The other night while I was on call, 3 patients were brought in from the same road traffic accident (RTA – as they say here in Ghana…as opposed to MVA or MVC used in the States to mean “motor vehicle accident or collision.”) One patient had head injuries, another had a open knee wound with a fractured patella, and the third had a depressed nasal fracture with nasal bleeding. I packed his nose with adrenaline soaked gauze and set him up for attempted reduction in the morning.
There are a couple books kept in the doctor’s lounge in the theater that explain surgeries and minor procedures for both trauma and non-trauma. I have referenced these books on several occasions. I opened up the chapter on facial fractures and found the treatment for nasal fractures. I discussed the patient with Dr. Faile in the morning. He said that he has never tried to reduce a nasal fracture, but that he was willing to try new things.
We again used ketamine for anesthesia. We inserted a pair of long, curved forceps covered with a rubber tubing into each nostril and tried to elevate the depressed nasal bridge. I’m not sure how successful we were. We may have elevated the bone a little bit (“small, small” as they say in Nalerigu), but we were not able to restore it totally. While doing the procedure I was able to check the patancy of the patient’s nasal passages which were fully open, and his nasal septum was midline and undeviated.
Although, we were not fully successful in achieving the desired outcome, I appreciate the fact that Dr. Faile is willing to try new procedures (within reason). There have been several times that I have heard him say, “well, I’ve never done it before, but we can try.” When working in a place with limited resources, I think that is the attitude that one must have. While I have been here, my confidence has been building. I am still a bit reluctant to try certain procedures, but I have gotten pretty good at others because I have been willing to try.
