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Head Injury And No CT Imaging



“Yet another 9-year old with a coin stuck in the esophagus,” explains Steve Foster, INMED faculty physician in Angola, southern Africa. “I grabbed it with the biopsy forceps, and up came the coin worth maybe 6-7 cents… Then a laconic comment from an ER nurse, ‘Oh, there’s a guy here who can’t talk.’ That led to a story of head trauma in a 32-year old who was clubbed while thieves tried to take his motorbike. The man slipped into coma and his family drove 200 kms where I diagnosed him with a depressed skull fracture… No CT scan available within 500 km radius,” describes Foster. “But there was an obvious depression over middle meningeal artery on the Lt skull. So we operated, drained a diffuse hematoma… Post op the man was moving arms and legs. So will see if he survives.”


What are the values at play in this drama-in-real-life? For one, worth of human life cannot be adequately measured by the value of a coin ingested or a motor vehicle possessed. Another, listen carefully, for subtle culturally appropriate comments maybe extremely important. This scenario also highlights how an attentive history and physical exam may compensate for lack of very useful technologies. Finally, for those people gloomy over their professional routines, opportunities abound for compassion in action, exemplified by outstanding individuals like Steve Foster.

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