November 20 th 2017 was time to face the future, the first day back at Bardai hospital and at last working full time.; would there be any patients to see? There have been plenty but here is the story of one from that first morning.
His name is Bardai Eli, an unusual name perhaps the only one. It was chosen by his parents, part of the military garrison, who are far from their home in the south of Chad. He learnt to walk early as children often do here and at 9 months of age eager to explore the world he fell into a cooking fire. He suffered burns to 2% of his body, not much in terms of size, but the burns were to his entire face and forehead. Two days later I saw him on my first morning, his face was a mess having first been painted with gentian violet to dry it at the hospital and then an additional treatment of goats fur had been stuck on at home creating a thick black matted crust. The wound was getting infected and he had a fever.
|Dr Abdul Karim with Bardai|
His worried parents agreed to a hospital admission, and I told Andrea we already had a case for the operating theatre and so she set about cleaning it up, sterilising instruments and swabs and getting equipment ready for an anaesthetic. The hospital generator can no longer power the autoclave so she had to make do with the hot air oven for the instruments and clean but non sterile swabs and towels. Meanwhile he had some pain relief, anti tetanus serum and antibiotics. The hospital has no creams or ointments so his father went to town to get some Vaseline, but came back with some perfumed very yellow petroleum jelly. This was not a good idea, so he went back to town and came back with a tube of fusidic acid cream from a little shack of a pharmacy on the main street.
Bardai was first on the list of 3 patients for the next morning. (The notion of a list in itself was a novelty as only one case had been operated in the 4 months of our absence, a victim of a landmine who unfortunately lost his leg.) Once Bardai was asleep we gently soaked and peeled away all the crust and found that there was raw burnt tissue all over his forehead, nose and upper lip. He must have had his eyes tight shut and this had protected his eyelids which were simply blistered. Once it was as clean as we could make it his face was lathered in cream and left open with this moist potentially healing dressing.
Twice more that week he went to theatre and at last it was clean. He was clearly feeling much better running around outside the ward oblivious of his white and pink face, Thankfully the wounds were only deep partial thickness and being young he had extraordinary healing capacity and soon his red raw bleeding cheeks were healing and he was able to go home. I didn’t take a photo at the beginning, you wouldn’t have wanted to see it anyway, but here he is as an outpatient coming back for a check just 2 weeks after his accident when his Mum said she was very happy for me to share his story. It’s not normal to smile for photos round here.
It was such simple medicine, but in my experience of strange dressings of toothpaste, tomato puree and probably worse gentian violet, can lead to infected wounds and full skin loss so simple things can make a big difference. Two adults, gold miners, with much larger burns to legs (10%) and arms and chest (20%) are also doing well, this time with home made non perfumed petroleum jelly (vaseline) gauze dressings. Clearly teaching our colleagues burns care is going to be an important part of our work and thankfully our colleagues are keen to learn.
As you can see from the description above even doing simple things takes time as supplies are not automatically to hand and many things need organising to make the hospital efficient. We are a long way from Ndjamena, in need of help, and so were delighted to receive a large pressure cooker which MAF were able to put on one of their flights chartered by the EU for a fact finding trip. They were followed by a UNHCR team who came in their own plane. Both teams were interested in displaced people, be they gold diggers plenty of whom are coming from all over Chad and beyond; or migrants who don’t seem very common in this part of the Sahara. After looking round the hospital the lady heading the UNHCR team noted we were sterilising in a pressure cooker. She had also received a request for a young boy that we were treating for a septic arthritis and probable osteomyelitis ( bone and joint infections) to be flown on to their next stop Abeche where he could have an X-ray as our generator is too weak to make the brand new machine function. Her not surprising conclusion for her report was that for the hospital to function well it needs a good 15KW generator for general power such as lighting but especially so that the good equipment in the sterilisation and X-ray dept are able to work.
The report will probably just gather dust, things tend to do that in Chad! However it was good to see that although they really there to assess the bigger picture they could also make the effort to help a small child get access to care about 1000 miles away. So last Saturday morning. Dr Abdul Karim and I were able to take our young patient and his father to the airstrip. (His mother and younger brother had to stay behind.) and put him on their plane. We had done a lot to improve his situation, operating to drain the pus and giving antibiotics, but because of the lack of a simple thing like electricity we were unable to complete the care he required.
Simple things matter.