I stood during the ward round gazing through the window lost in thought with a blank distant stare.
The nurse’s voice jolted me back to reality. “Doctor what is your plan for him” She said. You may be wondering why a doctor will get lost in his own thoughts during a ward round in a hospital.

The reason is because in that cubicle I had 3 boys aged between 4 and 8 years all with amputations of one of their upper limbs! They all had injuries to the upper limbs from falls at home. 2 of them had no fracture of any bones. 1 had a minor fracture of the humerus( arm bone).
The first child is Musa a primary 1 pupil he fell down while playing in school and had a closed injury to his left elbow.He was taken by his parents to a traditional bone setter that same day who after some incantations tied the limbs tightly with a piece of cloth. Few days after this the limb became swollen and foul smelling with severe pain. At this point the bone healer referred them to our hospital ascribing the bad condition to spiritual forces

Now the problem with tying the limbs tight is that the blood supply to the limbs would be cut off resulting in death of the; limb. On arrival at the hospital the limb was already dead and decaying. The child was febrile and very ill due to spread of toxic substance into the circulation.
The only way too save the life of the child was to remove the limb surgically (amputation.)… The story is similar for Adamu and Ali They both ended with an amputation. Their limbs had to be removed from shoulder down to save their lives. Coincidentally the 3 cases happened within a 2 week period so they where all in the hospital at the same time.

Why was I deep in thought?
I have children my self in this age group and thinking of them having to go through this harrowing experience sends shivers down my spine! I am no stranger to tragedy having been practicing medicine for more than a decade. But this particular situation really touched me.
Nigeria has a very high unemployment rate with able bodied young men and women still not able to secure a good job. These boys have been given a very horrible start. It will be tough for them to compete in a very harsh environment they may end up being beggars, therebye perpetuating the vicious cycle of ignorance, poverty and disease. In a country that does not have adequate laws to protect the physically challenged individuals, situations like this should not be allowed to happen.

Who is to blame? The parents for ignorantly taking their children to a quack to treat?

The quack? For going beyond his limits and practicing medicine illegaly thereby endangering the lives and limbs of the unsuspecting public?

The regulatory Authorities for not doing their jobs and ensuring that only those qualified to practice medicine do so?
Do we take some blame too as medical practitioners for not educating the public adequately on what to do if they sustain injuries to the limbs?
Beyond laying blames we all must play a role in helping ensure that this kind of scenario is not played out over and over again.

For the avoidance of doubt a fracture may not need any treatment to go on to heal. All you have to do is splint it and wait for nature to take its course. That is what the traditional healer relies on; they tie the limb using sticks as splints and wait for nature to take its course.
The problem with this is that the bone may heal in an abnormal position (malunion) or may not even heal at all due to some peculiar factors which the bone setter does not take into consideration. The other problem is that the limb may be tied too tightly leading to problems as happened with the boys.

The regulatory agencies and law enforcement agencies must step up their activities to curb this quacks that have constituted themselves as a danger to the public.

Orthopaedic surgeons are specialists who are trained in art and science of treating fractures and other diseases of the musculoskeletal system. Besides all doctors have training in basic treatment of fracture care
The best place to treat a fracture is in the hospital where your doctor will examine you and decide what kind of treatment you need. An orthopaedic referral will be made if required.
In summary situations like the one described above happens quite frequently as many orthopedic surgeons know.
We should be careful who we entrust our limbs/lives and those of our friends or family to!
( This is not fiction!names have been changed to protect identity of those involved)

www.doctorsalami.com

So what does the future hold for this boys?