narrate stories of Daktari’s magical hands. Their reasons for seeking Belione’s services range from bad roads and poor communication network compounded by very distant, expensive and ill-equipped medical facilities.

“There was a time I went to one of the hospitals in Eldoret and was booked in for surgery but I had to wait since there was a waiting list,” explains Mr Joseph Kemboi. Daktari son and assistant, Nixon Kipkemboi, aged 33, says they do not sell their services to the people but it is their duty to help the community. Kemboi states that he and his father traverse the larger Elgeyo/Marakwet and West Pokot Counties when they are called to perform operations.

Most patients attest that he is the best and due to lack of well-equipped health facilities offering surgical procedures, they have opted for their local ‘doctor’. The visiting doctors that were filling a questionnaire comparing traditional and medical surgery had their reservations though. Doctor Koech and Moi University and Moi Teaching and Referral Hospital (MTRH) Anaesthetist Kituyi Werunga led them.

They noted that though the exercise was a service to the people in remote areas it was not being conducted in accordance to the required standards. “The operations are not to the required threshold in medical practice but on the other hand traditional surgeons fill up the gaps due to the deficit of professionals in the country,” said Koech.

Emergency interventions

Koech is the only neurosurgeon in Western Kenya, serving a population of close to 18 million people. He commended the traditional doctors, saying they act fast to offer emergency interventions before patients are referred to hospitals. Koech noted that though the traditional practices were dangerous, myths associated with conventional surgical procedures had encouraged people to embrace local methods. “They have the skills but we must intervene to ensure we offer them basic training on how to handle patients and procedures,” he added.

He said that after the untrained doctors are taken through conventional training they should be accredited by the Government to allow them to perform the operations legally. Anaesthetist Kituyi Werunga observed that although the traditional surgeon had administered anaesthesia, the procedure that he was performing required general anaesthesia and in the correct dosage.

“Local anaesthesia was administered but I did not witness the right amount being used and the procedure required powerful general anaesthesia,” he said. Mr Kituyi, who is the only anaesthetist serving MTRH said that the area and tools that were used to conduct the operation were also not hygienic and risked the lives of the patients. The doctors now call on the Government to intervene and set up medical facilities that will help ease provision of services to people in remote areas.