We don’t just amputate people’s limbs —Orthopaedic hospital

Your hospital is known for dedicating a ward for motorbike accident victims, how frequent the come?

It is not true that we have a dedicated ward for okada accident victims. This is a national hospital to handle all manner of orthopaedic cases. And we have patients from other parts of the country-Kaduna, Enugu, Ekiti and all that, and not Lagos State alone. You can go round to confirm this yourself. So, we treat them where we treat other patients.  On frequency, it is fluctuating. Before the ban on commercial motorcyclists on some routes, including highways in Lagos for example, okada accident cases, injuries and associated deaths were very high. It reduced significantly immediately after the ban but going up again after sometimes when the enforcement seems to have relaxed.

In the last one year- January 2018 to January 2019- we recorded 518 okada accident victims in all, 286 males and 232 females. We recorded the highest figure in November and December, 64 and 62 respectively. Most of them them are in their economic active ages, from 15 to 64 years and more males than females.

What are the nature of their injuries and treatment like?

Injuries are varied. We all know that some do pass on at the accident scenes or on their ways to hospital. But we realise that passengers usually suffer significant injuries than riders. It could be limb fragment or life threatening injuries. When you talk of limb fracture, we talk of open fracture or damage of bones and all that. And unfortunately, treatment has to take some money out of pocket. And that most times become a problem because we can only give patients between 24 and 48 hours free-medical services within which we expect them to rally round to raise money to further their treatment. But within that window period, we treat their wounds and stabilise their fracture as a way of saving the limb or any affected part. Once that is done, we fix the fracture or cover the wound and that is when the issue pf payment comes in as the hospital does not have the means to carry such responsibilities, except on a very special case that will be handled by our social arm.

But it seems many are not comfortable coming here for fear of possible amputation

Well, we have that unfortunate narrative associated with us for some years. It is very unfortunate because that image has stuck with the public. The truth is that less than 0.01 per cent of people who come to us for care get their limbs amputated.   And out of that 0. 01 per cent, we find out that 99 per cent of them have been messed up elsewhere, especially by the traditional bone menders. So, by the time they come to the hospital, you don’t talk about saving the limb again but life. This is because, they had applied all sorts of so-called medications and messed up with their conditions, infected their wounds and all that. And of course, they don’t release those patients until they would not be able to manage their conditions again, especially when they realize that the patients want to die. Because when infection occurs in any part of the body, it goes into the blood stream and then to other systems- lump to kidney, intestines, brain and all that. At those times, their conditions have gotten to what we call multiple organs dysfunction. And once a patient condition gets to that stage, what you will be looking at is how to safe life by taking out that source of infections otherwise, the infections will keep spreading to other organs and in no time, the patient will pass on.

And unfortunately, those traditional bone menders having realised the damage done would now be impressing upon the patients that once they get to Igbobi their legs or limbs will be amputated. You know, patient relatives would have been mounting pressure on them asking them why the condition of their persons is not improving. They know what they had done and by the time such patients come to us, we may not have alternative than to cut off the heavily infested leg or arm. They would now be telling us that they had been told that once they get to Igbobi, they would be amputated as if that is all that Igbobi is doing.

I think that is how that narrative came up. But the beauty of it is that majority of our patients don’t end in amputation.  Even if there is significant bone fracture that comes to us on time, we can grow or lengthen the bone again. We can replace those bones using the simple new technology in town which has nothing to do with a patient’s age. I had done that on patient who is over 90 years old. But then, people have to come on time and not until when there is no remedy again.

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But many still throng traditional bone setters’ homes.

Yes that is true and mostly for their ignorance. Traditional homes charge by bit most times. They ask for N10, 000 today, tomorrow N5, 000, another day N15, 000 and so forth. And by the time you calculate all these money, it will be more than what they would have spent in a hospital like ours. And unfortunately, most of them will still end up coming to hospital when their conditions have become critical. And by that time, they would spend more money than if they had come ab initio. This happens often. I can remember a patient about two years ago who had fracture of the tibia, after assessing his condition and gave him his bill, he left and about 30 minutes later, he came back to ask again if that was all the money he was charged. We gave him a bill of a little over N100, 000. When I asked him why, he said he was surprised at the amount. That he had already spent close to one million naira at a traditional bone setter home. Before then, I had harassed him why he didn’t come to Igbobi ab initio when the accident happened. He said he thought the bill would be too high.  Whereas, it is cheaper to come to the right place where to get the right diagnosis and treatment from day one and not to come after the condition had been messed up elsewhere. You will not only spend less in the hospital, you will save time and man hour, prevent yourself from unnecessary pains and all that. The condition will also be easier for hospital to handle.

But some still ended up in amputation?

Yes at times they do. You know some do sustain permanent disability or what we know as traumatic amputation. That means part of their limbs-bones, muscles and vessels- have already fallen off but remains only the skin at the back. Those type of patients, at times, may be lucky to get the limb fixed back if they come early. And if fixing is not possible, there is nothing hospital can do than to amputate the limb. I have a case not too long involving a lady who had okada accident. After assessing her condition, we told her that we would need to remove the skin and amputate the limb. She said ‘no, no, no,’ that we should do all we could while at the back of her mind knew success was remote. We actually tried to salvage the situation but no way. We need about six hours for a limb that is already amputated to get blood flowing again to that part of the body and once it is beyond that hours, survival is unlikely. But the lady came about four to five hours after the accident had happened as she had earlier gone to a private hospital.  That is what we call traumatic amputation. Amputation that had already occurred right at the scene of the accident. So, those are the kind of few patients who come to us early and still get their limbs amputated. So, the fact that you come to the hospital even early does not necessarily mean that everything will go back normal. Severity will play a great role here.

How about cost implications then?

Well, let me start by saying good healthcare is generally expensive. And even in the society where they tell you that healthcare is free. That is not true. There is no free lunch so to say even in Freetown. And that is the home truth. And what you find out is that even in those places where we can say things are working, people pay but by installment, by insurance. And again sometimes, government subsidizes what is left. Or government provides social network for the very young ones who are not economically engaged or for the elderly who are no longer working.  So, somehow, somebody pays. Coming back to our own society, the fact is that healthcare is expensive as I had said, particularly injuries are much more expensive, especially when it required multiple surgeries. Take a scenario where a patient has open fracture on the leg for example, and also loses some blood. That patient will require a ‘wounded the more approach. This means to take-off the dead line tissues and foreign bodies from the place. That is a surgery on it own. The patient will require blood because he or she had lost some. And then we fix the limb, ensure the person is relieved of pains, and prevent further damaging of surrounding tissues. So, that is surgery. And this depends on severity also. If very severe, the treatment will be in multiples.  After that, you do another surgery, called plastic. Then you will now begin to think of fixing the broken bones and all that. At the end, you may do up to five or six surgeries. And unfortunately, at this part of the world, money is not easy to come by.and that is why all these become enormous burden on patients and their relatives. The hospital equipment are also very expensive. For example, the one to lengthen the bone, soroscopic machine, is very expensive. One costs up to N35 million, and that is just one equipment out of many to get effective treatment result.

The workload?

The workload is enormous. You know why.  In the whole of Nigeria with about 200 million people, we don’t have up to 500 orthopaedic surgeons. It then means we have one surgeon to 40,000 people. The ratio would even be higher because some in the official record of orthopaedic surgeons in the country, are old and no longer practising.

Then what do you advice?

That is simple. Government should try to provide comfortable public transportation system and fix all the bad roads. It should enforce traffic rules already in place. The typical example is the ban on okada riders on major roads in Lagos State. If government can enfoce that effectively, it will have significant reduction in okada and other road crash cases in Lagos and every other state. If the wearing of crash helmet and speed limit rules are also enforced, these will further reduce the number of casualties and injuries from okada accidents. Then enlightenment and education of road users are also important.  Many okada riders and bus drivers, for example, don’t know the traffic rules and road signs let alone obeying them.

People should understand that healthcare is expensive. They should try as much as possible to prevent avoidable accidents including that of fire. They should also embrace the health insurance scheme as that will help in time of need, and go to the right place to access right and prompt care.