by Eulana Weekes
St. Kitts and Nevis (WINN): General Surgeon in St. Kitts and Nevis, Dr. Natalie Osborne, said violence affects the whole society significantly as she and the rest of the Federation have taken note of the rise in violent crimes leading to death.
“We’re starting to get an uptick again in the violent wound gunshot wounds. That impacts our healthcare in a very significant way, and as a medical professional and as a medical professional and as a General Surgeon, it would impact me, and it would impact the staff and everyone with this,” said Dr. Osborne on the April 4 broadcast of WINN’s Island Tea.
The General Surgeon expressed that while it seems people are desensitised to the violence as it seems somewhat far removed if they are not directly affected, these crimes impact society.
“Oftentimes, people see these things in isolation, but it affects everyone, each of our lives and then, even the staff is left with trauma as a result of these injuries. So, [people] may think, “Oh, the gunshot violence only happens with a certain society”, but no, it affects all of us. It affects us, the staff at the institution psychologically, the financial strain on the resources that are often times limited, as well as the family and the supporters.”
During the Tuesday, April 04 edition of Daily Dose on Island Tea, Osborne presented some local data from the Joseph N France General Hospital from 2011 to 2023 as it relates to gun-related injuries. The data included a combination of patients who were presented to the hospital for treatment, those who succumbed to their injuries and others who died at the scene.
“In 2011, we saw a total of 32 patients with gun-related injuries, and with this data, those were the only cases that came to the hospital cause there are some persons who died on the scene and did not make it to the hospital. So in 2012, we had a total of 16 persons who came to the hospital requiring medical intervention. It ranges from severe to minor injuries. In 2013, we had about 13 [people]. In 2014, [there were] 18; in 2015, we had 22 persons coming to the hospital for medical attention as a result of gunshot wounds; in 2016, there were about 23 persons and in 2017, there were 25, and when we got to 2018, there were about 33 persons. Many of those persons might have been admitted; some were seen and discharged based on the level of the injury, and some persons had to have surgical intervention.”
Additionally, in 2019 there were 22 cases of gunshot wounds in St. Kitts; 13 were serious, and about nine fatalities. In 2020, there were 11 gunshot cases attended to; five varied in severity and 6 were fatal. In 2021, 14 gunshot wound cases were presented to the Joseph N France General Hospital; four had various degrees of injury, and six succumbed to their injuries. Most recently, in 2022, six persons received gunshot injuries, of which four were fatal.
By April 04, 2023, Osborne confirmed that one case of a gunshot wound was presented to the hospital and treated, whilst there were seven fatalities; but, just a few hours shy of Osborne’s presentation on Daily Dose – Island Tea, the country had recorded another fatality which increased the number of fatalities to eight.
The Surgeon explained the severity of gunshot wounds to the body and the complications that can result in death.
“Something very important you want to think about as well, you’ve got the trajectory of the bullet and the fragmentation; it’s the damage that the bullet causes as it penetrates. So, It breaks up all these tissues, and it creates this cavity, you lose tissue mass, and you lose blood vessels and stuff, as the bullet penetrates through the body.”
Dr. Osborne continued, “Common causes or major damage that can result in loss of life is injury to blood vessels; severe blood loss, that’s one of the main things that can cause the loss of life immediately. So that comes down to what blood vessels are injured. One of the main blood vessels that is in the body is called the Aorta. That is the largest blood vessel. It comes off the heart, it passes through the chest, it passes down into the abdomen, and it distributes throughout the entire body.”
Osborne explained that if the Aorta is affected, the injured can have devastating results, leading to hypovolemic shock.
The heart, she said, is a vital organ. It is the pumping muscle that sends blood throughout the body. The doctor explained that a bullet to the heart can cause a hole, thus leaking blood; and as a result, the blood that is usually pumped throughout the body can no longer be pumped, which causes internal bleeding and may also lead to death.
Dr. Osborne expressed that other organs damaged by gunshot, such as the lungs, liver, brain and spinal cord, can also lead to sudden death.
The process for a gunshot patient to get care can be pretty tedious, especially considering the facility’s limited human resources. Osborne explained the likely process when a gunshot – patient arrives at the hospital.
“The patient is brought in, usually by the EMS, and they are assessed. Of course, they start doing things. We spoke about the ABCs, your airway, assessing the patient, making sure that they can breathe well, that there’s nothing obstructing their airways. You want to make sure you can address their circulation, group and cross-match. A lot of these persons, if they have to go to the operating room and they’ve had significant blood loss, you want to ensure that you have blood to replace them. You want to also then examine the patient, start looking for the point of entry, look and see if there is a point of exit and determine, “Does this person need emergency surgical evaluation?” At that point, you will have to call in your general surgeon, or you have to call in your orthopaedic surgeon, your vascular surgeon or several of these different surgeons to make a determination. Also, you may have to call in the operating room staff, and then you will take that person to the operating room based on what you think your findings [are].”
Osborne mentioned that X Rays and scans may also form part of the assessment process, and the technicians may have to be called in to assist. Other medical professionals have to be on call, as there is a low human resource capacity to have them at the hospital all the time.
