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Kenya: surgeons dissect lessons from post-election violence

19-05-2008 Feature

Following Kenya's December 2007 general elections, hospital staff had to face a massive, and unexpected, influx of victims of violence. Now, during a series of ICRC-organized workshops geared at peace-time emergencies, they are discussing the lessons learned. The ICRC's Iolanda Jaquemet reports.

   

  ©ICRC/I. Jaquemet    
 
  Dr Dan Raburu, Pamela Olilo and Jane Owuor at the ICRC workshop in Kisumu.    
     

" Even if the patient has his bowels hanging out, it does not necessarily mean this is the most urgent case on hand, as long as he is in stable condition. " The 20 members of the audience listened attentively to Dr Mauro Dalla Torre, the ICRC surgeon, as he i llustrated the principles of triage.

Later, they looked with calm, clinical interest at a picture showing a little boy with horrendous leg wounds, used by Dr Dalla Torre to illustrate " the high energy transfer " caused by a bullet.

The participants'poise was not surprising: they were surgeons, nurses and clinical officers from five hospitals in Nyanza province, Western Kenya. During two days in April, they swapped experiences at an ICRC-organized workshop on " emergency preparedness and treatment of wounds due to violence " .

The Kenyan Ministry of Health and the ICRC had agreed to put to good use the lessons learned during the post-electoral violence in early 2008, in order to help hospitals face an influx of casualties due to peace-time disasters – such as a bus overturning or a plane crashing at take-off.

 29 December, the wounded flood in  

" Mass influx of casualties " was nothing new to Dr Dalla Torre's audience. " On 29 December, in a matter of hours, we received 88 patients with injuries. On a normal day, on average, we get 30 patients in 24 hours! " recalled Dr Dan Raburu, chief surgeon at Nyanza Provincial General Hospital, in Kisumu.

That day, Nyanza, like all other health facilities in the country, was taken by total surprise. " No-one had anticipated that the elections would not be peaceful, " added Dr Raburu. He himself was on leave, like many other members of the staff. Others fled the town during the following days, or did not dare report to work in the face of violent mobs. " In the beginning, we hardly had a quarter of the normal staff, " he remembered.

Access to the hospital was a nightmare, for both patients and personnel. " We soon discovered that the safest way to c ome was by ambulance, but even like that, I personally had to plead to get through, " said Dr Raburu. At least one ambulance was set on fire.

Pamela Olilo, who as a clinical officer was receiving the patients into the hospital, recalled the long days: " For safety reasons, we had to come to work at dawn, and could not leave before 10 pm. "

 Surviving on tea  

" At the beginning, " said Dr Raburu, " we would stay in the hospital three days in a row, without changing clothes. " Food was an issue, for patients as well as for their caregivers, who sometimes had to survive on strong tea. Fortunately, kind neighbours donated juice and bread.

Little by little, though, he said, they got better organized, formed teams and learned to react quickly to treat the incoming casualties. More staff, as well as material – like the badly-needed intravenous fluids and dressing kits – came from Nairobi. International agencies donated other essential material.

An additional challenge for hospital staff was to remain neutral in the face of what Dr Raburu calls " tribal inclinations " : to treat everyone impartially, whatever his community affiliation and regardless of any outside pressure. Reporting to work was not easy when you left a spouse and children at home, not knowing what could happen to them during the day, Dr. Raburu said. His own private practice in town was burnt to the ground.

 Staff still absent  

Today, things have normalized. Except, that is, the staff levels. " Forty staff members have never returned; only a few have been replaced to this day. And there was a shortage even before the crisis, " says Jane Owuor, a nursing officer. She, together with Dr Ra buru and Pamela Olilo, represents Nyanza Provincial General Hospital at the workshop.

The team said they found the workshop very useful – after all, the ICRC can draw on its broad experience, having treated over 100,000 war wounded worldwide in 30 years. Dr Raburu is already preparing a report for his management, with suggestions for improvements in the way the hospital is run.

Altogether, four workshops are taking place, with a total of a 80 participants expected. Apart from Kisumu, the venues are Nakuru, Machakos, and Nyeri.

Success is guaranteed, to judge by the enthusiasm in Kisumu, where eager participants worked on oblivious to the lunchtime gong in order to prepare a contingency planning scenario.