Wednesday, 17 April, 2024
HomeOccupational TherapyHand replantation following a muti-crime amputation – KZN case study

Hand replantation following a muti-crime amputation – KZN case study

A KwaZulu-Natal man, identified by the pseudonym Bongani, is believed to be the first survivor of a muti crime involving a hand amputation, and has shared his ordeal with occupational therapy experts in a Journal of Hand Therapy study.

The study was authored by hand therapist Wendy Young and University of KwaZulu-Natal occupational therapy associate professor Pragashnie Govender and senior lecturer Deshini Naidoo.

Bongani was referred to Young by his surgeon for post-operative therapy. He received his rehabilitation at a private clinic and his treatment was paid for through the Compensation Fund.

“The purpose of the study was to obtain insight into the lived experience of the trauma, challenges and success during the expected long journey of rehabilitation after a hand replantation. Bongani agreed without hesitation,” the researchers told the Sunday Times.

In a series of interviews, Bongani related how his hand was chopped off at his workplace about three years ago.

He was with a co-worker when an intruder came in, made them lie down, and tied them with cable ties. After taking their valuables the attacker ordered Bongani to put his hands on the table.

“I thought maybe he was one of those guys who cuts people’s parts, maybe for the purpose of selling them. I did as the man demanded,” said Bongani.

The man chopped at his hand, but fortunately never severed it completely.“It was hanging with a little piece of flesh to my arm.” The attacker then fled, fortunately, without a second attempt, and minus the limb .

Bongani lay in a pool of blood for several hours before being taken to hospital. “They … put my hand back. It’s an unbelievable thing. You only see it in the movies but it’s happening in my life.”

Bongani attended a total of 123 occupational therapy sessions over two years, but returned to his job six months after the attack.

The study states that “based on a perusal of available literature, the authors are unaware of any survivors of a muti crime involving hand amputation, nor reattachment of severed parts”.

Elani Muller, head of the South African Society of Hand Therapists, said:

“Anecdotally we estimate around six attempts of hand replantation a year across two of the largest public hand units in SA, but unfortunately probably only a 50% success rate.

“For replantation to be an option the patient needs a specialist orthopaedic or plastic surgery within a few hours after injury as the time to replantation determines whether surgery is an option. Access to this kind of specialist care is not possible for most South Africans.”

Around 17,000 patients with hand injuries or conditions are treated by a South African hand clinic each year.

According to the American Society For Surgery Of The Hand, a number of steps are involved in the arm, hand and finger replantation process.
Step 1: Damaged tissue is carefully removed.
Step 2: Bone ends are shortened and rejoined with pins, wires or plates and screws. This holds the part in place to allow the rest of the tissues to be restored.
Step 3: Muscles, tendons, arteries, nerves and veins are then repaired. Sometimes grafts or artificial spacers of bone, skin, tendons and blood vessels may be needed too. The grafts can be from your own body or from a tissue bank.

Study details

“It was like a bad dream”: Making sense of violent hand amputation and replantation in South Africa

Wendy Young, Pragashnie Govender, Deshini Naidoo.

Published in Journal of Hand Therapy on 12 January 2022

Highlights
• Perception of muti crime makes this a novel contribution to rehabilitation literature
• Qualitative narrative of an extreme and unusual case including hand replantation
• Violence is normalised and the impact of the spiritual realm is considered
• Hand therapists urged to be attentive to psychosocial needs after violent injury
• Value of occupation-based hand therapy is highlighted

Abstract

Background
South Africa is faced with one of the highest rates of violent crime in the world. Accordingly, therapists treat high numbers of deliberate hand injuries. There is, however, a paucity of literature exploring the lived experiences of these survivors.

Purpose
The aim of this study was to describe and interpret the meaning of living through a violent hand amputation and replantation, the impact on occupational adaptation and to reflect on therapeutic intervention, within the context of South Africa.

Study Design
An exploratory embedded single case study using a qualitative approach.

Methods
Interpretative phenomenological analysis was used to analyse data from: 8 interviews with the primary participant, over a period of 33 months; an interview with his work colleague; interviews with 5 health professionals; a review of the occupational therapy rehabilitation file and a review of the audio-visuals, recorded over 2-years.

Results
This narrative reveals a man who understood his terrifying assault to be part of a southern African ritual of spiritual origin – using human body parts for traditional medicine (muti crime) or witchcraft. He perceived his expensive hand replantation and therapy as surreal and violence as normal. Challenges highlighted the importance of being attentive to the psychosocial sequelae of violence; and the most valuable part of therapy was perceived as occupational engagement.

Conclusions
The perception of attempted muti murder situates this extreme and unusual case study as a novel contribution to the medical and rehabilitation literature. South African therapists are urged to be actively involved in changing the culture of violence, and hand therapists are reminded of the importance of applying holistic and occupation-based intervention.

 

Sunday Times article – KZN man’s hand severed in muti crime saved through rare replantation surgery (Restricted access)

 

Journal of Hand Therapy article – “It was like a bad dream”: Making sense of violent hand amputation and replantation in South Africa (Open access)

 

See more from MedicalBrief archives:

 

UK man's severed hand saved by temporarily sewing it into his groin

 

Albinism killing for muti: Immunity for state witness accomplices

 

 

MedicalBrief — our free weekly e-newsletter

We'd appreciate as much information as possible, however only an email address is required.