Saturday, January 7, 2012
you don't want to look at them too long, not at the burns, and
especially not in the eyes.
3rd. 4rth. degree burn.
its easier to think in terms of the Parkland Formula. wt. in kg X 4 X
BSA burned. replace fluid accordingly.
% burned? roughly 55% body surface area burned.
both arms. all the way around. palms of hands
entire torso. all the way around
both outer thighs.
so now we have our percentage.
so now we should give fluid....right?
and we should keep him from getting hypothermic....right?
and we should prevent infection....right?
and he should be in a heated burn unit. and everything touching him
should be sterile. and he should have a central line. and.... and...
he is lying on the cracked black pediatrics mattress, the same one that
doesn't get washed between patients, the same one that has absorbed
countless forms of childhood secretions over the last few years. nothing
is under him. he covered in by a thin dirty sheet. he is shivering.
no one has applied any Silver Sulfadine (creme that can be used for
burns, prevents infection as well as keeping the burned skin moist to
allow for healing and prevent severe contracture). there are flies all
over him. no IV. no one has given him water. no one has bathed his
so we ( me and another lovely medical student volunteer named Mayline)
go on the warpath. First we find a tchadian nurse to translate, not an
easy task. When is the last time you gave him water? last night?
here, here is a cup for water. tell them to give 90 ml every hour (3
little cups). We filled up the basin. They said they would do it.
Then we got clothes sheets from the OR, scrubbed the mattress down with
bleach, put clean sheets on, carefully bathed him, covered him in
creme. okay. better.
no money for an IV, the feet are so swollen none of the other nurses are
willing to try. so we will push the liquid.
in the US, when you tell a parent to give the child a certain amount of
liquid, every so often. they set their alarms. they will give it every
hour on the hour. they will worry if one drop spills from the glass.
not here. when I say, "give your child water" I get a blank stare.
and then a yes. and then noncompliance. I pass by an hour later. the
cup is untouched. I get someone to translate. they didn't give it. I
repeat myself. you need to give your child water because..........
2 hours later....no one gave him water........
at the end of the day, neither of the parents have give him water once.
.......1 week later......
we are out of burn creme. like, no silver sulfadine, no zine oxide in
the country of Tchad. We are a hospital with a pediatrics ward that is
OUT of burn creme. with now 3 burned patients. words like
unacceptable, reprehensible, unfathonable, rediculous, come to mind.
and the worst part is, a week ago, THE DAY the child got here, i went
to the pharmacy. I asked them, how many tubs do you have left? how
many are in storage? do we need to order more? and he laughed at me.
and said "beaucoup" ( = many, many, many) and I kept asking for an
exact count, and he kept saying "beaucoup"
okay. well, we ran out the next day. called around to all the major
cities in tchad (all, well, 3 of them) and we asked if they had
anymore. they were out too.
thankfully, some of the volunteers here had Shea Butter and donated that
to the cause, buying us another week or two. I talked to the
administration - are you ordering more creme? they had forgotten.
and then we are back to the same old song and dance in pediatrics. the
have you washed the clothes he has laying on? no? why not? get a
nurse to translate. get the husband to make the wife do it. get her to
do it. have you given him water today? no? why not? re-explain the
importance of fluids. Have you bathed this child today? washed the
skin that isn't burned? no? why not? explain the importance of hygiene.
and then we scrub down the kid with bleach water (not the burned parts)
and we scrub down the bed and 2 hours of argueing and fighting later he
is semi - fixed up again.
and then we run out of shea butter.
has anyone ordered more burn creme? of course not.
so, we make our own.
Amanda (another volunteer, med student and bible teacher) and I decide
to make burn creme. because we are so highly qualified for such a task.
first, we walk to the tchadien bar and in a slightly shady transaction
fill our water bottles up with millet wine.
then, we get to raid Tammy Parker's medicine cabinet. among other
delights found there was a bottle of vitamin E capsules, barrier creme,
colloidal silver, and vaseline. sweet.
then, we pick Alum and Neem leaves from friendly trees ( leaves known to
have mysterious "healing" properties....).....
also donated was some precious olive oil and honey.
so, in case any of you are about to travel to a third world country and
work in a pediatrics ward with burned patients and no appropriate products, here is the recipe for
"New and Improved Burn Creme"
20,000 IU Vitamin E
1 cup Millet Wine
I cup Olive Oli ( with Neem and Alum Extract) chilled
2 Tbs vaseline
60 ml colloidal silver
1 cup honey
chill and whip and whip and blend and chill and whip.
the final product was surprisingly, creamy.
so we have been using this with good results the last week and finally,
yesterday, zinc oxide arrived.
and felix, his name is felix, he is still alive. he is eating and
drinking and recovering from malaria. he has an IV now and parts of his
skin are healing.
he has a long road left but we will keep fighting for him.
and in the meantime we need a public health broadcast on the local radio
detailing the dangers of carrying pots of boiling water on your head
with children strapped to your back...........