It was late October in the rainy season, with thunderstorms occurring on most of the otherwise hot, dry days. Eric Kibondo, a 27- year-old nursing. student, was at the house of his friend, Patrick. It was early afternoon. He was sitting. at a table revising.
Suddenly there was a bolt of lightning, simultaneous with its thunder. Later someone described it as 'the sort of ominous crack that sends shudders down your spine because you know that something has been hit'. That 'something' was Eric.
The current had been conducted through a metal bar supporting the roof above Eric. It caused a cardiac arrest. Patrick was hit too and initially appeared very confused as he went to seek help. Several nursing students tried to administer heart massage but it took another 10 minutes before proper cardiopulmonary resuscitation cycles commenced.
Ever since returning to Bristol, I have thought more about cardiac arrest management and compared the crash teams here with the events in Zaire. Medical staff in the-UK also take several minutes to arrive at an arrest, but they usually expect to have an ECG, an anaesthetist to intubate, oxygen and a defibrillator to shock the heart into a regular rhythm. Instead, having asked for an Ambu bag from theatre to ventilate Eric more effectively, a non-medical friend rushed back with the bag used for newborn babies!
More important than differences in resources and frustrations with the limitations of medical management in rural Africa, however, is the power of prayer. Regrettably, this is not part of the standard protocol for doctors in UK hospitals as they hurry along corridors to a crash call. In Boga students, hospital staff and friends immediately joined together to pray, and this earnest corporate prayer continued late into the evening and beyond.
Lonu, a close friend of Eric, set up an IV and gave l mg of adrenaline, 20 minutes after Eric's heart had stopped beating, The heart restarted. with a good output. Eric was carried by stretcher- to the intensive care unit in the hospital. He was extubated a short while later when his voluntary respiratory effort returned. Although he did not speak, or show signs of being able to see, he was extremely agitated. There were movements of all four limbs and he had to be restrained, the danger of masking signs without monitoring equipment ruling out sedation.
Eric had a superficial burn from the top of his head down to his chest. with an exit burn on his legs, but with no equipment for further investigations to assess internal damage, the outlook was uncertain.. Prayers changed from petitions for- his survival to trying to place into God's hands the fear of this bright, fit, young,, student going into a persistent vegetative state..
Lightning injuries often cause death, mainly through cardiac arrest. However, the chance for successful resuscitation is usually greater because the majority of victims are relatively young and healthy and seldom have significant heart disease. Nevertheless, the spectrum of neurological lesion., includes the entire neuroaxis from cerebral hemispheres to the peripheral nerves. Morbidity also follows burn injury to other organs lying in the pathway of the current, and from damage caused to the brain and other organs by anoxia during cardiac arrest.
Therefore, next morning, Eric's threat in jumbled Swahili and Lingala brought both relief and great joy: 'Na kobeta yo . . . acha mi' - 'I'll hit you ... leave me alone'!
Over the following, weeks his recovery continued. Short term memory loss, confusion and unsteadiness on walking were understandable. But he was determined to join us several days later on the grass bank overlooking the volleyball pitch to watch a very important match, the nurses versus the fourth year student team.
I have several further reflections about Eric's case:
Suddenly there was a bolt of lightning, simultaneous with its thunder. Later someone described it as 'the sort of ominous crack that sends shudders down your spine because you know that something has been hit'. That 'something' was Eric.
The current had been conducted through a metal bar supporting the roof above Eric. It caused a cardiac arrest. Patrick was hit too and initially appeared very confused as he went to seek help. Several nursing students tried to administer heart massage but it took another 10 minutes before proper cardiopulmonary resuscitation cycles commenced.
Ever since returning to Bristol, I have thought more about cardiac arrest management and compared the crash teams here with the events in Zaire. Medical staff in the-UK also take several minutes to arrive at an arrest, but they usually expect to have an ECG, an anaesthetist to intubate, oxygen and a defibrillator to shock the heart into a regular rhythm. Instead, having asked for an Ambu bag from theatre to ventilate Eric more effectively, a non-medical friend rushed back with the bag used for newborn babies!
More important than differences in resources and frustrations with the limitations of medical management in rural Africa, however, is the power of prayer. Regrettably, this is not part of the standard protocol for doctors in UK hospitals as they hurry along corridors to a crash call. In Boga students, hospital staff and friends immediately joined together to pray, and this earnest corporate prayer continued late into the evening and beyond.
Lonu, a close friend of Eric, set up an IV and gave l mg of adrenaline, 20 minutes after Eric's heart had stopped beating, The heart restarted. with a good output. Eric was carried by stretcher- to the intensive care unit in the hospital. He was extubated a short while later when his voluntary respiratory effort returned. Although he did not speak, or show signs of being able to see, he was extremely agitated. There were movements of all four limbs and he had to be restrained, the danger of masking signs without monitoring equipment ruling out sedation.
Eric had a superficial burn from the top of his head down to his chest. with an exit burn on his legs, but with no equipment for further investigations to assess internal damage, the outlook was uncertain.. Prayers changed from petitions for- his survival to trying to place into God's hands the fear of this bright, fit, young,, student going into a persistent vegetative state..
Lightning injuries often cause death, mainly through cardiac arrest. However, the chance for successful resuscitation is usually greater because the majority of victims are relatively young and healthy and seldom have significant heart disease. Nevertheless, the spectrum of neurological lesion., includes the entire neuroaxis from cerebral hemispheres to the peripheral nerves. Morbidity also follows burn injury to other organs lying in the pathway of the current, and from damage caused to the brain and other organs by anoxia during cardiac arrest.
Therefore, next morning, Eric's threat in jumbled Swahili and Lingala brought both relief and great joy: 'Na kobeta yo . . . acha mi' - 'I'll hit you ... leave me alone'!
Over the following, weeks his recovery continued. Short term memory loss, confusion and unsteadiness on walking were understandable. But he was determined to join us several days later on the grass bank overlooking the volleyball pitch to watch a very important match, the nurses versus the fourth year student team.
I have several further reflections about Eric's case:
- Lightning injuries are reported to affect about 1,000 persons worldwide each year, but this must be a great underestimate In equatorial Zaire in the heart of Africa during the rainy season, the threat of lightning is a daily reality.
- This reinforces the importance of basic life support skills. I arranged small group teaching in Boga for nurses and nursing students, in French and using an old resuscitation mannequin. The students were not only keen to learn, but very aware of the importance of CPR because of Eric.
- The dedication to prayer of Eric's colleagues, the power of' prayer, and their response in thanksgiving- made a tremendous impression on me. I still feel amazingly challenged. For many in Boga, this incident gave local people new strength and unity in prayer, and faith in God's plan for renewal in their crumbling, land. My prayers now are for peace to be restored to Zaire, Rwanda and Burundi.
