Mumbai: Rajawadi doctors save man’s eye pierced by stray nail

The injured eye; Illustrations of the injured eye made by the doctors reveal the extent of damage

Even as MARD doctors across the state were protesting to condemn the Kolkata rape and murder of a junior doctor on August 17, a team of experienced doctors at the BMC's Rajawadi Hospital performed a emergency surgery to save the eye of 35-year-old carpenter. The patient identified as Sharif Ali Mohammed Khan had been rushed to the Rajawadi Hospital with a corneal tear injury in his left eye. A stray nail had hit Khan's eye at a construction site resulting in the injury. Timely intervention and multidisciplinary team work by experienced doctors and staff at Rajawadi Hospital made it possible to successfully perform the emergency surgery and salvage the eye of the patient.

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On the fateful morning

Khan hails from Ghorakpur, Uttar Pradesh and has been working at various construction sites in and around Mumbai as a carpenter for the last seven years. On the morning of August 17, he was working at an under-construction site at Diamond Garden, Chembur. Khan recalled that when he was trying to extract a nail from a centring frame, the nail came out in force. The nail flew towards him and pierced his left eye sharply before falling down.

"I was in deep pain and was unable to see anything the very next moment. I tried to see from my left eye but I was not able to even though my eye lid was open. I was in pain and bleeding, I was immediately rushed to Rajawadi Hospital by my co-workers," recalled Khan.

When asked if he was wearing any safety gear at the construction site to prevent accidents Khan replied in affirmative and said, "We usually wear safety glasses. The iron nail passed through the opening between the frame of the safety glass and the face, injuring the eye. It was all of a sudden and before I could realise, I was already injured," he said.

At the hospital

Planned surgeries were put on hold and the regular Out Patient Department (OPD) services were called off, due to the doctors' strike. Only emergency services were functional and the senior consultants were available on emergency call.

Dr Jigisha Sharma, head of the ophthalmology department was informed about the injury sustained by Khan, around 10.15 am, soon after he was brought to the casualty ward. "The patient had sustained a serious left eye corneal tear injury, with underlying iris tissues prolapse and lenticular damage. As it was an emergency, we had to immediately take him for surgery, to prevent any spread of infection and to salvage the eye. Any delay in surgery would have led to a faster spread of infection, as iris tissue had already prolapsed, which had potential of even losing the vision permanently," said Dr Sharma.

Team work

"We had very little time in hand and timely intervention and multidisciplinary team work provided by the staff and doctors at Rajawadi, despite the ongoing strike, made it possible to successfully perform the emergency surgery and salvage the eye of the patient," said Dr Sharma.

When asked to elaborate, Dr. Sharma, said, "We had to arrange the operation theatre, which the OT team had taken up for cleaning. The blood tests had to be conducted to rule out underlying health issues and moreover the anesthetics fitness was crucial. Dr Saket Benurwar, cornea consultant attached to Rajawadi Hospital, operated on the patient. The surgery took about 45 minutes."

What next

Dr Sharma explained that they had to cut the iris tissues which had already popped out and had to provide sutures to the torn cornea. The impact of the injury was so bad that the internal lens sustained injury, resulting in advanced cataract in the left eye, Dr Sharma said.

"Though we have discharged the patient after three days of surgery, we have to wait for the wound to heal, and probably after a week or ten days, the patient will be called in for a cataract surgery and post his cataract removal, he will be able to get back his vision, which may take few additional weeks, and with corrective glasses," said Dr Sharma.

She has a word of caution for Khan, stating, "The patient will have to take utmost precaution of his left eye, hereafter, as any further injury to the same eye will be a bigger challenge, as the tissues are already weak and fragile due to the traumatic injury he has already sustained. A second time, it will be difficult to save his vision, with a similar injury."

Dr Sharma said, "On an average daily they get around 100 patients for various ophthalmology issues in OPD and around 3 to 4 cases on an average of injury to eye. Due to the extent of damage to the eye this case was one of a kind."

Sole breadwinner

Khan earns a daily income of Rs 740, working at a construction site. He said, "My aged father, wife and a child are at native place and I will lose my daily income if I do not report to work. Already, since Saturday, I have been in the hospital for three days, and I am not sure if I will be paid for those days of leave, though my employer has assured me that he will pay."

"I never had such an experience in my seven years of work. My last construction site was at DN Nagar, Andheri. It is my bad luck that such an accident happened to me," he said.

When asked about his vision at present, Khan said, "I have been given post-operative sunglasses, to protect my eye. I am unable to see from the injured left eye, though I can see light, I am unable to see anything else. I am worried, with one eye it won't be easy to work as a carpenter. I have been told that I will get my vision back by the doctors and I trust them."

DNB programmes are a saviour

Dr Bharati Rajulwala, medical superintendent, at Rajawadi hospital said, "I would thank the corporation for having Diplomate of National Board (DNB) courses started in most of the peripheral hospitals in the suburbs, since the last three years. At present Rajawadi Hospital provides 11 DNB specialised courses in medicine, surgery, gynaecology, ENT, ophthalmology, etc." DNB is a three-year post-graduate degree.

"It is only due to DNB courses that we have got experienced teaching faculties with vast clinical expertise which has almost reduced the practice of referring patients from Rajawadi to higher tertiary care centres like Sion and KEM hospitals. And in this case, an exemplary multidisciplinary team work showcased the best medical care practice, which resulted in salvaging the eye and protecting the vision of the young carpenter," said Dr Rajulwala.

Dr Mohan Joshi, dean of LTMG hospital and the brain behind starting DNB, said, "Earlier, the tertiary medical care centres would provide ordinary treatments including surgical treatments and this was only limited to either medical colleges or postgraduate institutes. But over the period of time, this tertiary medical care centre, was unable to cater to the increase in flow of patients, coming from all over the city and MMR regions, even from outside MMR areas, and therefore it was need of the hour to have the peripheral hospitals to gear up to provide tertiary care treatment to patients, and hence we started the DNB courses, in most of the civic run peripheral hospitals in the suburbs.

"Today, we have 185 DNB teachers and 90 Resident students pursuing DNB courses, which have changed the entire set up of peripheral hospitals. Earlier we would conduct weekly two to three surgeries at peripheral hospitals but today the number has gone up by ten fold, and that too by giving high quality pre and post patient care and treatment," Dr Joshi concluded.

45 min
Time taken for the surgery