Meet city medics who restored boy’s severed hand in delicate surgery – PHOTOS
When the time came for surgeons to let blood flow from Joseph Theuri’s right arm to the hand they had just stitched into its former position, the man in charge of tranquilising the patient got scared.
A lot of blood was oozing from the point where the hitherto severed hand had been re-connected to the arm. And it worried Mr Leonard Orunga.
Mr Orunga, who was part of a team of 15 which conducted the operation on the night of January 26 at Kenyatta National Hospital (KNH), recalls feeling sorry for the patient.
“The patient lost a lot of blood. I nearly told them to just let him live without that [re-attached] hand,” said Mr Orunga, whose responsibility was anaesthesia (inducing a state of lack sensation by administering drugs) to ensure Mr Theuri did not feel pain throughout the operation.
“It was scary. We were going to lose this young man because we were trying to construct a hand yet he could live with one hand,” he added.
The team called for blood to be brought in, and it turned out that the blood transfusion unit had only two pints available.
The two pints were not enough to recover the loss and the team came up with an ingenious intervention.
“What they did was to replace the loss with intravenous fluids. That is what we used most of the times,” he told Lifestyle.
That was among the many nick-of-time decisions made by the team led by University of Nairobi (UoN) plastic surgery professor Stanley Khainga to make the re-stitching a success, one of the first such feats in the region.
Now, 17-year-old Theuri is recuperating at a KNH ward, awaiting a procedure where a piece of skin will be hived off one part of his body to fill up a space that surgeons left on the stitched hand.
“Because of anticipated swelling during the operation, we had to leave a small area. It is always a safety precaution for injuries on the limbs,” said Dr Benjamin Wabwire, the head of KNH’s Department of Plastic and Reconstructive Surgery.
When Lifestyle visited Mr Theuri in his ward on Wednesday, he said he was doing fine even as he awaits the other procedure.
“I’m progressing well. Doctors have done what they could and the pain has subsided,” he said nonchalantly.
On that fateful Friday, Mr Theuri who is an orphan, was cleaning a chaff-cutting machine at his adoptive family’s home in Gachie, Kiambu County.
With his right hand on the blade’s path, he accidentally switched it on, and off went the hand. He only realised it had been cut when he saw blood spurting out and excruciating pain hit him.
When one looks at the profiles of the people who grafted the hand back to the arm, one gets a feeling that it was no fluke that the operation — said to be the first in the country — ended well.
CALLING THE SHOTS
Calling the shots in the surgery were two plastic surgeons who lecture at UoN and are consultants with KNH — Prof Khainga, the surgeon on call that night, and Dr Wanjala Nang’ole whom Prof Khainga called to assist.
They were assisted by two surgeons currently pursuing their post-graduate training in plastic surgery — Dr Alex Okello and a Dr Awora.
Mr Orunga, the anaesthetist, was another vital member of the team, ensuring the patient remained unconscious for the entire duration of the operation that started at 10pm and lasted about six hours.
He had a choice of numbing only the arm but he thought it wise to have the patient wholly tranquilised.
“I decided to make him unconscious because I didn’t know the duration of the operation,” he said. “With that, you can maintain the patient’s unconsciousness and pain-free state for as long as you want. And he will not feel tired of lying on one side.”
Also present were a team of theatre assistants, porters and other auxiliary staff, some of whom had finished their work for the day but offered to stay on to help the young man who had been brought into the facility at about 5pm in an ambulance from the Kiambu County Hospital.
Looking at the résumés of the lead surgeons, one is left with no doubt that there was enough expertise to plan and execute a surgery just hours after the injury happened.
Prof Khainga, who turned 57 on January 2, owes his expertise partly to the knowledge he amassed during his four-year stay at Mwihila Secondary School in Kakamega County, from where he completed his O-levels in 1978.
He then joined Kakamega High School, obtaining his A-level qualification in 1980.
From 1981 to 1987, he was at UoN pursuing a degree in medicine and surgery. During the final year at university, he was a medical intern back home at the then Kakamega Provincial Hospital.
He returned to UoN in 1990 to pursue his Master’s degree in general surgery before going to work in 1994 at the Naivasha District Hospital where he became the Medical Officer of Health and the district surgeon.
In 1996, he joined the UoN medical school where he has taught to date.
Prof Khainga also obtained a certificate of microvascular surgery in plastic and reconstructive surgery at the Medical University of Southern Africa in 2004.
He was also a visiting fellow at the East Eastern Virginia Medical School in the US between May and July 1997 where he took a short course in plastic and reconstructive microsurgery and craniofacial resection.
With these, and many other papers, Prof Khainga knew he had the right academic equipment for the daunting task ahead of him. And he didn’t disappoint.
In a February 11 interview with Citizen TV, Prof Khainga was asked if there was a danger of getting the joinery wrong.
“We are really trained. We identify these things (and) we know the anatomy. There is no reason why we should make that mistake. We are experts in that area,” he replied.
But he acknowledged that there had been previous unsuccessful attempts to conduct similar operations in Kenya.
“In the 1990s, when I was a postgraduate student, there was an attempt to do a similar operation but I don’t think they did it the right way because of lack of capacity,” he said. “Within three days, the limb was dead.”
During the surgery, Prof Khainga mainly focused on the stump that had been left after the blade severed Theuri’s hand.
The other consultant surgeon, Dr Nang’ole, was working on the cut off hand, ensuring all disconnected parts were prepared for re-joining.
Dr Nang’ole, 46, who comes from Kiminini in Trans Nzoia County, studied for his O-level exams at Mother of Apostles in Eldoret, finishing in 1987.
He went to Mang’u High School for his A-levels, completing studies in 1989 before joining UoN’s medical school.
He did his internship at the Nakuru Provincial General Hospital between 1996 and 1997.
Dr Nang’ole obtained his Master’s degree in surgery from the UoN in 2003. In the same year, he became a consultant surgeon at Isiolo District Hospital, a post he held until 2006.
He has also taken various surgery courses overseas, including a fellowship in plastic and reconstructive surgery at the University of Cape Town, a flap elevation training at the Dukes University in North Carolina and has been a fellow under the European Board of Plastic and Reconstructive Surgery.
Dr Nang’ole wants Mr Theuri’s experience to be a lesson to Kenyans on what to do in case a body part is chopped off during an accident or an attack.
“Ideally, we aim to have the surgery done within 24 hours of the injury but in the event that is not possible, we shall still give it a try,” he said in a February 8 interview, urging that as soon as an accident happens, a cooler box to put the severed limb is a priority.
Mr Orunga, the anaesthetist in the historic surgery, has been a clinical officer at KNH since 1991 and has assisted in numerous operations.
An old boy of Maranda High School in Siaya County, Mr Orunga studied clinical medicine at the Kenya Medical Training College.
“I worked briefly in Meru before caming back to MTC for a diploma in anaesthesia. I was then posted to Makindu Sub-District Hospital in Makueni but there was very little work there and I soon came back to KNH,” he said.
He describes his job during the operation on Theuri as simply “to keep the patient alive and free of pain”.
By analysing a patient’s weight, he determines which dosage of drugs to administer to make the patient relaxed but alive.
“Once I give you the drug to make you unconscious, I maintain you asleep on some drugs that we administer through the anaesthetic machine. It delivers oxygen and a drug called nitrous oxide,” he said.
One thing which makes him tick, he says, is the patience of the lead surgeons.
“I’ve worked with Prof Khainga and Dr Nang’ole several times. I appreciate their patience. They do their operation meticulously and very slowly. But that is also what makes us anaesthetists more worried. They go about it very slowly while we can’t wait for the end of the operation. It is teamwork, though, so you have to tolerate the speed,” he said.
Yet another member of the team which conducted the historic operation is Dr Alex Okello, a plastic surgery registrar at the UoN. He is presently pursuing postgraduate studies even as he works as a medic at KNH.
Dr Okello, 33, was born and raised in Mombasa. He attended St Joseph’s Boys High School in Trans Nzoia County for his secondary education which he cleared in 2002.
He then attended Moi University where he studied medicine and surgery, graduating in 2010. It was followed by a year-long internship at the Forces Memorial Hospital in Nairobi.
He was later posted to the Garissa Provincial General Hospital for three years before coming back to the University of Nairobi.
Dr Okello was in the accident and emergency department on the day Theuri was brought in. A caller told him to urgently review the case.
“He had come in with a nurse from Kiambu and everyone around was seated a far away from him. They were all in awe at how he was because he came with his forearm bandaged and there was no hand. And then there was a cool box right next to him,” recalled Dr Okello.
After various tests, he established that the detached hand had been stored in the right manner, meaning a re-stitching procedure would be possible.
He contacted Dr Wabwire, the plastic surgery head at KNH, who advised him to reach out to Prof Khainga, the specialist on call.
“I discussed with Prof Khainga and he said, ‘Yes; we need to give it a shot,’” recalled Dr Okello.
Securing a theatre for the operation was not easy because most were occupied that night. Luckily, one was found and surgeons made it on time and within 12 hours of the severing of the hand, it was back to its position.
Dr Okello said the whole process seemed daunting, but the men in charge knew their trade.
“The surgery itself is pretty routine for the specialists because they are trained,” he said.
Dr Wabwire, who has been heading the KNH plastic surgery department since last year, told Lifestyle that once Theuri’s hand recovers, he will be taken through a rehabilitation phase.
“It might take three to six months for any useful sensation to be back; so he has to be patient with us. But there will be an occupational therapist and a physiotherapist who will be working on him on the fingers and on the movements especially the joints,” he said.
Dr Okello said the re-joined parts are now growing slowly — at the pace of a millimetre a day.
“Sensation has been moving forward day by day,” he said, noting that bones were stitched back using wires while other vessels were reattached using very minute objects that cannot be seen without a microscope.
“He is already having some dysesthesia — some sort of abnormal sensation. But you can actually feel it. It is not yet refined, as such, like the way you can differentiate if someone pricks you with a pin,” said Dr Okello.
Mr Theuri’s guardian Virginia Gathoni terms the whole process a miracle.
“It is only God who can do this,” she told Lifestyle. “It’s a miracle. At first I didn’t believe it. Now I have faith,” he said.
Ms Gathoni, 40, has been taking care of Mr Theuri who lost his parents early in life.
On the day he cut his arm, she had travelled from the family residence in Gachie, to Narobi’s Hurlingham area. She thanks a Good Samaritan who drove Mr Theuri to hospital (as she made frantic efforts to return home) and medics who preserved the hand so that it was possible to stitch it back.