This is number 5 in a 5-part series on Medical Flood Relief in Pakistan. If you are just beginning to read please feel free to check out the other postings in the series beginning with “Orientation”. The authors are grateful for the interest and emails they have received.

Entry contributed by guest author Carol Brown(See Entry 3 – Triage)

• Elderly woman
  blunt contusion of the abdomen caused by charging buffalo

• Twelve-year-old girl
  Infected burns to the bone on three fingers of the right hand caused by electrical wire

• Four-year-old boy
  friction burn on the posterior thigh caused by injury from wheel of a cart

• Elderly man
  Cellulitis from infected scabies site on upper arm
  Reluctant to receive treatment from female doctor

• Elderly, frail woman
  Deep ulcerated heel of right foot caused by  trauma during transport out of flooded area

•  Seven-year-old boy orphaned of his mother in the flood
  Infected ulcer of left ankle

Wound care was my responsibility in our clinics since it is a routine part of my practice at home. Expensive, high-tech, scientifically-engineered agents of healing are my everyday tools in Western Massachusetts.  Silvadene, Acquacell AG, Versiva, Iodosorb, Duoderm, Kaltostat — the list goes on.   In Pakistan only a single, precious tube of Silvadene, was available to me.  Had I brought supplies, they would have been limited and insufficient for the needs and not reproduceable or sustainable by the families.   My tools here:  Boiled water, gauze pads, rolled bandages of torn sheets, gloves, antiobiotic cream, and the precious Silvadene.

The patient was perched on the wooden frame of a rope bed, with family members and curious bystanders eager to view the wound and watch the procedure, a captive audience for teaching.

“Keep the area clean.  Wash it with boiled and cooled water daily, applying this cream very sparingly over the wound.  Cover it with clean cloth.  Always wash your hands before and after you do the wound care.”   I heard myself explain the details.  My Urdu had come back quickly, and it all made sense — until I stopped to ask myself, how would they actually follow the instructions?

Living in a makeshift IDP camp, alongside their buffalos and chickens, collecting dung for fuel, with a single water pump for the camp, how were they to boil valuable water just to pour it over a wound onto the ground?   Yet they did.

On more than one occasion, I cut away the soiled homemade dressing fearful of what I may find. The wounds were invariably clean and well covered.  The families had been sacrificially caring for and protecting the wounds, salvaging cloth to protect the area.  I praised them and sensitively redressed the wounds.

Hameeda, a vibrant 12 year girl with a bashful smile,whose fingers were coated in yellow salve from the bazaar, was in visible pain. Her mother accompanied her to see Dr Wendel.   I was called over to cleanse and dress the electrical burn.  It was a painful process, and Hameeda was brave.  Dr Wendel had brought one tube of Silvadene from Amsterdam.  This was the day it would be used and given away. I was moved to see the care of the family as her father came in from the fields to see how we would be able to help and to watch the process.  Later in the week we heard from one of the team members who had returned to the village to do surveys of the ongoing needs that Hameeda was doing well.  The family was doing the treatment twice daily as instructed.