I had been asked to see him the 1^st wk I was at the hospital but when I went to find him on the pedi ward ( aka bedlam) his parents had taken him home. I have been through that before. Many patients just “abscond” with their kids never to be seen again. This seems particularly true of bad limbs that will never heal. The idea of amputation doesn’t sit well here in Kagera. You can’t blame them really. The chance of a prosthesis is next to zero. And if you’re a growing kid in need of several prostheses over your growing years… well that’s impossible. Facing a life of being crippled, the village “gimp”, the incomplete man or women, the stigma of imperfection, well it’s impossible. You can write off a big chunk of your life including facing the fact that you may never find a mate, a job, friends…. Well, you can see this can go on and on.

To stay on track, Adullah’s parents brought him back. And when I did find him in the crowded, 2 or 3 kids in a bed, pedi ward Abdullah was in a bed by himself! He had been placed in a relatively quiet room at the end of the ward. Later I realized the reason why and thought to myself “these nurses really do know what’s going on”. Abdullah was put in relative isolation not b/c he was infectious (which he probably was) but b/c the nurses knew he was trying to hide his hideous arm from anyone looking his way. When I first met him he wore 2 kangas. One wrapped his lower body and a second one wrapped his right arm. I almost lost my professional cool when I peeled the stinky kanka back and saw his mummified necrotic arm. It looked like something from a 1950’s bad horror film. But this was real.

From his wrist to his elbow was just skeleton, no muscle, like parana had attacked his arm and eaten all the tissue off the two bones of his forearm. From his wrist to his fingers was dried gangrene mummified tissue. Above his elbow was 2 to 3 inches of stinky infected tissue. Abdullah cried when I got near but never looked up at me. I am sure I terrified him; a tall white man. Maybe the first to touch him or see his wound. I have a love and fascination for pathology and usually the grosser the better but this one made me mad. Sure he was going to lose his arm and be crippled and stigmatized for the rest of his life. But this was cruel torture and psychologically damaging to this little kid. Why hadn’t this arm been removed before and who is so insensitive to leave this dead limb on this little kid for so long.? If this was in the U.S. Abdullah would be on the front page of the Boston Herald and the N.Y. Daily News. “Boy Mummy Back From Dead” His parents would be arrested for cruelty to children. Social Workers would go nuts! But guess what? This is not the US. This is Kagera. There is no money for medicine or surgery. There is just passive acceptance of bad things happening to innocent people.

We finally got Abdullah to the OR. My guess this surgery should have been done 3 months ago…at least. The first thing I did after we draped him was take the dull saw and cut through the 2 bones ( radius and ulna) of his forearm just distal to his elbow. His bones, completely stripped of tissue and muscle, along with his leather gangrenous wrist and hand dropped off into a bucket. I asked the runner to “ get that arm out of the room”. Next, we found a suitable clean level on his upper arm, cut down to his humerus, cut that in half and removed his distal upper arm and elbow. Then we created a nice round wrap of tissue to cover the bone and sewed his arm up to create a stump. Time of operation, skin to skin: 60 mins. Timing of operation: very late.

I followed up with Abdullah every morning in the hospital. He never complained of pain . His dad, a muslim, was there every day at the bedside. We got more comfortable in time even though we had few words in common between us. Forget about words, we had nothing in common except that he came to believe that this mzungu was helping his son. I brought Abdullah a pad and pen on post op day 2. I’m pretty sure he used to be right handed. I wrote the alphabet out and then he did the same with his only ( left) hand. Then I tried to write the alphabet out with my left hand. That was the first time I ever saw him or his dad laugh. Then I wrote “ practice makes perfect”. I hope they get that translated someday. The next day he was up and about and his wound looked clean. Against the better wishes of the nurses, I sent him home. I’m betting his house is cleaner than the hospital and I know his dad will be at his side.

Abdullah, with any luck and no significant complications will have an upper arm that is about 7 inches long. It won’t be beautiful but it won’t stink and he doesn’t look like a walking horror movie. His chance of a prosthesis… next to zero.

His chance of enjoying his life as a handicapped but otherwise possibly normal person…much improved.