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 2005
International Awardee of World Health Organization (WHO), Head
of the Surgery Department at King George's
Medical
University
, and former Chief Medical Superintendent of Gandhi Memorial and
Associated Hospitals Prof.
(Dr.) Rama Kant gave an interview to Bobby
Ramakant for the Indigenous
Herald. His book in English and Hindi (Head Injury Care
Manual) was released today by Honorable Vice Chancellor, to mark
the 52nd Foundation Day of Surgery Department, organized by
Lucknow College of Surgeons and UP Chapter of Association of
Surgeons of India. The following are the questions and answers
with Prof. Rama Kant.
What
is Head Injury and what is its incidence globally?
Nearly
2 percent of population is living with head injury. Remember
world famous quote by Hippocrates "NO HEAD INJURY IS TOO
TRIVIAL TO BE IGNORED, NOR IS SO SERIOUS THAT LIFE MAY BE
DESPAIRED OF." Head injury is a term all of us are afraid
of listening, it gives us a sense of panic and makes all of us
feel insecure. Head injury is an injury in which the impact is
directly or indirectly on the head leading to a visible or
invisible injury over the scalp, bones covering your brain,
inside the brain or one of its coverings, causing transient or
permanent neurological dysfunction.
It
is a relatively high-prevalence injury, being 10 times more
common than spinal cord injury. It may result in cuts and
bruises on the skin of your patient's head or may fracture any
of his skull bones with resultant damage to the underlying
brain. There could be bleeding in different parts of the brain
and blood may get clotted there. Sometimes this bleeding could
be severe enough and may start compressing the brain. The brain
is a tender and delicate organ, enclosed inside the shell of
bones and even a small amount of bleeding can lead to tremendous
increase in pressure inside and can compress the brain. There
could be fracture of the bones which can get depressed inside
the cavity thus leading to direct pressure on the brain; these
injuries are those that are best detected by a CT scan of your
patient's head. A few of these critical types of injuries may
need an urgent operation by a neurosurgeon. Another form of
injury occurs which is not visible on a CT scan. It occurs due
to changes at the brain cell level. It occurs due to swelling of
brain cells and will not need any operation.
This
kind of injury in our words is called as "Diffuse Axonal
injury." It is treated by medicines, which decreases the
swelling of brain cells. Remember right here that there is not
much medical treatment to such patients, so do not panic that
medicines given to a serious patient are few in number.
The
incidence is highest in people in the prime of their lives,
coinciding with important events such as completing their
education, developing their careers and establishing their
families, and thus at a time when they are more likely to have
financial problems, i.e. head injuries occur most often among
people aged 15 to 30 years.
Young
men are more likely as women to suffer a head injury (male:
female ratio, 3–4: 1). Much of this sex difference is thought
to be related to risk-taking behavior and is therefore
potentially preventable.
Two
other age groups are at high risk of head injury: the elderly
and infants. The elderly are likely to injure themselves in
falls; infants and children may be dropped from an adult's arms,
stumble down stairs, or fall from highchairs or changing tables.
Abused children may also suffer from head injuries. Too often,
children are injured in automobile accidents because they were
not protected with safety seats or seat belts. Children struck
by moving vehicles can also receive head injuries.
What
are the common modes of sustaining head injury?
The
common modes of sustaining head injury are:
1.
Road traffic accidents most commonly encountered by two wheeler
drivers and cyclists who do not put on helmets.
2.
Fall from height leading to an impact on the head.
3.
Fall of heavy object on head such as collapse of roof.
4.
Cases of assault, hit by a lathi or some other metallic heavy
object
What
is the treatment protocol for those who survive?
After
receiving treatment in the hospital, the head-injury patients
may be allowed to go home to complete the recovery process.
Outpatient therapy may be provided at a rehabilitation center or
in a hospital with a rehabilitation program. People with more
severe injuries, however, will live at a rehabilitation center
for some time in order to participate in a more intensive
program of physical and psychological therapy. These patients
may make periodic visits home. In
India
however these centers are not so well developed.
Many
people who have had a head injury are sad or depressed. Helping
the patient cope with these and other effects of head injury is
one goal of long-term therapy.
As
mentioned above, a number of specialists may be called upon to
help rehabilitate the head-injury patient. Psychologists can
help patients to understand the consequences of their injury,
cope with marital and sexual difficulties for assistance when
they need it. Services offered to he patient include instruction
in basic living skills such as bathing, dressing cooking and
reading. Although
some patients remain combative, most people progress to a
condition of greater control. Whatever the patient's disability,
any denial of the problem by the family can subject the patient
to more frustration and put pressure on the person to reassume
responsibilities prematurely.
Even
when a patient recovers, the rehabilitation process can be
terrifying to relatives. Distressing effects of personality
change and impaired intellectual function — no matter how
temporary — can be overwhelming. One research study in
Scotland
found that an injured person's mental handicap tends to break up
a family far more than does a physical handicap.
For
more information, please contact PROF RAMA KANT at ramakantkgmc@rediffmail.com
(The
author is a senior public health and development journalist and
writes for English newspapers in 11 countries. He co-authored
‘Head Injury Care Manual’ which was released in January
2007. He can be contacted at: bobbyramakant@yahoo.com)
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