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Dedicated staff at Neuro-trauma unit bring new hope to shattered bodies
View(s):By Kumudini Hettiarachchi
It is like a scene from a science fiction movie. In walks a youth with only part of his skull, the skin covering a huge dent while on a bed elsewhere in the same building a middle-aged man smiles in hope as he gains slight sensation in his foot where earlier there was none.
While for the Sunday Times this seems extraordinary, for the dedicated doctors and nurses of the Neuro-trauma Unit of the National Hospital in Colombo it is just a routine day.
With a “catchment area” of almost two-thirds of the country — except the South, Central and Uva areas — in the NHSL’s Neuro-trauma Unit, Consultant Neurosurgeon Dr. Saman Wadanambi and Trauma Surgeon Dr. Jagath Rathugamage handle a large number of brain and spine trauma cases due to accidents and Consultant Neurosurgeon Dr. Himashi Kularatne “cold neurosurgeries” such as tumours.
For 25-year-old Eranda Kaushalya the blow from a co-worker was unexpected. He was engaged in welding work at Kelaniya and asked his co-worker to move the grinder when the iron bar came down on his skull, cracking it. He had no memory thereafter. With the Neuro-trauma Unit doctors bringing him back literally from the dead, Eranda now awaits titanium cranioplasty (the technique of repairing defects of the skull with titanium) to get back to normal life.
R.M. Ranaweera Bandara
It was a motorcycle accident which sent 28-year-old G.T.S. Sampath from Horana to the Neuro-trauma Unit. A collision with a double-cab threw him off the motorcycle and with the lock on his helmet snapping, it was a matter of seconds before his head hit the road with a sickening thud. Usually, the level of consciousness is measured on a scale of 1 to 15, with 3 being very low. Sampath was at 5 and not doing too well. Six days after serious brain surgery, however, he has been able to go home and was back at the Neuro-trauma Unit 10 days after for a scan to be followed by the removal of stitches.
It was not the brain but the spine of 41-year-old R.M. Ranaweera Bandara that was severely injured when he fell off a karabu tree from a height of about 20 feet. With no sensation below the chest, he is not only worried about his paralysis but also how he will feed his three children, the youngest of whom is not even two years old.
The doctors have harvested Bandara’s stem cells from his blood with a special machine available at the Neuro-trauma Unit and transplanted them in his spine and he is sure that he feels some sensation in his right toe. Time will tell whether the stem-cell transplant will send Bandara home to live even a semblance of a normal life.
These are just three cases of the thousands of people wheeled in or rushed by ambulance to the Neuro-trauma Unit, more or less comatose, and with expert surgical, medical and nursing care walk out to resume their lives and get back to their jobs.
It was in 2010 that the state-of-the-art Neuro-trauma Unit opened its doors, allowing Sri Lanka to take a giant leap in the care of neuro-trauma patients.
Earlier, the “death statistics” from neuro-trauma which can happen in the home, on the road (the menace of current times which is the most common cause of both head and spinal injuries), in the playground, at a construction site or anywhere for that matter, were disturbing.
Two thousand people used to die of head injuries at the National Hospital each year due to lack of facilities, overcrowding of neurosurgical wards, no beds being available in the Intensive Care Unit (ICU) and there being only one operating theatre for neuro-trauma cases.
Those were the days when there was only a paltry four beds at the Accident Service ICU for head and spinal injuries. There was also only one operating theatre for neuro-trauma patients and when two people needed immediate life-saving surgery, the doctors would have to play god and decide which one should be operated on first. Of course, the chances of the other patient dying were very high, it is learnt.
The scenario, however, has changed drastically and the death toll brought down even though the Neuro-trauma Unit is working only to 50-60% of its capacity. Last year (2012), 105,000 were brought to the NHSL’s Accident Service of whom 37,000 needed admission. Four thousand of this 37,000 were admitted to the Neuro-trauma Unit, with 3,000 needing surgery for trauma. Meanwhile the Neuro-trauma Unit would also get about 3,000 referrals for other brain issues of which about 1,000 patients would undergo “cold neurosurgeries” such as removal of tumours.
With the newspapers highlighting many accidents daily, the need is to strengthen the Neuro-trauma Unit into the state-of-the-art centre it was meant to be, making it not only one of the biggest in the world but also one of the best. The lives that would be saved and the numbers that would be pulled back from disability need not be underscored.
Treatment of serious accident victims
When a person is involved in a serious accident, the commonest outcome would be loss of consciousness with the breathing getting affected or suffering a severe injury which causes massive bleeding, bringing the blood pressure down, the Sunday Times learns.
These are the dangers that need to be dealt with immediately, as the brain needs both oxygen and blood in adequate amounts to function. What happens in Sri Lanka is that the injured person would be bundled into a vehicle, in many instances, a three-wheeler, and taken to hospital.
At hospital, resuscitation would be the priority, with doctors checking out the accident-victims airway, breathing and circulation, preferably in a well-equipped Emergency Treatment Unit followed by continued monitoring in an ICU.
With regard to consciousness, under world reference standards, a normal person would be 15/15 on the Glasgow Coma Scale. However, an accident victim who is deeply unconscious would score 3/15, while anyone having below 8/15 needs to be intubated and ventilated or put on the life-saving machine.
Accident injuries include bleeding into the brain, swelling of the brain or contusions (bruises) of the brain, making a CT scan mandatory to assess the extent of damage. Thereafter, a decision would be made whether to perform brain surgery to remove clots or treat the patient with medication and ventilation or without ventilation.
All the while the patient would be kept under observation in the ICU, to catch the complications early. The best outcome for such patients would be at centres such as the Neuro-trauma Unit with a multidisciplinary team and all facilities.
It was envisaged to be the “biggest” in the world, when being custom-built with massive financing from the Saudi Fund, secured through the good offices of Consultant Neurosurgeon Dr. Sunil Perera, while the Sri Lankan Government too made a major contribution.
With neurosurgeons working closely with those handling the construction, the vision was to have 320 beds for head and spinal injuries including 66 ICU beds, eight operating theatres, OPD facilities, a CT and an MRI scan, a rehabilitation ward, an auditorium, teaching facilities etc.
It is up and running well now, said NHSL Director Dr. Anil Jasinghe. There is a dearth of nursing staff, he conceded, adding that he hoped to fill the slots gradually.
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