Written Stories

Saving the Saviors Life

26 Mar, 2018 By: Dr. Navindra Dhakal

I am working at Patan PHCC Baitadi since last 10 month as a medical officer. Before being selected by Public Service Commission, I was doing my MD residency in Anesthesiology and Critical Care for near about 6 months at Bir hospital Kathmandu. My inner interest to serve remote part of country drives me to quit residency and made my journey towards Baitadi, far western part of Nepal.

2017/09/13 at 8:30 am, I was attending a program at DHO Baitadi during which heard the news of RTA (bus hit the back side of jeep) at Dehimandu, 10 km away from district hospital. Immediately rushed to emergency where injured cases were just arrived. Immediate management has been started. In the mean time I got information that one of the serious case was our ANM sister (Tika Dhakal) who was working on health post at Dehimandu and was on the way to DHO Baitadi for training.

She got sustained injury over head and right arm and was unresponsive since she met accident. On examination her GCS was 7/15 (E1V3M3). Blood pressure, pulse respiratory rate, O2 saturation was within normal limit. Rt pupil was dilated (4mm) and left pupil was constricted (1mm) and both were reactive to light. B/L plantar was up going. 2 episodes of focal seizure at left leg was noticed during examination.

Local examination of Rt arm shows swelling and deformity with intact DNVS suggesting fracture Rt humerus. She was kept in left lateral position with oxygen supplementation, iv NS drip was started, Foley’s catheterization was done. Inj. midazolam 2 mg iv stat and was repeated for 4 times in a span of 30 min. inj. mannitol 20gm iv over 20 min was given along with inj. pantop 40 mg iv stat. posterior slab was put at Rt arm. Intubation set was made ready, as at any time she may need intubation. Dr Bidur Bhandari (medical officer at Bajhang) who was incidentally at Baitadi on his way to Bajhang and other staffs of district hospital were constantly helping.

In the mean time her GCS starts to fall and neurological examination reveals the urgent need of CT scan of head to R/o ICH which means urgent referral to higher center which was Nepalgunj, at least 12 hr. drive from baitadi (as at that time CT scan at Dhangadi was not functioning). The experience at anesthesia and critical care propels me to think alternatively as the prognosis after 12 hr. will surely be worst considering her condition. Discussion with Dr Gunaraj Awasti (Medical Superintendent and DHO head) and other staffs of DHO Baitadai regarding any possibility of urgent airlifting to higher center was made as early intervention will surely save her life.

Case has been informed to her family at Nepalgunj, CDO, DSP, LDO and all the stakeholders at Baitadi, and even personal secretory of health minister and home minister via various channel and the coordination was led by Dr Gunaraj. But lack of helicopter in nearby area made every effort seems impossible. Decision was made to leave Baitadi ASAP via ambulance and in the mean time effort for coordination for airlifting was on its way. Dr. Bidur and Chandra sister (ANM from Patan PHCC) was along with me on the way in ambulance. The challenge of difficult road conditions with lots of turnings and maintaining her airway gets worsen when she got seizure on the way. Titrating the dose of midazolam and maintaining her airway with constant monitoring of vitals was really challenging. Life saving drugs along with intubation sets and AMBU bag was standby on the way.

In the meantime, I got information that commercial helicopter was on its way and will lift her from Dadeldhura. The medical team of Dadeldhura sub regional hospital was coordinated for necessary arrangements of iv Mannitol IV fluids and other medications.

At around 2 pm airlifting was done and planned to divert the helicopter towards Grande hospital KTM as consultation with neurosurgeon at Nepalgunj via phone advised for KTM landing. I was along with her during the whole journey to KTM. On the way she got seizure but this time it was GTCS and saturation starts to fall down. Pilot was requested to hold helicopter on the air. Oropharyngeal airway was put, inj. midazolam was given, bag and mask ventilation with AMBU bag was started.  After 45min of this event we finally landed at Grande hospital (total near about 4 hrs). Immediately medical team was mobilized supporting role of Dr Chakraraj Managing Director of Grande hospital made everything easy.

Preliminary management along with urgent CT scan of head was done. Provisional diagnosis of severe head injury with raised ICP with diffuse axonal injury, Rt humerus fracture with right radial nerve palsy was made and was admitted in ICU/HCU for close monitoring (from 2017/09/13-2017/09/27) and conservative management. After 13 days of incident she starts to gain consciousness and condition starts to improve afterwards. She underwent ORIF and DCP of shaft of Rt humerus on 2017/09/25 and was shifted to general wards. After 2 months of hospital stay she get finally discharged and was kept under regular physiotherapy and regular follow up. At present she is resting at her own home, residual radial nerve palsy still persists but is improving.

The whooping amount of helicopter charge 8.5 lakh was paid in coordination with secretory of MOH as recommended by the committee at district (CDO, head of office of treasury controller, DHO head) after continuous effort of 3 months.

This incident should be taken as a lesion in initiating and activating the system of urgent rescuing of health workers in need who are serving in the very remote part of the country who may meet such type of incident in near future. Early rescuing when indicated will surely saves the life of health worker who are constantly saving the life of others. “LETS UNITE TOGETHER AND RAISE OUR VOICE FOR SAVING THE SAVIOURS

Dr Navindra Dhakal
Medical Officer,
8th level
Patan PHCC, Baitadi

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