Bone infection: Tiny boil almost costs his leg

By Vicky Wandawa, Humphrey Wampula, David Kibanga and Robert Kalibala

Bone and joint infections, also known as ‘ettalo’ in local dialect, are a significant cause of permanent disability in children in Uganda. This condition can be cured but due to false cultural beliefs and ignorance, it worsens and could lead to loss of a limb. Salima Kibanga of Kayunga district shared her ordeal about her 12 year old son.

Her son was wincing in pain, his face stained with tears, she sorrowfully recalls. What had started as a simple boil on his lower left leg had turned into a septic wound exposing the bone! He suffered a common condition locally known as ‘ettalo’, also osteomyelitis in the medical language.

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Like any mother, 49 year old Salima was ready to do anything including  visiting three different hospitals and spending over shs600,000 of her meager income to save her 12 year old son’s life. Despite the visits, his health was deteriorating, each passing day.

Two months down the road now, Salima is relieved because Wantante underwent surgery and has a fixator attached to his leg. A fixator is a device used to hold weak bones especially the tibia and fibula together. “We use it also to hold the leg as the bone heals. Sometimes we use it to reconstruct the bone,” says Nyiiro.

Though Wantante is walking around on clutches, all signs show that soon he will be able to walk normally, and even play his favorite, football. Salima is a mother of eight. She is a farmer of coffee and banana plantations, a resident Kisoga in Kayunga district.

Small boil turned big wound

“I was playing football with my friends, when I twisted my leg. It hurt so much,” the soft spoken Wantante narrates. He continues that he had gotten quite a number of simple injuries at the playfield, and knew that he would soon be fine. The boy limped home, had diner and went to sleep.

“In the morning, my leg was still paining. It continued for two days and then I told my mother. By then it had started swelling. She took me to the hospital and I was given an injection and tablets. But it swelled more and was very painful,” Wantante recollects.

By then he could neither play with his friends nor attend school, due to the extreme pain. Even sleep had become a rare occurrence. Despite visiting a clinic and hospital, the relief never lasted longer than two days.

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Witchcraft blamed   
                         
Salima, the mum says that as soon as her son complained of the excruciating pain, she sought the services of a doctor, at a local clinic. “Our neighbours kept telling me it was witchcraft locally known as ‘ettalo’ and would not heal in a hospital.

This is majorly because in our culture, most swellings on the feet point to witchcraft,” says Salima. As if to prove the theory right, two weeks down the road, there was no change.panic besieged her.

Shs500,000 spent in vain

Meanwhile, the treatment was taking up all her finances, since she needed to transport the boy on a boda boda, which was very costly. By then the swelling had turned into a septic wound persistently discharging pus. Three weeks after a fruitless search for relief, the doctor advised that Wantante be taken to a hospital, Kayunga. This is after, the peasant had spent over shs500,000 on treatment and transport to the clinic!

 “The doctors said we needed an x-ray done and yet the hospital did not have the required facilities. I then took him to another clinic, Suubi, where the scan was done and we were referred to Mulago hospital.”

By then the flesh on the leg had given way and underneath the grisly pus, was part of Wantente’s tibia bone, slowly getting exposed.

At Mulago hospital, the doctor asked her to take her son to CoRSU, a hospital along Entebbe road. “I told the doctor, I had never been to Entebbe all my life, and now he was sending me there. I carried my son, got onto a taxi and was dropped off at the hospital.”

The boy was admitted, and underwent surgery. His mother paid only 130,000. He is now in clutches and recuperating.

 

‘Ettalo’ is curable
Dr Francis Nyiiro, an orthopedic at CoRSU says that Wantante was suffering from a condition known as Osteomylitis, an infection that destroys the bone and joints, forming pus within the bone to cause a smelly discharge.

The orthopedic says that the condition, commonly known as ‘ettalo’ in local dialect, in reference to witchcraft, actually has nothing to do with witchcraft. Consequently, children are taken to herbalists and witch doctors, which unfortunately does worsen matters, yet using anti biotics during its early stages can actually lead to complete healing.

“The more time wasted with traditional healers, the worse the condition and the more likely for the child to lose its leg!” Nyiiro warns.

“It’s not a curse, its not witch craft, it’s a treatable condition,” Nyiiro reiterates.

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What is Osteomyelitis?

Osteomyelitis is an infection of bone mostly caused by bacteria and fungus. It’s a treatable condition. Compared to adults, children are more susceptible to the catching it because they have low immunity and are also more likely to get injuries on their limbs as they play. Such injuries can develop into boils, leading to osteomyelitis.

 “The earlier you treat it, the simpler it becomes.  Giving anti biotics, either oral or intravenous, takes the swelling away,” Nyiiro advises.

That way, there will be no need for surgery, hence making the treatment affordable.

Early symptoms
⦁    Severe pain in the leg
⦁    Small boil develops
⦁    Boil develops into severe swelling
⦁    High temperature which is usually confused with malaria. The false diagnosis worsens the condition.
⦁    Eventually, the swelling bursts and starts discharging pus.  Before long, part of the bone is exposed.
A leg can be lost

Nyiiro explains that when the patient does not seek treatment early enough, the bone is destroyed, necessitating surgery.
The surgery depends on the level of destruction of the bone. The simplest incidence is where you have pus in the bone. The pus is drained and anti biotics given.

However if part of the bone is dead, it should be removed. That also depends on how much of the bone is dead.
“If it’s only a small piece destroyed and the rest of the bone intact, the destroyed part of bone is removed and anti biotics given. However, there are instances where by the whole bone is destroyed. That is more challenging, very difficult and expensive to treat. It involves constructing a bone and then replacing that bone that has been lost, says Nyiiro.

In Wantante’s case, only part of the bone was destroyed. Right now he is recuperating and his tibia is being held together by a fixator.

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About CoRSU

CoRSU is a private nonprofit, non-governmental organisation in Uganda with a rehabilitation hospital. It offers preventive, curative and rehabilitation services for people with disability, with special focus on children with physical impairments. For minors, the treatment is greatly subsidized, almost free.

According to Malcolm Simpson, the CEO, CoRSU is the leading hospital in Uganda for hip and knee replacement as well as other surgical procedures. “We carried out over 4600 surgical procedures on over 3000 adults and children with disabilities.”

Related link
Medicinenet website