Submitted by Mathew Porter
Well, on Monday of this week, whilst stopping by Alai and Amina's place at the Fulani camp, Alai mentioned to me about one of the girls in the camp having an infected hand. So off we went to check it out...
Monday...
We went to the house of Draiman. I haven't really met him or his family before - seems they arrived in the camp about a month ago. Living in a little 9foot squared cabin, cooking out front. Wife has three children, and a daughter from previous marriage living there as well. Draiman is a milk trader - goes up to another camp a few kilometres away to buy milk to bring it back, where the women make wagashi for market. Wife is very pleasant, and speaks very good Twi.
Seems that their daughter, Asamau, got a stick in her hand some time ago. Hard to tell when exactly. The mother pulled it out, but it got infected. The mother, it seems, actually went to Alai's place when it was getting bad - people know that Alai has a small first aid kit and go there with small cuts and grazes. From what I can have pieced together, Alai gave her some cream for her hand but on seeing that it was not looking good, recommended she went to the hospital to have it looked at. On this Monday, they have already been to the hospital on the previous Thursday and been given some paracetamol, antibiotics and cough syrup. However, Asamau, who is almost 4, has a hand that looks like this...
Now I am very happy about several things - the first being that no herbs have been stuffed into any wounds...! The second that she has been to a hospital, and the third that Alai can see that there is still a problem, and is seeking more help. I literally call Nurse Lydia whilst I am still with the family, and describe to her the problem. Nurse Lydia asks us to bring the girl to her house so she can look at it, and off we go right away.
Some of the aspects of this are very familiar - a few years ago, we came across a bigger infection than this in a 14 year old girl's hand, stuff with all sorts of ineffective local remedies. Amina's thumb from a few months back was a similar situation, but one of the things that struck me here was that the young girl was most comfortable holding her hand in the same position as Little Lydia from the AvTech Academy's hand is fused in place now. This worried me, as if the infection remained it may spread to other tissues and even bones - possibly resulting in something similar to what Little Lydia is dealing with now.
On arriving at Nurse Lydia's place with Asamau, along with her drugs from the hospital, she was obviously in a lot of pain. Nurse Lydia was very gentle with her, checked her hand and arm for muscular damage, asked a bit of history and checked out the drugs. The stick had gone in the palm of the hand, but the swelling, along with the infection had gone through her bones and muscles, and now also as a protruding sac of pus on the top of the hand. Nurse Lydia told us to go back to the same hospital, where they would be aware of the case, and they would make an incision and extract the infected liquids. Because it was not clear if muscles would be affected she did not want to do it there and then. It was also clear on inspection of her drugs form the hospital that they had not been administered accurately. Rather than 10mls four times a day of antibiotics, it seemed that Asamau had been getting 5mls two or three times a day.
We arrange that I will take her to the hospital in the morning - this is to ensure she gets there at all, as well as on time. I also want to be able to find out what doctor says in case of further recommendations and future administration of drugs/treatments...
Tuesday...
Today I meet Draiman, Asamau's father. I also get to the house to find that the top of her hand has burst overnight and is oozing this morning. Her father is happy that we don't have to go to hospital now it has burst... Well, me and Alai have some news... We are going to the hospital all the same!
I need to stress here that the family are really doing the best that they know here - and thankfully Alai is on hand to guide them with his own experience of his wife's hand, and help them to understand where I am coming from and the logic towards getting further care. Right now, we can see that the open wound needs dressed - it may need further treatment, especially as there may be some debris stuck inside the hand. Draiman has to come with me to the hospital. His wife is looking after other children at the house. This means he is going to lose a day's earnings. However, untreated, this is going to cost a lot more than that. Thankfully, Asamau is registered under the National Health Insurance Scheme, and this should be covered under that.
Above we see Alai and Jane are there - Jane is surprised by the fluent Twi of the mother.
The hospital visit is lengthy. One hour to get the records, one hour to see the doctor and one hour to collect drugs. In there, Draiman was very friendly and open with me - he speaks good English so communication was good. He was thankful for us going there together, and understood that I wanted to understand what was going on as well. The doctor, once Draiman had explained everything, pointed to the date on the records for the nurse to see... Asamau had been in the same hospital four days earlier. And here she was back again. Had the infection gotten much worse because the drugs were not being taken accurately? Had the previous doctor made the wrong call or underestimated the seriousness on the hand - had it been that bad the previous visit? Was it left too long before going the first time? Probably yes to all the above questions...
The doctor sent us to the theatre straight away, and prescribed a different course of antibiotics. We were met by a nurse at the theatre who set about dealing with Asamau without hesitation - no doubt the nurse has seen much worse than this. The time that we have been in the hospital, the hand has continued to weep pus. So the nurse has no trouble just squeezing it out. Asamau however, is in a lot of pain. We have to hold on to her tight whilst between 25 and 50ml of pus is squeezed out. The ensuing 1cm hole wide hole is packed and bandaged. Asamau is also left with a hole inside the hand where the pus has come out from. My teeth are gritted the whole time. She is to come back in 2 days. After a lot of screaming, but a lot of relief, Asamau falls asleep whilst we are waiting for her drugs. Draiman and I manage to stay awake whislt we watch our third Nigerian movie in the waiting room. NHIS covers everything even the drugs. I explain to Draiman the dosages very well. He will come back in two days for re-dressing. He is also happy, but heart broken at the pain Asamau is going through.
Wednesday...
Asamau slept very well in Tuesday night, as is looking a lot happier on Wednesday! However, the dosages need to be explained again to Draiman and his wife. They understand it, but get confused with having to give one 5 ml spoon of this and 10 ml of that. I have spoken to Nurse Lydia who is happy we have been to a doctor, and we have agreed that we need to arrange our next session very soon - next week is earliest we can do it, and the session will be entitled Drug Dosages! I have had some ideas that in the school we can put up visual charts for 5mls and 10mls, and times to give 3 times daily drugs and 4 times daily drugs to make it all a lot easier and safer for the men and women to give and take drugs! The hospitals tell patients these - and there is a pictorial system of circles for drugs dosages that is drawn on boxes by pharmacists and doctors. Lack of education though limits the understanding and increases the confusion. I agree to drop them off at the hospital on Thursday morning to make sure they get there early and seen before things get busy.
The parents understand not to touch the bandage which is also very good. It would not have been the first time someone comes back from hospital only for the family to decide that they know better!
Thursday...
Thursday morning, 7am... No, nobody is ready to go to the hospital...Asamau is not dressed and not taken her medicine yet. She is much better - I talk to Draiman, and am sure that he will send her with the mother later - I have to get to work.
Friday...
I don't get a chance to go there again till Friday morning - this morning in fact! Her bandage has been changed, and she seems to be getting the right dosages of drugs. Unfortunately, the mother has decided that the 6month old baby could also use a little paracetamol syrup for a cough when I get there this morning - I get there just as she is getting the baby to take it. I ask if it is prescribed, and on finding no, I try to stress in my Twi that this is really not cool if the doctor has not recommended it - and thankfully another French speaking Fulani woman comes to my rescue to make sure it is understood very well. I have to explain the whys and the why nots in as nice a way as possible - whilst being firm. The balance between not embarrasing and offending and upsetting and insulting is a difficult one! I also mention this to Alai on the way out - he assures me he will go and clear things up there as well! Nurse Lydia's Dosages event is going to be a mandatory event!
On the way home again tonight, I stop by Alai's - he was able to understand the seriousness of giving drugs to babies that are unprescribed and spent time with Asamau's mother today. In talking to Alai tonight, I have been getting some insight into how far he has come in his ways of thinking and doing. It was tonight that he was telling me that his little first aid kit from Nurse Lydia has run out - comprising of gentian violet, cotton, paracetamol and antiseptic ointments, the children and men come to him for their little cuts. I ask if Amina is involved in this too, and he tells me she deals with the ladies as he cannot as a man... It seems that Asamau's mother came to him on the Wednesday or so before going to hospital with her hand, and he applied some cream to it but recommended she see a doctor. Exactly which events took place when and how is a bit hard to decipher in Alai's broken French - but he definately knew that it was not good and not better when coming to us about it - and has definately learned a lot; I think he has learned the lessons from Amina's thumb a few months back. I also think he is ready for some more training on dealing with basic injuries, as is Amina. I have also seen a change in Alai's other outlooks on life. He is less satisfied, and even slightly frustrated, with the other men sitting and drinking tea when there is work to be done around the place...AND has swept up the rubbish around his house and yard! These changes in habits and attitudes are growing and spreading. In the near future, at this rate, trips to the hospital will become less common.
Asamau is due again to hospital for dressing tomorrow. I will try and get some pictures of her smiling! I have explained to the family and Alai the purposes of taking these photos and documenting this, and they are quite okay with it.
Update Monday February 7, 2011
Today, one week after coming across Asamau, she was out playing with her friends at lunchtime when we were working on the hut. I wasn't able to catch up with her till evening... When she was smiling!
The hand is also looking good - she got some good wrist movement, and the swelling certainly has down, as has her pain...
Glad I went by tonight though, as the mother wanted to take her to a differnet, closer hospital tomorrow for dressing - and I found out this was because other hospital was too far and transport too much, not having consulted doctor... I explained to her the problems with this, and got Nurse Lydia on the phone to re-enforce the point - ie., new hospital, no records, don't know what to do, any other problems, they wouldn't know history! So we agreed that I would drop her there in the morning, they would change the dressing, and Nurse Lydia would come by in the evening to see how it is doing, and maybe talk to a doctor in Akuse about carrying on there, or some other way...
But she is still taking her drugs, at the right times, in the right dosages too. Still doesn't like taking them though! So, we will see what tomorrow brings...!
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