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Thursday, January 8, 2015

Somaliland : My Emergency Medicine Experience in 2014

(Medeshi)- By Dr Essa Abdi Jama -An emergency is an unexpected event requiring immediate action to make people & property safe, examples of emergency could include flood, bushfire, tsunami, earthquake, terrorist attack, bomb threat, chemical spill, Car Accidents.

Somaliland is a post-conflict developing country where road accidents are on the peak for the last decade. For the last year alone, road Traffic accidents claimed the lives of many Somalilanders and caused a lot of casualties (As preliminary Data Shows). Most of the accidents are multifactorial  specifically   negligence from drivers. On the other hand our health facilities are not prepared to deal with these kinds of emergencies yet

    My experiences beyond the health system, and the days and nights in emergency volunteer scenarios. I am passionate about helping people and making a difference (it doesn't matter how big or small that difference is) in the lives of the vulnerable people in terms of health, fitness and well being. During my incumbency in the field of Humanitarian aid my sense of humanity developed which is supporting those who are left in the dark, has developed. As long as I can make some one’s life a little easier or better, I am happy.
    Even contributing a simple idea on transferring a patient to the right specialist and practicing physician is worthwhile to me.
   In our medical set up the number of medical doctors are not sufficient , and number of patient to doctor ratio is high , this causes all health care professionals to be ready to help 24/7,  with the help of the peace and stability our country Somaliland has. While we don’t have most of the new medical technologies but we are still trying our best to satisfy our patients and clients, and fulfill community trust in general.
    I have witnessed how hard it is to turn around circumstances. I learned that a lot of our patients had dreams much bigger than they were living. I learned that for some, coming so close to death and finding out the fragility of life is the trigger to change course, thanks to their faith. Mostly, I learned that we are creatures of habit and that we will do the same thing tomorrow; even if what we are doing today lands us in the ER.
    Yet, this year, like last year and the years before, I made a resolution about what I hope we can do as a society to improve the health care of our communities In general. So that all people can understand their health care options and get easy access to medical care services when they need it--both for physical and emergency health care needs.
    I saw a lot of patients that should have been cared for in Health centers, district hospitals and private community clinics. Many of these patients believed that they didn’t have alternatives for getting health care, so they came directly to emergency department without official referral letter. And since these patients didn’t get regular care, when they came to us they were very sick and it was harder to treat them.

    I summarized below the main risks that Associated with  the loss of lives last year and early this year:
a) Preventable communicable diseases,
b) Unhealthy life styles, smoking,
 lack of exercise) use of drugs (Like Khat).
c) But road traffic accidents were the main cause of death as evidence showed.
I witnessed a young teenage boy with multiple fractures and who has done an emergency splenectomy (spleen removal)  and recovered.
I witnessed a forty five year old man with cerobrovascular accident (sub arachnoid hemorrhage) in private hospital, with no previous risk factor except for khat addiction.
I witnessed a pregnant mother hit by a big truck, presented with ruptured uterus, splenic rupture. This case was managed by Dr Kell, an Australian doctor who came to teach medical students in Hargeisa. Fortunately the mother and baby were saved and they both recovered.
     While driving to my way home, as I passed the ER, I saw an old obese woman with known history of hypertension presented with shortness of breath and convulsions. Unfortunately it took the ER nurse one hour to find a sphygnanometer and when he finally found an automatic sphygnanometer, its batteries were dead. The Emergency department team successfully managed the case as hypertensive encelopathy  she recovered and was discharged on the third  day.
I witnessed a young teenage boy with strangulated inguinal hernia at 3: 30am and was referred to emergency surgical intervention and who recovered.
I witnessed a famous middle aged man with road traffic accident; he came with multiple fractures on the ribs and the spine, was transferred by senior consultant to neighboring country and lost his life after 48 hours.
I witnessed old poor woman who was suspected of having osteosarcoma on the skull that caused drooled eye and facial palsy. She was unable to access biopsy and computed tomography and was supported by volunteer Diaspora group.
 I witnessed a twenty five year old newlywed with road traffic accident; he had severe head injury and cervico thoracic injury which lead to his death.
Recommendations to my fellow Somalilanders:
To drive slowly and limit over speeding, especially at night time.
To Visit the nearest health care center or hospital when they or a family member is suffering and that will make a life saving difference for their health.
To minimize  the Unhealthy life styles like, smoking, lack of exercise, use of drugs (eg khat),
Lack of physical exercise and sedentary life also increases non communicable diseases, like Hypertension, Diabetes and other metabolic disorders.
To sustain or make a habit of physical exercise like walking, running or playing sports.
To establish volunteer organizations that supports the poor and vulnerable people.

Dr Essa Abdi Jama
Health systems Expert