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Multidisciplinary approach saves teenager from near amputation
A broad smile wreathes his face as he walks with the aid of crutches which soon he will discard. He will also put behind him a very long hospital stay, nearly half his young life, and attempt to pick up the pieces of his humble life.
Dhanushka hobbling along. Pic by M.A. Pushpa Kumara
There was, however, not much to smile about a few months ago, only fear that he may never walk again normally after undergoing an amputation of his right leg.
For, a cut on his leg, close to the ankle, suffered when playing with a knife turned out to be a never-healing wound, growing larger and larger and leaving doctors of several hospitals baffled.
The key to success which will send 16-year-old Dhanushka Pathum Kumara back to his home in Kolonwinna, in the interior of Moneragala, boils down to a spot-on clinical diagnosis and the ever-important multidisciplinary approach.
These are the essentials which are available through the vibrant State health system to the poorest of the poor, the voiceless, even from the remotest corners of the country.
It is in Ward 75 at the National Hospital of Sri Lanka (NHSL) that we meet Dhanushka. No more are there lines of agony on his face, neither is his brow furrowed.
Not only has Dhanuskha with his impish smile and ready retorts become a favourite of all the doctors and nurses of this ward under the charge of Consultant Orthopaedic Surgeon, Dr. G.L. Punchihewa, but he has also won the hearts of the other patients who would get their family members to make him special tidbits, treating him as their own son.
His impoverished circumstances have made him worldly-wise, generally able to fend for himself, as his father who was a cultivator died of a heart attack when Dhanushka was very young and his mother had to eke out a living, working long hours as a labourer on a plantation to feed her young family of three children.
Starvation was never far away and regular schooling where he loved to draw and paint became an impossibility, with Dhanushka dropping out after Grade 3.
Prof. Seneviratne
Then befell the injury when Dhanushka was nine years old, followed by stays at different hospitals — a week at one followed by four years at another but the wound did not get better, only worse, leaving the doctors baffled. “Loku thuvalayak,” shudders Dhanushka.
In desperation, the outstation doctors transferred him to the NHSL in 2013, where a different tack, grafting skin from the left thigh, was performed to get healing for the huge wound on the right leg, before he was sent back to the outstation hospital.
But to no avail and the teenager’s woes increased. “Pesawanna gattha,” he says, explaining that the wound began to fester.
The wound was oozing and bad and the pain agonising and it was back to the NHSL in 2015, with fears that he would have to sacrifice that leg.
Coming under the care of Ward 75’s Matron and nurses, he found in them “second mothers” who were not content to just dole out only medication.
They immediately put him under the shower, scrubbing him up thoroughly and giving him a short hair-cut, dispelling the appearance of a waif.
Cleaning his wounds, they also scrupulously, in coordination with the dietician who drew up a special nutrition plan, put him on a high-protein diet to build up his strength.
While the hospital diet included eggs and milk every day, Dhanushka hobbling along on his crutches had won the hearts of everyone around.
The slightest yearning by this teenager, who had rare visits from his family, would result in angels in the form of patients asking their relatives to bring such delicacies as home-cooked kos mallun and karola.
All this while, Dr. Punchihewa and his team which included Medical Officer Dr. Niroshana Premaratne were looking closely at the wound.
Dhanushka had “multiple leg wounds exposing muscle and bones which were extremely painful”, says Dr. Premaratne.
What had started off as a small wound seven years earlier had spread to become a huge sore. Even the place from which the skin-graft had been taken was not healing.
A multidisciplinary team which included the orthopaedic doctors, plastic surgeons, vascular surgeons, a haematologist, a microbiologist and a psychiatrist were wracking their brains and poring over the bulging bed-head ticket of this ‘long-time’ hospital resident.
They wondered whether there was a congenital factor which was the cause of the wound not healing.
Earlier, when being transferred from an outstation hospital, Dhanushka had been sent to an NHSL ward where he was administered vascular therapy as he was complaining of leg pain due to the blood supply to his leg being less.
He was anaemic for no reason and there were suspicions that he was suffering from thalassaemia, it is learnt, but attempts at blood transfusions had been rejected. When he was transferred to Ward 75, he had also been mentally down.
Suddenly, the multidisciplinary team came upon the idea of seeking a dermatological opinion and it was then that Prof. Jayamini Seneviratne, Head of the Dermatological Unit of the Lady Ridgeway Hospital for Children, walked into NHSL’s Ward 75.
Prescribing some orally administered medications to cover several germ types as well as a medication to be applied on the wound, turned out to be the answer, for a sore that had been incurable for seven long years.
Very soon a healed Dhanushka will head for home in Moneragala to hopefully undergo a vocational training course which would enable him to fend for himself and get into society as a young man.
| Spot-on diagnosis saved his life An accurate clinical diagnosis and multidisciplinary approach saved Dhanushka from certain death. Otherwise, he would have been in hospital with this lingering sore until an agonising death, it is learnt.Firstly suspecting a plant infection, Prof. Jayamini Seneviratne points out that he ruled this out due to inadequate evidence. Next he zeroed-in on a bacterial infection, hitting the nail on the head. It was MOTT or mycobacteria other than tuberculosis, commonly found in the environment, causing illness in people with weakened immune systems. Although Prof. Seneviratne waged war on these atypical mycobacteria with medications getting a significant improvement after a month, the wound did not heal fully. “Then we realised that the blood vessels were blocked due to immune complexes generated by the infection,” he says, adding that the simple and cheap answer was giving Dhanushka 1/4th of an aspirin daily which cost a mere 25 cents. Adds Prof. Seneviratne: “This was the key to sending him along the path to recovery.” |
| Appeal for help Please help not only Dhanushka but also his impoverished family to get back on their feet again. Generous people may contribute towards his wellbeing by sending their donations to: Account No. 0-68-200-15-00-47-832 at the People’s Bank, Moneragala branch, in the name of R.R. Dhanushka Pathum Kumara. |