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How to deal with subungual hematoma



Subungual hematoma is a phenomenon in which there is bleeding under the nail, be it fingernail or toenail. It is mostly caused by a crush injury to the concerned digit usually by slamming a car door over the finger, using certain tools like a hammer, or something heavy falling over the digit. Subungual hematoma can cause severe throbbing pain especially immediately after the injury happens, and worsening gradually as the blood collects under the nail (pressure effect). Most people get into a panic mode from this heart-wrecking pain and do all sorts of unimaginable things.

What to do?
Ice compressions – placing ice wrapped in a towel over the affected finger/toe can help arrest the bleeding and prevent further consequences. It can help with the pain a lot!

Elevate the limb – placing the hand or foot above the level of the heart (rather than letting it hang) can help in decreasing the swelling and the pain as it limits the amount of circulation to that area
Take a very strong painkiller – preferably NSAID like diclofenac or ibuprofen
Keep the injured finger or toe as dry as possible and away from closed shoes or moisture
Seek medical help immediately – if unsure seek medical help for advice or active intervention
Trephination/Decompression – if experienced enough and there is clean equipment available, one can make a small hole on the nail bed to drain the blood, depending on the size of the hematoma. But this is better left off to medical personnel as there is slight risk of infection and further damage associated with this procedure

What not to do?

There is absolutely no role medically for any of the following home remedies in changing the course or the progression of the subungual hematoma apart from acting as a ‘placebo’ and making the patient feel like they have done something. In other cases the actions will even cause more harm than good;
Soaking in warm salty water
Applying vinegar
Applying charcoal
Applying toothpaste, or any kind of paste found at home
Shaking of the finger
Sucking on the finger
Try to remove the nail

Care at the health facility

Subungual hematomas differ in size.
If the pain is very mild and the hematoma is less than 25% of the nail area,  home remedies can be enough
For larger ones (>50%), medical attention is needed. The Doctor may numb the affected nail or toe with a nerve block (depending on the decision between the doctor and the patient) and use either cautery wire or a small needle to puncture the nail to let the blood out. 

After the hematoma is drained the pressure beneath the nail is relieved and the pain decreases significantly. The main complication associated with decompression is infection as the hole might act as a portal for bugs that may infect the residual hematoma. Antibiotics may be prescribed but this is not done routinely

X-ray – Very large hematomas might be associated with injuries like broken bones or severe damage to other supporting structures so the injury need be examined properly by a medical professional. There is likelihood of an X-ray in severe cases

Nail removal – if subungual hematoma affects almost the whole nail, the nail bed underneath is likely to have had significant injury. There is also a high chance that the trapped blood will be infected in due course. The most sensible management will be removing the nail altogether, and inspecting and cleaning the nail bed underneath (suturing may also be needed in severe cases).

After – care

If one has had their nail removed (either by the injury or the doctor) these are the steps to follow to ensure healthy recovery;
Daily soaks in warm salty water  or with antiseptic for 10-15 minutes
Daily dressings with dry sterile plaster /band-aid
Turning up for doctors follow-up appointments as scheduled
A new nail can re-grow fully in as little as eight weeks.
NB – Even with the best repair, there is still that possibility that the new nail may grow back with an abnormal appearance.

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Chronic Joblessness: How to Help Curtail it

30th November 2020
Motswana woman

The past week or two has been a mixed grill of briefs in so far as the national employment picture is concerned. BDC just injected a further P64 million in Kromberg & Schubert, the automotive cable manufacturer and exporter, to help keep it afloat in the face of the COVID-19-engendered global economic apocalypse. The financial lifeline, which follows an earlier P36 million way back in 2017, hopefully guarantees the jobs of 2500, maybe for another year or two.

It was also reported that a bulb manufacturing company, which is two years old and is youth-led, is making waves in Selibe Phikwe. Called Bulb Word, it is the only bulb manufacturing operation in Botswana and employs 60 people. The figure is not insignificant in a town that had 5000 jobs offloaded in one fell swoop when BCL closed shop in 2016 under seemingly contrived circumstances, so that as I write, two or three buyers have submitted bids to acquire and exhume it from its stage-managed grave.

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The Era of “The Diplomat”

30th November 2020

Youngest Maccabees scion Jonathan takes over after Judas and leads for 18 years

Going hand-in-glove with the politics at play in Judea in the countdown to the AD era, General Atiku, was the contention for the priesthood. You will be aware, General, that politics and religion among the Jews interlocked. If there wasn’t a formal and sovereign Jewish King, there of necessity had to be a High Priest at any given point in time.

Initially, every High Priest was from the tribe of Levi as per the stipulation of the Torah. At some stage, however, colonisers of Judah imposed their own hand-picked High Priests who were not ethnic Levites. One such High Priest was Menelaus of the tribe of Benjamin.

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Land Board appointments of party activists is political corruption

30th November 2020

Parliament has rejected a motion by Leader of Opposition (LOO) calling for the reversing of the recent appointments of ruling party activists to various Land Boards across the country. The motion also called for the appointment of young and qualified Batswana with tertiary education qualifications.

The ruling party could not allow that motion to be adopted for many reasons discussed below. Why did the LOO table this motion? Why was it negated? Why are Land Boards so important that a ruling party felt compelled to deploy its functionaries to the leadership and membership positions?

Prior to the motion, there was a LOO parliamentary question on these appointments. The Speaker threw a spanner in the works by ruling that availing a list of applicants to determine who qualified and who didn’t would violate the rights of those citizens. This has completely obliterated oversight attempts by Parliament on the matter.

How can parliament ascertain the veracity of the claim without the names of applicants? The opposition seeks to challenge this decision in court.  It would also be difficult in the future for Ministers and government officials to obey instructions by investigative Parliamentary Committees to summon evidence which include list of persons. It would be a bad precedent if the decision is not reviewed and set aside by the Business Advisory Committee or a Court of law.

Prior to independence, Dikgosi allocated land for residential and agricultural purposes. At independence, land tenures in Botswana became freehold, state land and tribal land. Before 1968, tribal land, which is land belonging to different tribes, dating back to pre-independence, was allocated and administered by Dikgosi under Customary Law. Dikgosi are currently merely ‘land overseers’, a responsibility that can be delegated. Land overseers assist the Land Boards by confirming the vacancy or availability for occupation of land applied for.

Post-independence, the country was managed through modern law and customary law, a system developed during colonialism. Land was allocated for agricultural purposes such as ploughing and grazing and most importantly for residential use. Over time some land was allocated for commercial purpose. In terms of the law, sinking of boreholes and development of wells was permitted and farmers had some rights over such developed water resources.

Land Boards were established under Section 3 of the Tribal Land Act of 1968 with the intention to improve tribal land administration. Whilst the law was enacted in 1968, Land Boards started operating around 1970 under the Ministry of Local Government and Lands which was renamed Ministry of Lands and Housing (MLH) in 1999. These statutory bodies were a mechanism to also prune the powers of Dikgosi over tribal land. Currently, land issues fall under the Ministry of Land Management, Water and Sanitation Services.

There are 12 Main Land Boards, namely Ngwato, Kgatleng, Tlokweng, Tati, Chobe, Tawana, Malete, Rolong, Ghanzi, Kgalagadi, Kweneng and Ngwaketse Land Boards.  The Tribal Land Act of 1968 as amended in 1994 provides that the Land Boards have the powers to rescind the grant of any rights to use any land, impose restrictions on land usage and facilitate any transfer or change of use of land.

Some land administration powers have been decentralized to sub land boards. The devolved powers include inter alia common law and customary law water rights and land applications, mining, evictions and dispute resolution. However, decisions can be appealed to the land board or to the Minister who is at the apex.

So, land boards are very powerful entities in the country’s local government system. Membership to these institutions is important not only because of monetary benefits of allowances but also the power of these bodies. in terms of the law, candidates for appointment to Land Boards or Subs should be residents of the tribal areas where appointments are sought, be holders of at least Junior Certificate and not actively involved in politics.  The LOO contended that ruling party activists have been appointed in the recent appointments.

He argued that worse, some had no minimum qualifications required by the law and that some are not inhabitants of the tribal or sub tribal areas where they have been appointed. It was also pointed that some people appointed are septuagenarians and that younger qualified Batswana with degrees have been rejected.

Other arguments raised by the opposition in general were that the development was not unusual. That the ruling party is used to politically motivated appointments in parastatals, civil service, diplomatic missions, specially elected councilors and Members of Parliament (MPs), Bogosi and Land Boards. Usually these positions are distributed as patronage to activists in return for their support and loyalty to the political leadership and the party.

The ruling party contended that when the Minister or the Ministry intervened and ultimately appointed the Land Boards Chairpersons, Deputies and members , he didn’t have information, as this was not information required in the application, on who was politically active and for that reason he could not have known who to not appoint on that basis. They also argued that opposition activists have been appointed to positions in the government.

The counter argument was that there was a reason for the legal requirement of exclusion of political activists and that the government ought to have mechanisms to detect those. The whole argument of “‘we didn’t know who was politically active” was frivolous. The fact is that ruling party activists have been appointed. The opposition also argued that erstwhile activists from their ranks have been recruited through positions and that a few who are serving in public offices have either been bought or hold insignificant positions which they qualified for anyway.

Whilst people should not be excluded from public positions because of their political activism, the ruling party cannot hide the fact that they have used public positions to reward activists. Exclusion of political activists may be a violation of fundamental human or constitutional rights. But, the packing of Land Boards with the ruling party activists is clear political corruption. It seeks to sow divisions in communities and administer land in a politically biased manner.

It should be expected that the ruling party officials applying for land or change of land usage etcetera will be greatly assisted. Since land is wealth, the ruling party seeks to secure resources for its members and leaders. The appointments served to reward 2019 election primary and general elections losers and other activists who have shown loyalty to the leadership and the party.

Running a country like this has divided it in a way that may be difficult to undo. The next government may decide to reset the whole system by replacing many of government agencies leadership and management in a way that is political. In fact, it would be compelled to do so to cleanse the system.

The opposition is also pondering on approaching the courts for review of the decision to appoint party functionaries and the general violation of clearly stated terms of reference. If this can be established with evidence, the courts can set aside the decision on the basis that unqualified people have been appointed.

The political activism aspect may also not be difficult to prove as some of these people are known activists who are in party structures, at least at the time of appointment, and some were recently candidates. There is a needed for civil society organizations such as trade unions and political parties to fight some of these decisions through peaceful protests and courts.

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