The man walked five days from Chocha to arrive at our clinic. His hand had been pierced through in a knife fight, stabbed at the base of the thumb on the palm side with the puncture wound exiting between his thumb and index finger on the back of his hand. He had been on IV antibiotics for a wound infection for three days. I inspected the wound carefully, and noted a fibrous white patch at the base of the entry wound. One by one, he moved each of his fingers – except his thumb. “He can’t move it because of pain,” the Health Officer explained. I picked up the ragged white fibrous tissue in the wound with a forceps. It wasn’t pain. He couldn’t move his thumb because the tendon was cut clean through.
In the US, hand surgery is a sub-specialty of its own. Hands are pretty complicated, and if they get messed up, it can cause a lot of disability. Especially a thumb. Of course there is no hand surgeon here. No surgeon, period. I asked Solomon the midwife to examine the severed tendon, since he has the best surgical skills of the nurses (anyone who has witnessed childbirth knows why midwives have to be good at stitching!). The problem with tendons is that they act like rubber bands, springing back and retracting deep into the wound after they are cut. Only one end of the tendon was visible. Solomon cut open the palm of the patient’s hand to expose all the thumb muscles, and then he fished around to try to find the lost end of the tendon. He worked patiently, gently, to avoid harming the other fine tendons and nerves that course through the hand. He fished for half an hour. The government will not allow us to buy morphine, so we used local anesthesia and Valium to help the patient endure the procedure. Eventually the missing end of the tendon was found, a subtle white stub buried in red muscle, and the tendon was repaired with two quick stitches of silk suture. “Move your thumb,” Solomon told the patient. The sinewy white rope with two black stitches in it moved like a pulley, and thumb moved with it. Good as new!
It was fascinating to look deep in the dissected muscles and see the inner workings of how our fingers move. And miraculous, perhaps, that this patient had walked five days to the nearest clinic and fallen into good hands. A thumb seems like a small victory, but a farmer or laborer who cannot use his hands loses his livelihood.
In the US, hand surgery is a sub-specialty of its own. Hands are pretty complicated, and if they get messed up, it can cause a lot of disability. Especially a thumb. Of course there is no hand surgeon here. No surgeon, period. I asked Solomon the midwife to examine the severed tendon, since he has the best surgical skills of the nurses (anyone who has witnessed childbirth knows why midwives have to be good at stitching!). The problem with tendons is that they act like rubber bands, springing back and retracting deep into the wound after they are cut. Only one end of the tendon was visible. Solomon cut open the palm of the patient’s hand to expose all the thumb muscles, and then he fished around to try to find the lost end of the tendon. He worked patiently, gently, to avoid harming the other fine tendons and nerves that course through the hand. He fished for half an hour. The government will not allow us to buy morphine, so we used local anesthesia and Valium to help the patient endure the procedure. Eventually the missing end of the tendon was found, a subtle white stub buried in red muscle, and the tendon was repaired with two quick stitches of silk suture. “Move your thumb,” Solomon told the patient. The sinewy white rope with two black stitches in it moved like a pulley, and thumb moved with it. Good as new!
It was fascinating to look deep in the dissected muscles and see the inner workings of how our fingers move. And miraculous, perhaps, that this patient had walked five days to the nearest clinic and fallen into good hands. A thumb seems like a small victory, but a farmer or laborer who cannot use his hands loses his livelihood.
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