HEALTH: Why Kisii needs a trauma centre, urgently

Dr. Jacqueline Nyaanga's road safety awareness posta.

On January 20, 2020, Mr Anthony Monayo woke up at 4:30 a.m. As usual, he said his morning prayers, took a shower, and had a light breakfast.

The retired teacher, dairy farmer and senior civil servant left his Milimani residence in Kisii Town and headed for his rural home in Kiogoro Boguche, Nyaribari Chache Constituency, Kisii County.

When he arrived at the sleepy shopping centre in Kiogoro, he went straight to his farm and spent some time inspecting the maize, tea and Napier grass patches.

He is reported to have returned to the shops where he enjoyed a drink at a pub before hiring a boda boda operator to ferry him to the nearby Menyinkwa urban centre.

Having dropped him off safely, the rider turned and went back to Kiogoro.

At around 3 p.m. an unknown boda boda rider dropped him off at the gate of his home and sped off. He was dazed and unable to speak.

It is not known where he was injured, or the circumstances behind his accident. No witnesses have come forward to share their account of the incident.

His worried wife Agnes Monayo rushed him to the Christa Marianne Hospital, where he was registered, taken through the triage process and then admitted.

Doctors ordered that he be given an intravenous does of glucose and water. He did not respond to treatment, or recognize family members that visited him.

The next morning, he was taken for a CT Scan examination at the recommendation of consultant physician Dr Raymond Oigara.

The scan showed that he had a blood clot in the brain. Medics recommended his immediate transfer to the intensive care unit of a referral hospital followed by urgent surgery to handle the clot.

“We looked for an ICU bed at Moi Teaching and Referral Hospital, and once it was found and booked, we called for an ambulance to transfer the patient to the facility,” said Mrs Monayo.

Just as the nurses and nurse aides lifted the now unconscious 67 year old from the bed to the stretcher to wheel him out to the waiting ambulance, the father of four and devout Catholic began to foam at the mouth.

“We wheeled him back to the ward and the medics kicked us out as they surrounded him in an attempt to resuscitate him. It was all in vain as he passed on a few minutes later,” she told the writer.

Mr Monayo’s untimely death robbed the family of a loving father, a husband and a respected member of the St Charles Lwanga Cathedral Catholic Church.

Data obtained from the National Transport Safety Agency (NTSA) shows that a total of 3,975 people died due to road traffic accidents in 2020. This is compared to 3,586 people that died over the same period in 2019.

Some 1,383 pedestrians lost their lives to traffic accidents in 2020. These were 7 less than the 1,390 that died in 2019.

A total of 580 passengers perished in 2020 as compared to 704 in 2019. A staggering 1,136 motorcyclists died in 2021, as opposed to just 725 in 2019.

The number of pillion passengers who died in 2020 are 439, a 33 percent increase from the 348 deaths in 2019.

Focusing on the months of December alone, the data indicates that 497 people died in December 2020 as compared to 372 people in December 2019.

NTSA’s list of those that escaped with injuries shows that  people 8,027 people were seriously injured in 2020 compared to 6,952 in 2019.

Those listed as slightly injured were 4,968 in 2019 as compared to 5,209 in 2020. This represents a marginal decrease of 4.6 percent.     

Pedal cyclists that died in 2020 are 90, reflecting 16 more deaths from the 74 that perished in 2019.

Had Christa Marianne Hospital acted sooner to find out the cause of Mr Monayo’s dazed state, he would have been transferred to a referral hospital earlier.

Unfortunately for Mrs Monayo, her children and other relatives, they will have to come to terms with the loss of the celebrated Human Resources consultant as a result of that late diagnosis.

“We were shattered by the death which took him away from us so suddenly. His memory will never be forgotten,” she said.

Mr Monayo’s sad demise is just one of the many that occur in Kisii County and its neighbours including Nyamira, Narok, Migori and Kisumu due to casually handled emergency circumstances.   

Kisii County should urgently consider setting up a trauma centre to cater exclusively to accident survivors, a medic has now advised.

According to Dr Jacqueline Nyaanga Ondande, a trauma centre will quickly assist patients in need of emergency care.

“As a county, it’s time we constructed a trauma centre specifically for emergency cases like accident survivors, “said Dr Ondande.

Speaking to scholarmedia.africa, Dr Ondande who works at Kisii University said the treatment of emergencies could be delayed in case of going through the process of ordinary admissions.

She opines that the normally slow process of patient registration and triage can waste valuable time that would have played a vital part in saving lives at risk.

“There are cases where the patient needs to urgently be taken to theatre for life saving surgery, among other instances. Such cases could result in the death of the patient if immediate medical attention is not given. A trauma centre will handle such cases exclusively and help to save lives,” said Dr Ondande.

Dr Ondande lamented the relaxed attitudes of the medical authorities towards the issue, saying the trauma centre has never been mentioned as a future project in the policy meetings she attends.

“I have been to meetings where the county’s health needs are tabled and discussed but I have never heard anyone talk about the need to have a fully operational trauma centre,” said Dr Ondande.

She said the conversation about trauma centres for emergency care needs to become a national one, with policy changes to establish them in law and practice.

“As a country, we need to position the health system to support the development of trauma centres. I think it’s imperative for every county to have one,” said Dr Ondande.

Recounting her experience working in Nakuru County, the medic said the devolved unit had set up a trauma centre to handle the high number of road traffic accidents.

“I worked in Nakuru County and the administration there decided to set up a trauma centre to handle the high number of cases from Salgaa and other accident scenes,” said Dr Ondande   

The medic said the facility could be located at the Kisii Teaching and Referral Hospital, but still operate as a separate entity dedicated to handling emergencies.

“Once it is in place, the primary function of the trauma centre will be to extract and assist trauma victims. This means that all patients arriving at the facility will be emergency cases,” she said.

Dr Ondande estimated that a fully operational centre would reduce the death rate among accident victims by as much as 90 percent.

To achieve this goal, she advocated for the centre to be fully furnished with the required resources, personnel and equipment.

“The centre should have a fully functional theatre, blood bank, diagnostic equipment and expert staff on standby. If we manage to address all trauma cases in time, we can reduce the fatality rate by 90 percent,” said Dr Ondande.

She said there was need for the county government to take the initiative and commence the project.

Dr Ondande warned the county government against expecting the help of the national government during the early stages of the project, saying it was more likely to chip in after seeing that some effort had already been applied.

“We should not expect that the national government will take up the project on our behalf from the beginning. What we should do is begin the construction and demonstrate willingness to get it done. Our head of state and the national government will then see whether to help us complete or even equip it,” she advised.

Dr Ondande was speaking to The Scholar during the start of the Road Safety Week which was marked from May 17-23, 2021. The university is conducting the awareness campaign in conjunction with the National Transport Safety Authority (NTSA).

She said the university used to experience a high number of accidents involving motorbikes but added that they all occurred outside the institution’s grounds.

“We used to have many cases of accidents involving students, but these did not occur within the university. Remember, students also have a social life, and weekends were the riskiest for many, who would be on the move,” she said.

This trend has been reversed, she says, through heightened safety awareness campaigns and stricter safety measures on campus.

“We do not allow boda boda operators on campus, mainly due to concerns on the risk of pedestrians being hit by speeding bikes,” she said.

Dr Ondande says the campaign has extended to university vehicles on trips outside the institution.

“We also have road safety ambassadors who are part of the school student population. Their work is to confidentially inform us in case the college vehicles were carelessly driven on trips, or whether a motorist on campus endangered the lives of other road users,” the medic said.

Dr Ondande noted that road carnage still ranks as one of the country’s top killers and causes of disability.

“Road traffic accidents are a leading killer in the country and a public health concern. We are determined to contribute to a better standard of living in the community which definitely includes heightened road safety awareness and compliance with traffic regulations,” she said.

She is urging pillion passengers to insist on boarding motorbikes operated by riders that provide helmets and reflector jackets.  

“Please do not board a bike if the rider has not provided you with a helmet and reflector jacket. We have many cases of people that have become invalids as a result of injuries suffered as a result of motorbike accidents,” she pleaded with Kenyans.

Noting there was an unhappy gender angle to the accidents, Dr Ondande said the motorbike accidents had led to the breakup of marriages and distortion of family units.

“Some of the bike accident survivors, especially the women, are affected beyond the accident itself and the injuries they suffer,” said the medic. “I am the Lions Club president in the county and have witnessed cases where the husbands have abandoned their wives after they became invalids due to the injuries sustained in road accidents,” she went on.

Dr Ondande is stressing on concerted, collective efforts if the country is to make the roads a safer place for Kenyans.

“We must all work together to ensure that we follow the laid down traffic rules. Our discipline and concern for other road users is the best way to save lives and avoid injuries and hospitalizations from traffic accidents,” she said

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