The injuries sustained by the late Keroche heiress Tecra Muigai were from a high-impact force, a doctor told court on Tuesday.
Doctor Barack Mubarak testified before Milimani principal magistrate Zainab Abdul that from his assessment, the injuries could not have been sustained from a fall from a staircase.
“There was a cut in her head, which is not a normal fall. Such an injury is likely caused by an object with an external force,” he said.
The doctor said the impact was very heavy.
“From initial assessment, it did not appear like it was a normal fall on the stairs. If it was, there would be bruises, but there were no observations of bruises,” Mubaraka said.
He said it is impossible to damage internally located bones, which are very hard, in the impact of a mere fall.
The doctor, who attended to Tecra at King Fahad Hospital in Lamu, said her left temporal bone fractured, extending all the way to the back.
Lawyer James Orengo, who is representing Tecra’s family, asked whether a temporal bone is hard. The medic said it is the hardest bone in the human body.
“The temporal bone is found at the base of the skull. It helps with hearing and the balancing of the body. The brain is in between the two temporal bones,” he said.
Mubarak said that from a report prepared by the hospital radiologist, a fracture of the temporal bone affected Tecra’s left earlobe.
The temporal bone is largely responsible for creating and preserving both conscious and long-term memory.
He also said Tecra was conscious but not able to communicate before she left Lamu Hospital to Nairobi for further treatment.
“The patient was not in a position to give her history. She was alert but not able to communicate,” he said.
Even though the patient had been brought in unconscious after treatment, she could go to the toilet and back without assistance.
Mubarak said he received a CT scan report at 5pm on April 23 and realised that he was dealing with a serious case.
Mubarak was testifying during an inquest into Tecra’s death. She died on May 2, 2020, after allegedly falling.
Omar Lali, who was in the same remises with Tecra when she allegedly fell, was present but did not sit in court. He is set to testify on Wednesday. Omar was Tecra’s lover.
The doctor said Tecra’s clothes had bloodstains on the shoulder and she was bleeding from the ear.
“The brain was swollen, which causes internal bleeding. This showed that it was a serious issue that required surgery,” the court heard.
On cross-examination, lawyer Abubakar Yusuf, representing Omar Lali, questioned if the doctor got any history of the patient at the hospital.
Mubarak said the late Tecra was alert and had bloodstains on clothes and bedding. She also had alcohol breathe and a deep cut in the left ear.
“The ear had cotton wool. I removed it and there was active bleeding. No external clinical findings indicated severe head injuries,” he said.
Another doctor who examined Tecra said she had incoherent speech after being taken to The Nairobi Hospital.
Esther Matu, of The Nairobi Hospital critical care unit, accused King Fahad Hospital of mishandling the case.
She said instead of conducting a blood test together with a CT scan, they only relied on the scan.
“I thought King Fahad was a resource-limited hospital based on the material they presented us with. They did not accord the case the seriousness it deserved,” Dr Matu said.
She said when Tecra was evacuated in Lamu by Amref ambulance, her speech was incoherent. Even though she could speak, her words were not comprehensible and they had to rely on information from her boyfriend Lali, Dr Matu said.
“We did not manage to get any information from Tecra. Throughout the flight, she kept saying mmmh, mmmh,” she said.
According to Matu, Tecra was brought in almost an hour later after the plane arrived. She was dressed in clean dera. She was in the company of Lali and two other women in the ambulance.
Throughout the journey, Tecra remained aggressive and restless.
“She was aggressive, didn’t want to be touched, and was not sitting still.
“There was no bleeding of the skull and no bleeding from the left ear [as captured in] the initial doctor’s report.”
She had swollen left arm and looked sick but did not have any visible injury.
Matu said Omar reported that she had fallen off a flight of stairs after a night of drinking. She said Omar did not witness the fall as he had earlier blacked out from the drinking.
“He told us that he only woke up at around 6am to find her at the bottom of the staircase. She regained consciousness after about an hour after she was taken to hospital,” Matu testified.
Even though the two doctors confirmed that Tecra fractured her temporal bone, Emily Adhiambo Rogena, a pathologist representing Lali, disputed it.
She said Tecra only had one fracture that extended to five bones but not touching the temporal bone.
Rogena also noted that after dissecting Tecra’s body, they identified 11 soft tissue injuries. She was also bleeding from the brain stem.
She added that her brain had shifted to the right, her liver looked fatty and degenerative, the lung had air, and her stomach a bit of erosion.
“The cause of death, as I established, was a severe head injury from a blunt trauma.”