Within  just a month in trauma and orthopaedic ,I have seen several patients present with mangled  extremities associated with accidents at the job site. Most of these patients are employed in jobs that pay little or no attention to safety. Little can be said of payment of compensations  after such injuries because most of these jobs are not registered with any insurance company. After brief hospital visitations from their employers,  the victims are usually laid off to fend for themselves. This poses great challenges for victims and family economically and socially.
As health workers we go through the daily difficulty of counselling patients to accept painful decisions for amputation of  limbs with poor MESS score ( Mangled Extremity Severity Score ) . A significant number of such patients initially turn down such managment option of amputation leading to far severe late complications. Those who boldy accept amputations and appropriate prosthesis may have to go through several social adjustments such getting a suitable job or life partner.  Such difficulties in a resource limited country where little provision is made for physically disabled becomes more apparent during decision making by patients.
The few big companies available may pay some form of compensation to severely injured workers, however the teeming number of small and medium-sized companies get away without paying any compensation. The farthest they go will be helping to pay for hospital bills during the initial hospitalisation. It may become necessary as health workers to forward copies of hospital bills and disability scores to local agencies with the legal framework on labour laws that helps to secure worker compensations . This will force most companies to register and pay risk allowances or compensations in the event of severe injury to their employees .The few self employed who do not adhere to basic safety rules on the job can also receive caution or however best the law interpretes.
Some of the common occupational injuries recorded are:
1. Crush injuries to the hand among operators of mortar mixing machines
2. Crush injuries to hand amongst corn and flour mill operators
3. Severe burn injuries of the hand in operators of sachets water sealing machines
4. Crush injuries to the hand during the pounding of fufu ( a local dish prepared by pounding boiled cassava and plantain in a mortar) The victim’s hand accidentally gets crushed whilst mixing the food whilst a second person pounds. Attempts at mechanising the process has not caught on well with locals
5. Blast injuries to the foot from loaded hunting rifles. This is common amongst hunter and forest guards
6. Crush injuries to lower limbs from falling trees, common with illegal chainsaw operators.
Fig 1
 

18 year old whose hand was caught in a casssava  grinding machine while operating.
Fig 2

 
50 year old man with near avulsion of palm of Right hand, dislocation of second metatarsophalangeal joint, lacerations of dorsum of hand. injury was sustained when his hand got caught in the roller parts of a flour mill.
 
Fig 3

 
18 year old had his right leg crushed when the tree he was logging in the middle of the night fell towards him. He arrived 8 hours after injury with severe ischaemic injury to the distal tissues. Limb couldn’t be salvaged. Patient refused amputation and opted for discharge against medical advice.
Fig 4

 
43 year old was injured at the same work site with the younger 18 year old brother. He sustained open fractures of proximal tibia and fibula with complete transection of the popliteal vessels. At presentation limb was cold pulseless with no sensation. Medial head of the gastrocnemius is seen in the picture, severed and devitalised. Both patients requested discharge against medical advice.
 
Fig 5



18 year old boy school drop out ,was operating a flour spinning machine when his hand got trapped in the roller parts lead ing to severe injury. He reported to the hospital accompanied by brothers. He suffered avulsion injuries to the distal forearm and palm. His hand was held in flexion , active extension was not possible. Passive extensions revealled flexor tendons largely intact. Flexor retinaculum was grazed but largely intact. Palmaris longus tendon was avulsed.
How do we prevent such serious injuries
1. Better design of mortar mixing, satchet water sealing , corn grinding and flour mixing machines with safety devices that helps minimises contact between operator and revolving parts.
2. Periodic checks of firearms with safety workshops organised as part of renewal of license for usage of firearms
3. Strengthening of labour laws that oversee safety of workers , applying sanctions for offenders.
Credits : Dr Kofi Ametih, Dr Ekremet, KATH, Kumasi