Magazine article Humane Health Care International

Tetanus

Magazine article Humane Health Care International

Tetanus

Article excerpt

Tetanus did not frighten me. Neonatal tetanus was part of everyday life at the one-doctor hospital in Azumini, our Nigerian village. My wife, Soon, who is not medically trained, picked out the pathetic spasms and rictus sardonicus in the newborns whose parents knocked at our front door during afternoon rest. Omphalitis and fever confirmed the diagnosis. With antiserum, sedation, and tube feeding of expressed breast milk, the midwives and I managed to lower the death rate from over 90 percent to about 40 percent. Tetanus was a familiar opponent among the many that challenged us daily.

Nevertheless, tetanus was far from my thoughts when Chief Udoni arrived at the outpatient clinic with an infected mosquito bite on the dorsum of his foot. Had he not been trained as a dresser in the King's African Rifles in World War II? Had he not lanced it with a sterile razor blade? It was open and draining nicely; intramuscular penicillin would surely clear the surrounding erythema effectively.

At the end of a mighty clinic the next day, his daughter, a smartly dressed, articulate woman, took me aside. "My father has a very stiff neck; could you see him?" Chief Udoni's neck was stiff and his foot was red and swollen. "Cellulitis of the foot and cervical disk degeneration in an elderly male," I wrote archly on the admitting diagnosis. "Give him Pen and Strep and, just to be sure, tetanus toxoid." On my evening rounds, the chief would not eat, but his neck was a little better with some aspirin and his temperature had come down.

The next morning on ward rounds, the only response that the Chief could make to my enquiries was obvious trismus. My self-serving assurance gave way to silent, angry questions. How could a Chief, a dresser, and a World War II veteran not be immune to tetanus? How could I have failed to give tetanus antitoxin to an adult with an infected wound, whose tetanus immune status was unknown? How could I have neglected the basic fact that the villagers go barefoot as much as possible; it is a way of being at ease in the village, in contact with the earth and the sustenance it provides. How could I presume to be the village doctor and fail to think about tetanus? In desperation, I gave him several vials of intravenous tetanus antiserum, opened the wound generously, and sedated him.

As I stewed and worked through the 40 or so outpatients and the six operations of the day, tetanus intruded more and more insistently. At the least stimulus, hideous spasms racked the Chief's body and clamped his jaw shut until I thought his clenched teeth would shatter. I abandoned the working of the hospital to the nurses and concentrated on providing some relief to his tortured body. From the short list of available drugs, I selected intravenous morphine and per rectal thiopental. A neonatal suction bulb was all we had to extract oral secretions. He seemed calm for a time, but as airway secretions, respiratory muscle spasms, and morphine conspired to overwhelm respiration, death was not to be defied.

A village Chief was dead. Other elders and chiefs came to my house to arrange the funeral, because the custom of same-day burial common in the equatorial heat could not be observed in the case of a chief. The chiefs spoke a broken English, but not as badly as I spoke their language. …

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