Suubi Trust

Dr. Ian writes this personal account outlining how he and the team at IHK responded to the Kampala bombings…

I was watching the match at Kisemente, but decided to go home at half-time since the match was boring. As I was driving past the Ethiopian Village Restaurant I noticed some unusual activity, but did not realize that a bomb had gone off. When I reached home I got a call that there had been a bomb and that the casualties were being brought to IHK. I drove to the hospital while calling in other doctors and when I arrived found Moses the surgeon already there. He had assessed two patients and was preparing to take them to theatre. Emergencies come in waves, the first may not seem too bad, but then there is another and another and if the hospital is not prepared it will be overwhelmed. I took charge of co-ordinating and got on the phone to call in more help. I called four surgeons, two neurosurgeons, four anaesthetists, one orthopaedic surgeon, the whole radiology team, the director of nursing, the director of clinical services, more nurses and the electricians and maintenance people and everyone came in willingly and quickly. The relatives of the injured were around but they were generally orderly, except for one woman who was falling down and creating a fuss. We eventually found there was nothing wrong with her, but she diverted attention from others who were really sick and got up and threw her arms around another of the patients, weeping and wailing. We disentangled her and found she had stolen his wallet (some people never give up). We restored the wallet to the patient and threw her out.

The surgeons and medical officers were triaging and assessing, while the nurses were cleaning up the wounds and blood. As patients were moved to the ward or theatre more arrived to take their place. I asked the cleaners to clean up the blood urgently and the nurses to disinfect the couches as we went along, so that new patients were not put on bloody couches. Then a man was carried in with a bad head injury; at this stage we did not realize another bomb had gone off, but other casualties began to arrive, most with head injuries and the police then called to ask us to send ambulances to Kyadondo. The ambulance picked up three seriously injured cases, brought them back and went for more. By this time the waves were really coming and there were many relatives and onlookers. I ordered everyone to wait outside unless they were an immediate relative as we dealt with the casualties, since we wanted to get on with our work with as little chaos as possible. A policeman was stationed at the door and managed to keep order – we wouldn’t even let the press in.

In such an emergency one has to select the patients one can help the most. Those who appear to have minor injuries can wait and be re-assessed later. Sadly, those who are very badly injured and passed hope cannot have your attention either; one must concentrate on those for whom there is still hope. One doctor was dealing with two bad head injury patients, but he could see that the young girl was deteriorating before his eyes and there was nothing he could do – she died within an hour. People were now carrying in severely injured victims on tarpaulins and laying them on the beds; one man was covered in blood and was already dead, but another, who was lying face down in his own blood was still breathing and had a chance. We got the dead shifted to the mortuary and dealt with the living. The waves were now moving through the hospital departments – from accident and emergency department to radiology, to Intensive Care Unit, to theatre, to the wards. Theatre block had three theatres working at once, ICU had nine seriously injured patients, the wards had the more stable patients.

There were two main types of injury – the serious head injuries and those who had penetrating wounds from ball bearings, nails or secondary missiles. One man had hardly a mark, except for one small puncture wound on the chest, but he was dead on arrival – a piece of shrapnel had punctured his lungs. Another man had what looked like a ball bearing on X-ray, neatly lodged in his spine. He also had some small innocuous wounds on his side. It turned out that the ball bearing was harmless, but other bits of shrapnel had pierced his abdomen, tearing holes in his liver and gut. He was taken to theatre where they were repaired. Some of the victims had had been peppered with shrapnel and it took the surgeons hours to explore all the wounds and pick out the debris.

Meantime we were doing CT scans on the people with head injuries – the damage was devastating. Not only were skulls fractured and shattered, with some people having blood and brains oozing out, the scans showed that there was bleeding and bruising throughout the brains. We knew that many of those with head injuries would not survive, but their best chance was to put them on ventilators (life support machines) and give them drugs to reduce the swelling of the brain. By this time it was approaching morning and the activity had shifted to ICU, where we had nine patients, but only four ventilators available. Once again we selected those who had the best chance of survival and treated them most aggressively. For the others we did what we could, but several died within twenty-four hours. The staff who had been working all night were now tired, but early in the morning more staff had heard about the bombs and came in to help, so they were fresh and the operations in theatre continued working throughout the next day. Everyone had a heavy heart, but we had no time to grieve.

As I write now five days later I am filled with sadness for all those who died so pointlessly. As a doctor one learns to be professional and get on with the job at the time, but afterwards one sees the images: the young people who were enjoying life one moment and had their lives snuffed out the next.

I want to thank the Ugandan nurses and doctors who worked tirelessly to save the bomb blast victims at both IHK and Mulago – they were professional and caring and can hold their heads high. I wish that the mortuary part had been handled better. The police insisted that all bodies be taken to City Mortuary, but the scenes there were shocking, the least we owed the victims was some dignity in death. We need to remedy this situation for the future.