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Friday, July 9, 2010

This little Piggy Went to Market...

Submitted By Jonathan Porter
We all remember the nursery rhyme... based around our finger or toes... but this week one of our local Fulani women came to us with a very very swollen little piggy - her left thumb. It was enormous and swollen down into her hand. She had used herbs and gone to the hospital, but the hospital refused to treat her due to some bureaucratic trash. They sent her away, and she did some more herbal stuff, and then asked us if we could help.
Basically, she got a thorn in her thumb. No big deal if you use antiseptic cream. However, one of the men-folk in the camp (Fulani's are nomadic and although they stay a while they really do not build anything substantial to live in), decided he could cure her sore thumb. He used a (already non-sterile and probably blunt, used) razor blade to open the thumb and then stuffed a mixture of herbs, cow-dung and dirt in the wound. Obviously she was instantly cured.

We used it as a training opportunity at the airfield. All the staff watched (apart from the gory bits) - and learned.
Cleaning the wound was a challenge. Repeated soakings in hydrogen peroxide, rubbing with cotton wool (all whilst wearing surgical gloves, I hasten to add - several pairs) as we reduced the amount of non-sterile materials and pus. As we worked over about forty minutes we started to get a strong ooze of a green and brown substance - to be honest, it looked like decomposed insect body, as I gently squeezed the swollen thumb it burst out - not dissimilar to the Sigourney Weaver scene in Aliens... Everybody but I looked away. I simply struggled to hold back the tears as the pretty heart shaped face of Amina turned towards me and smiled.

More soaking with peroxide, more pus and then, finally, a little bit of red clean looking blood. The table was covered with swabs, bits of 'herbal' remedy and spots of blood. A generous application of triple action cream and a clean bandage, topped with sticky tape and the date written on it (so we know if she touches the dressing before we change it in two days). Amina, her eyes wide, her skinny body, weighing in at around 45 kilos, relieved at the reduction of pulsating pressure in her thumb, spoke to me through Patricia and Jane, asking how much it would cost for the treatmentt. I decided on a high price.

It is going to cost her agreeing to train to do first aid, promise to never use herbs in a cut again, and to use 'triple action' cream on future wounds (anti fungal, anti bacterial and anti inflammatory) - and to promise not use the cream on the cows, goats, sheep, chicken or dogs. And ,in case that is not enough - to give me five smiles. And we would give her the half bottle of hydrogen peroxide and the rest of the antiseptic cream too.

She agreed, and donated the first smile. The final four emerged, without effort, in the next five minutes. So we are quits.

We've worked around the clock

And now after years of education, training, fighting for regulatory change, and building runways, facilities and aircraft, Medicine on the Move is at a crossroads. We need help. All our personnel are volunteers; no one draws a wage for their countless hours of work, not a cent.  To be blunt we need help, physical and financial: to keep our aircraft in the air we need funds to fuel and repair them; to better service the people, we need a full time doctor and a nurse.  We need to build a treatment room and complete our other aircraft.  Even a couple of weeks of your time to assist with building, FOD (foreign object detail) walking, teaching, training, cooking, cleaning, painting, sewing, car maintenance, tractor work, welding - whatever your skill, there is something you can do here... and you would go away a much richer person for the event. That is a promise!

We will continue to do all that we can - but as you can surmise we are overloaded,  we work 24 hours a day, training, flying, building, repairing, deal with runaway girls, working on policy and regulatory change, and fighting everyday for our hard earned pay…. a simple smile that lets you know what you’ve done has made a difference.
Imagine the countless lives Amina can change with some basic first aid training. - she has two fantastically beautiful children - one toinght ran out between the cows - butt naked, smiling and happy... We have a lot to learn from them about happy lives, as we teach them how to live healthier lives. If you think you can help please contact us, we’d love to hear from you.

Update: July 10,2010

Update By Jonathan Porter
Update: Tonight Amina ran out to the car as we passed the Fulani camp - her smile bigger than ever all she could keep repeating was about how she had been able to sleep. It appears that the pain had been so bad she could no longer sleep. Her husband came up alongside her and we made him also promise 'no more leaves in cuts', he agreed. We will dress the wound again tomorrow.

Update: July 12,2010

Update By Mathew Porter
I spoke to Amina and her husband yesterday - both are keen to learn some basic first aid and hygiene. As I was there, I was discussing drugs for sheep and cows with Abdullah, her husband, and as we had all these veterinary bottles in front of us, I pointed out to him that he always uses pharmaceutical drugs for his livestock, as he knows that they are good, and strong, and do the job. But that he then goes out and picks herbs for himself and the family?

He looked down at the drugs, looked back up and chuckled sheepishly - I think he really saw the point. He even asked me to give him a list of basic products to buy to keep at the house to treat small cuts and wounds. I told him we would go together to one of the good and quite large pharmacies in the town to look at them. He then, very ironically, told me he knew the owner of the pharmacy - he used to watch their cattle a couple of years ago!

Update: July 14,2010

Update By Jonathan Porter
Update: Most of the swelling has gone and she is no longer in pain. Some small amount of infection still present - changed dressing amid the flies, cow pats and many children running around playing in the dirt. Here's the challenges. Today they had 'lost' the elastoplast tape because the children liked to play with it. I went back and got some more - but would not leave it with them this time. Second challenge; she has more tablets left than she should - it seems the concept of one, three time per day is translated as one, twiceish per day. Fortunately, she is responding to the antibiotics anyway, I guess a body weight below 50kgs is pretty light... and so it worked... this time... but we need solutions to these two issues in future...

Tried to get across the concept of using the antiseptic cream on every cut - BEFORE it becomes infected.... it was too way out to go anywhere today - but we will keep on the concept...

Only problem is, this really needs other people to do this bit - we are supposed to be the 'link' between need and solution, not the solution to the need directly... the only way we can continue to do this sort of thing is that we get our full time nurse.... so, if you are a nurse (or a practical Doctor) - why not volunteer a year with us, please!

Update: July 22,2010

Update By Mathew Porter
Update for today... we had agreed that today Amina's husband would dress her finger under some guidance, so I went over there. Sat them both down, and went through the process a little bit. Abdullah has seen it done a few times, but really they both needed some briefing on hygiene and keeping things sterile where needed.

Hygiene is something the western and more developed and educated countries and people take for granted. So when one has to go through it, it's a bit like explaining Halloween to a fisherman in a village. One has to be careful to explain everything - such as when saying to go and wash one's hands before doing anything, add "with soap".

He put a latex glove on one hand to handle the sore thumb, and of course had to be told not to touch the outside of the glove with his other hand, and things like that. They understand the basics of all this, but are a little surprised when I tell them that even after washing his hand, he still has to wear a glove!

Gloved up, Adbullah really looked the part though. I did imagine that under different circumstances he may have ended up in a very different job.

The finger was looking good and dry, no pain or sign of infection, but the old skin is still there (calloused and hard from working), and her flexibility of it is still a bit low. All together he (they - Amina was co-operative) did a good job. They are very adept manually, and both understand the importance of keeping the dirt out for a bit longer. So now they are both getting used to this and understanding the importance of hygiene and dealing with small cuts they are to start telling the other ladies and men in the camp not to be using herbs on cuts, and instead cleaning them well (with soap!) and using antiseptic and even dressings if needed. I hope that a few more sessions with them and a bit more education, then next time one of the children from their own or another family hurts themselves they can be the ones to deal with it properly and save pain, money, time and hassle. They both have buckets of common sense, and with some guidance, should be able to know their limits and what they can do, but also expand their limits and their knowledge too!

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