Working in Africa you were in competition with other forms of ‘medical practice’. There were witch doctors who sometimes caused us great difficulties. One case that I remember very clearly was a pregnant woman at term who presented in severe shock and bleeding heavily from a placenta praevia. After urgent resuscitation with IV saline as we waited for blood for transfusion her haemoglobin when checked was 3Gm/100mls, about 25% of normal. I have no idea of what her haemoglobin was before she started to bleed but suspect that it was low or she would have been dead. We were very short of blood and there was no blood bank in the area and, using the 2 units available, I quickly did a Caesarean. (She was nowhere nearly fully dilated.) The baby was dead. She survived.
As a first choice she had gone to the witch doctor who sacrificed a goat which she provided. He got the meat, she had to drink the blood to appease the evil spirit causing the problem! It hadn’t helped.
Then there were local healers. I have no doubt that they often did good. A high infant and maternal mortality in the country is a warning that a better system is necessary. But where I mostly met with their failure was in their treatment of fractures. Their major approach was to use external fixation with strips of bamboo tied together very tightly with string. They didn’t have Xrays; they didn’t understand the practice of fixing the joints above and below; they didn’t know how to assess the potential excessive tightness of their fixation with possible nerve, vascular and necrotic problems. They surprisingly didn’t seem to have learned that fractures swell in the early stage of the healing process. We have been ingrained with the 5P principle, watch for – Pain, Pallor, Pulses, Paraesthesia, Paralysis. They do not understand this. They didn’t understand early mobilisation. Therefore we faced initially necrosis with gangrene +/- infection. Then stumps where the limb had dropped off, contracted joints, extreme sepsis etc.
Amputations performed, because of infections, usually had to be of the guillotine type with refashioning when the situation was better controlled. Occasionally on examination of the amputated dead limb we could not find evidence of a fracture. I will show you a few as they presented. Some of the pictures are a bit nasty. It was rare not to have one or more in the ward every week.