A nerve to help

Aruna (28) lives in a wheel chair, virtu- ally paralysed. Two years of intense physiotherapy has enabled him to move his hand and legs somewhat. Now he can feed himself and walk a few steps with two people holding him.

Aruna wasn't born this way. Two years ago, he was a strapping six-footer, a bright young man well on his way to a successful banking career. A road accident and his life overturned. When he regained consciousness many days later, Aruna was just a vegetable- unable to move a single muscle in his body but for his eyes.

Months and years of dedicated care by his family has resulted in what he is today. He will get better- with time, a lot of time.

But should he have ended like this at all?

Aruna was actually lucky. His aunt and uncle are both doctors and because of them the young man managed to stay in the Accident Service's Neurosurgical Intensive Care Unit (A/S NSICU) for a longer period than is the norm. But he was subsequently transferred to the general NSICU, where again due to the lack of room he was sent to a paying ward, which had only two nurses for 28 patients. "At this stage Aruna still needed intensive care, so we transferred him to a private hospital though the required facilities were not available even there," said Dr. Chrishantha Silva, the boy's uncle.

"We had to buy and get down various drugs and equipment for his care, since the hospital could not provide it."

After three months, Aruna came home -on a stretcher, still unable to move a muscle. Rehabilitation was long and tedious. Physiotherapists were difficult to come by and expensive. "We tried to get him into Ragama Rehabilitation Hospital, and after three months of trying succeeded. But even there, due to overcrowding, the facilities available were not satisfactory," Dr. Silva said.

This kind of traumatic experience was the common thread that linked many who had gathered at the Diabetes Association's auditorium last Sunday to look at how brain trauma patients could have a better chance at life than is afforded now. A voluntary organisation called the Neuro Surgery Development Fund (NSDF) headed by Dr. Chrishantha Silva has put forward a project proposal to construct an all-new hospital building for neuro-trauma patients. The association has already procured aid to launch a rehabilitation scheme, where a family member of the patient will be coached in basic physio-therapy to help in the recovery process.

"Basically we need to reduce the mortality," said Dr. Sunil Perera, neurosurgeon at the National Hospital. "Brain damage after an accident could compound if quick medical attention is denied to the patient. Although the primary damage, which happens due to the impact, is often considered irreversible, secondary damage, which happens when the cells surrounding the injured part begin to die, could often be treated. But this needs long term care and monitoring. Our hospitals are not equipped for such care."

More than 1000 patients die unnecessarily every year due to the lack of facilities. These are patients who die in designated neuro surgical wards; there is no accounting for the many who die in wards in outstation hospitals.

"In Sri Lanka to receive proper neuro-trauma care depends more on your luck than anything else," said Dr. Sunil Perera, who also treated Aruna during his long hospital stay. "We want that scenario to change. Proper medical facilities must be available for all deserving patients- irrespective of their position or their luck."

The project

The objective of the project is to raise Rs. 100 million for a specialised Neuro-Trauma Centre at the National Hospital. The Ministry of Health has already agreed upon the land allotment and the Centre will be very close to the present Accident Service, thereby minimising the time between Accident Service admission and Neuro-Trauma care.

The Centre will have a 12-bed ICU with facilities to ventilate critical patients. There will also be a High-Dependency Unit with 20 beds for patients who need near-ICU care and close monitoring. The ward will have 60 beds- 30 for male, 20 female and 10 children and it will be dedicated to the management of those with head-injuries. There will also be a theatre complex with three theatres set apart for neuro-trauma patients.

The second part of the project, which is being funded by the Canada-Sri Lanka Development Fund, is to seek practical ways of rehabilitation for the many patients who emerge from hospital as mere vegetables- unable to move a muscle. In a temporary hall on Gothami Road, Borella, a physio-therapy aide from Singapore will train a somewhat educated member of the patient's family on the basics. Patients will be staying at the Rehabilitation Centre for a week or so with this family member while they both learn how to help the patient to start moving and co-ordinating his limbs.

"The building we have now is a temporary arrangement. We are looking for some kind beneficiary who would like to donate a building or land for this purpose. We also need a vehicle which can be converted into an ambulance to take patients home after the initial rehabilitation," Dr. Silva said.

The Neuro-Trauma Development Foundation would greatly welcome contributions for both Centres- from individuals, associations, institutions and corporate bodies. Those interested could contact.

Dr. Chrishantha Silva/ Dr. Swinitha Silva Res. 647747, Surgery 611009.

Cheques should be drawn to Neuro-Surgery Development Foundation, Neuro-Trauma Project, No.49, Kolabathnathri Mawatha, Ethul Kotte.

What happens ?

What happens if you suffer brain injury in a motor accident?

If you are lucky enough, the accident will be in Colombo or close by, so the patient could be rushed to the Accident Service Neurosurgical ICU, within an hour. But remember, an astounding 10,000 patients with head injuries are admitted here. Almost always the four beds here are occupied.

So it depends on who is considered to be the more 'serious' patient. To make room, an unlucky person will be moved out into the general Neurosurgical ICU - which is for patients after brain operations.

This is not an ideal situation at all. Not only is the trauma patient deprived of the best care but also there is a risk of cross-infecting the post-operation patients.

If there are no beds here, the patient, however serious, ends up in a general ward or is transferred, in a comatose state to the district or base hospital closest to his home.

At the Accident Service NSICU, you'd be lucky to have the bed for more than two days. On average patients stay less than two days at this ICU with all its specialist care.

What a patient would need immediately after being rushed in from an accident with brain injury, is to be hooked on to a ventilator, where oxygen is pumped into his system to keep the body running as well as initiate the healing process for the injured brain cells.

Many are not ready to give up the ventilator in two days. Some have to be ventilated for weeks before they show some signs of recovery. But due to lack of facilities only a lucky few will be privy to such care.

Many have to make way for new patients, and die as a result.

In the General NSICU there are only twelve beds and two ventilators.

Patients are transferred to general wards or even to their regional hospital in a comatose state, simply to make room for new patients. The more affluent can opt to move into the paying ward of the National Hospital or the ICU of a private hospital.

During a military operation or bomb blast, victims with brain trauma are all rushed to share the same four beds at the Accident Service.

With road accidents on the increase, the number of patients coming into the hospital with head injury had been on the rise. A shocking number of 2050 head-injury operations were performed at the Accident Service's single theatre last year.

Although both Kandy and Galle General Hospitals have Neurosurgical Units, they admit serious trauma patients only twice a week. No private hospital in the country is equipped to care for patients with brain trauma.

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