Evie...

When we first arrived at Mount Meru hospital we were introduced to a beautiful little girl called Evie who was being treated on the paediatric burns unit for substantial burns she had received from hot fat to her head arms and torso. Evie always had a smile and a wave for the Mzungu students when you meet her around the hospital grounds, and so it was lovely to be welcomed onto the surgical unit by her and her friends. Evie always wears a headscarf draped over her head and shoulders and the extent of her burns was covered until we were assisting with wound dressing changes one morning.



Mzungu Kerry and Evie

This was taken just after dressing change

 The resources here are very limited and so gauze is used to dress the burns in attempt to keep the wounds free from infection. Unfortunately it sticks tightly to the wounds and on dressing change day, bottles of sterile saline are gently warmed in buckets of warm water and applied liberally to the wound areas to aid removal of old dressings. The children on the ward are so familiar with this routine now that their tears pre-empt the arrival of the saline bucket onto the ward. The mothers assist competently with the procedure, and as we moved quickly around the ward we come to Evie who is sitting quietly waiting.
She slid the head scarf off as we approached and I was shocked to see that her ears were almost completely burned off, with just two small stumps either side remaining. Her sweet smiling face beamed through the healing scar tissue, and I was genuinely moved by the bravery of this young girl as she sat stoically still as her wounds were redressed.

As part of rehabilitation, we encouraged the willing children to join in singing heads, shoulders, knees and toes which promoted stretching and circulation to their healing wounds. Just before I left to come out here, mummy Robbo bestowed many chapsticks upon me to “keep a happy smile” and one Thursday I remembered to give one to Evie for her poor sore lips and showed her what to do. Delighted, Evie hid the chapstick in her pocket and hugged me and whispered a sweet “Asante sana!”. I had moved to Obs and Gynae on the following Monday but popped back onto the burns unit at the end of my shift to find Evie waving and as welcoming as ever. The doctor appeared and said she thought Evie’s lips were looking much better and when she asked, Evie showed her an empty chapstick tube and beamed her biggest smile yet!

Evie had been in hospital for just over 5 months when she was discharged that afternoon. I was really delighted that Evie’s bravery had seen her through her horrific injuries and I believe that her sunny disposition will give her the strength to shine through the physical disfigurement of the burns. It was a sobering thought to compare the level of care and rehabilitation that Evie may have had back in the UK to all that is available here.

RAFIKIS Evie (on my kneee) and Versace (2nd from right)

Evie is just one of the many children who have been the source of such delight and joy during our time at the hospital especially as despair can feel a little overwhelming at times. 2 year old Versace, a brave wee boy who obtained severe burns to his torso after falling into an open fire, would cling onto my leg as soon as I set foot on the ward. One day Versace discovered the drawstring for my scrubs during ward round and decided to pull them down, which proved so entertaining for the inpatients, and a little embarrassing for me!

Some of the children were not so sure of these Mzungu vistors with their reactions ranging from open-mouthed awe, to sheer hysterical laughter. However, a lovely paediatric physio from Australia bridged the cultural differences on production of a bottle of bubbles which could lighten the mood, even during dressing change day and some of the children wept at the end of the shift as it was time to say “Kwa Heri” to them.

Rotation 2 - Surgical (photos to follow!)

After my rotation on general medical I moved to the surgical wards, and arriving to find the cleaners hard at it made me think it may be a slight step up from general medical. While the wards were still pretty basic on surgical, they were somehow cleaner and a little more orderly than those on general medicine. The surgical wards are over two floors in two buildings with a grassy area between, where the patients were relaxing in the early morning warmth. I soon discovered that this was not by patient choice and in fact the cleaners had turfed them out for this daily ritual as the floors were cleaned, with only the very, very sick or immobile permitted to remain. One morning I walked on to find one small boy from the paediatrics’ ward pushing the bed of a young girl in traction off the ward – cleaners ruled here!

On the adult block, the four wards were split male and female – (which is impressive as mixed wards continue to exist in Manchester, in Nightingale arrangements) with a further split between general surgical and orthopaedics. The smell of festering wounds is pretty pungent around the surgical wards, and it is very common to find poor stitching and wound care post-surgery has left the patient with gaping, oozing wounds that MRSA wouldn’t stand a chance in.

During ward round one Tuesday morning, we were accompanied by Tegan a radiographer in the house from Brisbane who was expertly showing us the x-ray films of the patients on the orthopaedic ward. Most of the patients had two sets of x-rays, a before and after. I cannot really begin to describe my shock at noticing the dates on several patients’ x-rays which clearly showed a marked difference in the bone setting process, where after 4 weeks in cast, the bones were further displaced than the original injury had caused. No explanation was offered for this almost horrific phenomenon, but our assumption was that little explanation and education had been offered to the patients once in their casts and perhaps financial pressure had led them to continue with manual labour after their initial discharge in their plaster cast.

On the orthopaedic wards, many of the lower limb injuries warranted traction which was a simplified version of home, where a screw would be protruding at the appropriate point attached to a length of string which was weighted at the end of the patients’ bed with a carrier bag containing rocks. During one ward round on the paediatric ward the Dr realised the small child with the fractured femur was able to wriggle free from her traction, and so he instructed the mother to gather more rocks for the carrier bag, and she was wedged into position with this.

While the fascinating insight into wound care and orthopaedic care was good, the greatest draw for me came from the two paediatric wards on the ground floor. One ward with 10 beds saw children with a variety of surgical and some medical complaints, ranging from hernias, injury sustained when thrown from a moving vehicle in road traffic accidents, to fractures sustained “playing”, and rather grimly, injury caused by sexual abuse and other forms of neglect. Each bed contained at least one child and their parent, but at busy times it was common to see two children with their respective parents sharing a single bed. On the other side of the nurses’ office was the burns unit, with its 12 beds containing mainly very young children with mainly severe burns to large areas of their bodies, caused by falls into open fires, hot porridge or hot water being toppled onto them. A glance in the report book told me that some of the burns sustained caused wounds susceptible to infection that their small bodies just couldn’t fight, and infant death rate from injuries caused by burns is high here.

I have studied to be an adult nurse, and so many of the illnesses and ailments facing these children surprised me, as I couldn’t believe that children could be struck with such a cruel blow so young. But as nit was explained to me, however big or small, the human body can make the impossible possible and I should never discount the unimaginable.