Series on Pakistan: Wound Care for the Wounded

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.

These wounds were symbolic to me of all that the people surrounding us had been through —  unspeakable losses, fearful traumatic flight from home, long journeys over rough terrain to an unknown destination.   I could not begin to fathom the full impact.  I felt like my act of pouring water on the wound with prayers in my heart for them was a gift of God to me.  They are a beautiful, resilient, appreciative, teachable and hospitable people!


Because of the interest in this series, a closing entry titled “The Benediction” will be posted on Saturday and “Holy Moments from an Unholy Disaster” will be an extra posting of general reflections before moving on to other topics on Sunday 1.9.11.  Stay tuned on to this blog  for ways to help the people of Pakistan.

 
Last night PBS Newshour had this special on the floods – A Validation of the ongoing need in Pakistan.
 

Series on Pakistan: Triage??

Note to readers:  This entry is Part 3 of a 5 part series.  If you have just begun to read please feel free to reference Part 1: Orientation.  Thank you for your interest!

This entry is authored by Carol Brown.  Carol is a Registered Nurse and worked in Pakistan for 2 years at the hospital mentioned.  She met her husband Dan while working there.  Carol currently works as a community health nurse and whenever she is given the opportunity boards a plane to encourage, work, and build relationships.

 tri·age –

  • the rationing of patient treatment efficiently when resources are insufficient
  • to treat all immediately; the process of sorting victims, as of a battle or disaster, to determine medical priority in order to increase the number of survivors

Following our morning clinic in a remote village where we had dispensed medicine in a rough lean-to, bumping our heads more often than I care to recount, we were headed to a nearby village for an unexpected, unplanned short clinic.   We were tired, hot and thirsty.  The set-up would be fast.  We would see as many as we could in forty minutes.  The decision had not been well met by some of us, anxious to call it a day, with the heat, dust and challenges having taken their toll.  Our team leaders had determined that for the sake of relationship, of high value here, we would need to do the clinic now and come back for a longer visit and survey of these families’ needs.   The short distance on the dusty, rough road was not long enough for the van’s AC to make a dent in the 105 degree heat.  We clambered out of the van – five of us, three foreigners and two Pakistanis – with our depleted nine-box portable dispensary.

“Carol, can you do triage?” asked Dr. Wendel.

My internal response:  “Yes, I can do triage.  I can prioritize well.”   Looking into the sea of Sindhi faces in the crowded courtyard, babies crying in their mothers arms, all of them sick and anxious for a hearing with the Doctor, I quickly realized my limitations.

“No,”  I answered, “Rahanna needs to do triage.”

I felt a sense of personal failure.  I’m an experienced nurse and I travelled ten thousand miles to help.   But our time is short, our resources are limited, we’ve given out most of the malaria drugs we have.   All of these people are sick.  I don’t want to miss the details of their stories, and mistakenly treat the baby with worms and a fever over the one with meningitis because I misunderstand a word or phrase.

Rehanna is a gifted, young Pakistani health worker.  She has served at Shikarpur Christian Hospital in numerous roles.   She has the discernment and skill to take in all the details and to prioritize appropriately.  Her patience and compassion are felt by the women.  I watched as she effortlessly took over and organized the crowd.

To realize our limitations is humbling.  This scenario played out repeatedly over the course of our two weeks.   We needed each other.  The experience of teamwork was a gift.   We could not function without the help of our Pakistani co-workers.  Neither could they accomplish the work without us.   It was exhilarating to participate.

Here’s the problem.

Those nine boxes were inventoried and packed on our last day, ready for use by the next team.  There hasn’t been a next team. The boxes remain in storage, the medications expiring and gathering dust.  The staff on the ground continue to work, but they don’t have the human resources to keep a hospital functioning and run mobile health clinics with the staff they have.

In early December I received an email.   Was there any way we could send more money to buy blankets for refugees facing the frigid, forty degree desert nights?   Funding had run dry.   From our small community in Western Massachusetts, we sent another 1000 dollars.  It will buy blankets, but then what?

Update- Pakistan has experienced yet another tragedy in the death of Salman Taseer – governor of the Punjab.  Taseer was a strong and outspoken leader,  recently working to change the blasphemy laws in Pakistan. See story here:

http://www.nytimes.com/2011/01/05/world/asia/05pakistan.html?_r=1&nl=todaysheadlines&emc=tha2  

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