Day #4: Saturday 11-8-2008 "Bows and Arrows"

Hello again from Africa,

Last night while our cardiac team was having dinner at the Chief Surgeons home he showed us 6 arrow heads that he had removed from patient's during one night on call at Tenwek Hospital. He had them mounted in a museum frame and they were all very ominous looking. Apparently the tribes will fight with each other over 3 things; property, cattle or women and most fights occur between family members. Since there are no guns in Kenya, the tribes still use bows and arrows.

Early this morning we were at the hospital unpacking several rooms of boxes trying to identify and organize (my forte) when the Chief Surgeon came into our room and said he had another arrow to remove if we wanted to watch (I have the most amazing photos thanks to Meghan loaning me her Nikon digital). As Marsha (our cardiac anesthesiologist) and I went into the room, there was a 21 y/o young man on the table with an arrow through his throat. He was shot in the neck sometime around 3 am and he arrived at the hospital around 9 am. The arrow went in the front of his neck below his adams apple and never exited his neck, but was on the way out the back of his neck. The arrow was broken off at his neck so a small portion of the shaft of the arrow was still visible. Not your normal patient in LA or Nashville, I might say. OK so this is pretty incredible, then we looked at the X-ray. To me, an arrow is a long wooden shaft with a small arrow on the end. This guy (whose name was Elvis, of all things) was shot with an arrow head that was 6 inches long.

OK, now see if you can get this mental picture. The arrow head was all metal, 6 inches long. Then imagine if you welded fish hooks around the circumference of the arrow 3 rows deep so the fish hooks were pointed away from the tip of the arrow. So if the animal (or in this case a person) gets shot, you would be unable to pull the arrow out because the hooks would dig into the flesh. There was a 6 inch piece of metal through this guy’s neck. He was coherent and speaking (although not very well) when he arrived at the hospital.

They were unable to intubate the patient because the endotracheal tube couldn't go down the trachea because it was hitting the arrow in his throat. After traching the patient the surgeon had to make an incision in the back of the patient's neck so he could push the arrow out because the barbs on the arrow prevented him from pulling it out. The arrow missed all the major vessels in this neck (carotid arteries and jugular veins) and his spinal cord. I got some spectacular photos of the procedure and the surgeon is saving the arrow for us after the police investigation. Apparently you can identify the tribe by the shape of the arrow.

It was by far the most amazing procedure I have ever seen, or probably ever will see. This place is amazing. The surgeon is a thoracic surgeon and he does any procedure that comes into the hospital, because if he doesn't try, the patient's have no hope.

We saw about 9 patients in clinic today and are putting together our surgery list for the week. Tomorrow the 2nd set of our cardiac team will arrive from Nashville and we'll set up the pump for our first case on Monday. It appears as if it will be a little 2 y/o Downs baby with an ASD. More tomorrow. Continue the prayers.