Teenager's road to recovery a year after doctors reattached his hand

As soon as he bids the Lifestyle team farewell, Joseph Theuri starts his motorcycle and powers it away, disappearing fast into the maze of roads in Gachie, Kiambu County.

One year ago, the teenager made headlines as he fought to save his right hand that had accidentally been chopped off by a sharp blade as he cleaned a chaff cutter.

It was later reattached by a team of 15 medics led by plastic surgeons at Kenyatta National Hospital (KNH). The lead surgeon said it was the first successful surgery of its kind in Kenya.

BLACK GLOVE

That the hand has regained functionality so fast as to enable 18-year-old Theuri become a boda-boda motorcyclist within just a year is baffling many, including the young man himself.

“I was never sure,” Theuri says when asked if he thought the reattached hand would ever recover that well.

His guardian, Ms Virginia Gathoni, who raised him after he was orphaned at an early age, is equally wowed.

“I thought it would take years and years. But even before one year was over, the hand had already recovered,” she says.

The right hand of a motorcyclist controls injection of fuel into the engine and handles the front brake.

From the way he controls the Boxer motorcycle, one can tell that Joseph’s right hand, which he has clad in a black glove, is doing those tasks perfectly.

March 27, 2018, is the day he was discharged after spending two months at KNH following the surgery that had happened on the night of January 26, 2018.

He left the hospital with the plastered right hand in a sling. No one could see the wires holding together his arm and the once severed hand, but surgeons knew the wires would offer support to the stitching they had done to reconnect the components — nerves, blood vessels, tendons and bones.

REGENERATION

KNH’s head of the Department of Plastic and Reconstructive Surgery, Dr Benjamin Wabwire, said then the chances of Theuri’s hand recovering were between 70 and 75 per cent.

“We want it to go back to as near normal as possible but the process is slow since the nerves have to regrow. Nerve tissue regenerates at the rate of approximately one millimetre a day and, considering that the hand is approximately 15cm long, we can only estimate that it will take a minimum of three months for him to feel any sensation in his hand,” said the surgeon.

Occupational therapist Paul Kirui told journalists on the day of Theuri’s discharge that the teenager would continue experiencing pain for many months.

“He will feel a great deal of pain over the next six months or so as we work to restore full function to his hand,” the doctor said.

Theuri, who spoke to Lifestyle this week, reckons that it was a painful recovery as had been predicted. He had to visit KNH three times every week for therapy.

“I had to push myself, alongside my (adoptive) mum, and continue medication on the hand, which kept improving. When the pain subsided, I decided to start working,” he says.

So, when did he realise that the hand had recovered enough?

“When I could lift items like metals,” he answers. “Whenever I went for therapy at KNH, I would lift items. And I kept trying till I was able to do it to some perfection.”

He admits that the hand is not yet fully recovered — that it still needs more work.

PRECAUTION

A look at the hand reveals the miracle that has unfolded over the period. One can spot the scars denoting areas where the skin on the severed hand reconnected with that on the arm.

There is also a distinct spot showing the part of his hand that plastic surgeons patched up with skin grafted from elsewhere in his body.

Dr Wabwire explained last year that the surgeons left the “gap” to create room for swelling and patched it up before Theuri could be discharged.

“If you are going to return blood which was cut off, a swelling will be expected in the first three or four days. The muscles in a limb are usually enclosed with something we call fascia which cannot expand. You always make a cut in that to give room for swelling,” he told Lifestyle.

With all the procedures turning right, Theuri can now afford to smile.

“I’m comfortable riding the motorbike. It is not painful. I ride to get money for my upkeep,” he says of the machine parked outside as we do the interview.

As a precaution, he avoids speeding and endeavours to carry only one passenger at a time.

“If I fall and injure the hand, it might cause problems,” he says. “When it’s cold, I have to wear a heavy glove.”

THERAPY

Interestingly, he did not know how to ride a motorbike before the reattachment surgery. He only learnt to do it as he recovered.

“I had nothing to do and I had needs. I had to train to ride and asked for a motorcycle from a friend who employed me. We agreed that I would be paying him per day,” he says.

His dream is to have a motorcycle of his own so he can have all the profits to himself. That way, he believes, he can attend therapy sessions more regularly at KNH, because his visits to the hospital have been limited by meagre resources.

“If someone helps me acquire my own bike, I would be saving the money I give to my employer. That will help me meet my expenses, like hospital costs,” he says.

He adds that he will be happy to get another job, not necessarily as a boda-boda.

His guardian, Ms Gathoni, also hopes that he can secure a job elsewhere so he can be away from the dangers of traffic.

As he continues with recovery, he has also decided to move out of his guardian’s home to stay in a rented house on the outskirts of Gachie, where he pays Sh3,000 a month.

Because the hand is not fully recovered, Theuri says, one task he cannot do is wash clothes. Someone has to do it for him.

“I also cannot lift heavy items. But I keep feeling the strength returning as days go by,” he says.

SCRIBBLES

It is, nonetheless, a sight to behold as Theuri scribbles his name on a notebook. The way he holds the pen will remind anyone that the recovery is still a work in progress, as the grip is quite loose.

Theuri’s guardian runs a clinic in Gachie and, though she was away in Nairobi on the day he cut his hand, phone calls she made were instrumental in administering first aid and the preservation of the hand before he was rushed to Kiambu Level Five Hospital and later to KNH.

Theuri reached KNH at around 5pm that day. Medical officer Alex Okello was in the accident and emergency department when the ambulance carrying Theuri from Kiambu Hospital rushed in, with a nurse in tow. The severed hand was in a cool box and his arm had been bandaged.

“We opened the cooler box, identified the amputated part and stored it properly. That means we wrapped it in a piece of cloth, put it in an airtight bag then placed it in a cool box. We added some water in the cool box; and that is how it should be appropriately stored before you transport it: Wrap it in cloth, place it in an airtight bag and then place it in water that has some ice,” Dr Okello told Lifestyle a few weeks after the surgery.

The saving grace for Theuri was that the chaff cutter had chopped off his hand in an instant, which caused what medics call a clean cut.

“Clean cuts are way easier to repair compared with those that have been crushed or have been pulled apart,” said Dr Okello.

NUTRIENTS

Celebrated surgeon Stanley Khainga was the specialist on call and Dr Okello reached out to him.

Prof Khainga wasted no time in mobilising a team to attempt the surgery. He linked up with another plastic surgeon, Dr Ferdinand Nang’ole.

Together with Dr Okello and another trainee, Prof Khainga quickly gathered a team of 15 with all the experts needed for surgery.

“We wanted to start re-planting the hand in three hours. We really wanted to reduce ischemic time (duration between cooling and re-attaching with the body) because by the time he arrived he had spent five hours out there,” Prof Khainga told Citizen TV weeks after the operation.

Prof Khainga led the team that was dealing with the severed hand while Dr Nang’ole was in charge of the group that dealt with the arm before the joining could start.

Reattachment of body parts does not happen like one would fix broken pieces of wood.

Every vessel, bone and tendon has to be stitched to the other, and the experts used microscopes to magnify the wounds so that all components could be accounted for.

“You really have to identify the arteries, the veins, the nerves and the tendons,” said Prof Khainga. “We do the arteries first because we want oxygen and nutrients into the amputated hand. That’s what we started with.”

The seven-hour surgery was the first successful one of its kind in Kenya, Prof Khainga noted.

MALE ORGAN

“In the 1990s, there was an attempt to do a similar operation but I don’t think they did it the right way because of lack of capacity,” he said. “Within three days, the limb was dead.”

Prof Khainga and Dr Nang’ole would also team up earlier this year to re-attach the male organ of a 16-year-old boy at KNH.

The hospital said in a statement that the “successful penile re-implantation was the first reconstruction surgery in Kenya and the region”.

Theuri says Prof Khainga and his team, after reattaching the boy’s organ, called him to KNH to examine him.

Theuri’s guardian considers the turn of events a product of God’s intervention.

“There are some things you will have to reckon are God’s doing. I was shaken at the possibility of a young man losing a hand. But I thank God because at least now it has been restored and he can work and ride a bike,” she said.

“But I usually tell him to check the speed. He can’t compare himself with somebody whose hand has not been cut then reattached. He is different,” added Ms Gathoni.

TRAUMA

Medics hope that the story of Theuri and other people whose body parts have been reattached will encourage more Kenyans to act fast whenever they are involved in accidents.

“Many of such cases occur, and they are due to assault and industrial accidents. If you are from Western region, Kisii and Meru, most of them are from assaults. If you are from towns, cities and so on, it is because of industrial accidents. The sooner the limb and the patient are brought to a trauma centre with microvascular surgery facilities, the better. Because then, the chances of success are very high,” Prof Khainga, a lecturer at UoN, said during the TV interview.

Stakeholders also hope plastic surgery will be understood better.

According to Dr Okello, people often associate plastic surgery with the repairs that happen after burns. But there is much more to it.

TESTIMONY

“It also involves hand surgery. We repair cut tendons. We also deal with very small nerves and vessels. We do a lot of reconstruction. That means, after cancer tumours have been removed from parts of your body and they leave wounds, we come and cover or reconstruct them,” he said.

For Theuri, he will never tire thanking those who gave him a lease of life: God, medics at Kiambu Hospital who preserved the severed hand so well to make the reattachment possible, the KNH surgeons and his guardian.

When he spoke with Lifestyle in a KNH ward last year, he said that after recovery, he would take up lighter jobs that the left hand could handle. But now it appears that the right hand might return to full service soon.

“Theuri will remain a living testimony and add onto the list of successful major surgeries that KNH and the UoN College of Health Sciences have performed in the recent past,” KNH said in a statement announcing the successful reattachment.