Monday, June 21, 2010

Staring Into the Face of Epilepsy and Burns

Ethelo is a young married woman. Six months ago, while cooking over a fire she had a seizure and fell face first into the flames. In Malawi, those with epilepsy are regarded as cursed, and because of this unfortunate cultural belief, no one would remove Ethelo from the fire, fearing her condition could be contagious. She arrived to our hospital seeking help for her scars. To avoid embarrassment, she wears a cloth wrapped around her entire head and stares down at her feet to watch her footing. She presents with a neck contracture, forcing her head to the left and eyelid contractures exposing her mucosa, painfully to the air. When asked how often she was having seizures at home, she replied 'everyday'. She denied that she was taking any medication and didn't seem to understand that it needed to be taken daily to avoid her convulsions. Near 25% of all patients we treat in Nkhoma have an associated seizure disorder that leads to their burn injury.
Ethelo is scheduled for the first of many reconstructive surgeries this week. We can improve some her scars functionally, but she will never appear the same. The scars will always be evident. Most heart wrenching is that her injury was completely preventable. With education regarding epilepsy, medication compliance and safety teaching around open fires we can prevent these horrific injuries.
Africa Burn Relief aims to enforce these prevention strategies and additionally help cover the costs of anti-convulsants. These medications, only about 5$/month per patient, are unaffordable to the common Malawian living in the villages.
If you are interested in aiding this project, consider a donation of $60 to fund medications for an entire year for an epileptic.

Sunday, June 20, 2010

Rediscovering Ellen

Ellen was the very first patient I ever encountered at the Nkhoma Hospital. Clinicians did not know what do about her difficult and desperate case. I found her in the corner of a small room, with labored breathing, skeletal appearance, flies swarming her, and fear of having her gangrene wounds touched. Her problem was far gone, and I feared that she would not be able to survive her condition in such a late stage. It was evident that she needed both of her feet amputated to have any chance of surviving. We did perform the amputations and gradually started showing improvement. She was discharged, healed, but without the large portion of her feet. Her grandmother(gog-go)took her in and carried her on her back for the next 4 years until an American teacher heard of this child in the village.
With the help of an Nkhoma nurse, Marelise, and the teacher Ellen was donated prosthetic feet that have enabled her to begin walking again! Now that she is has her feet and she is no longer embarrassed of her disability she is now looking forward to attending the local primary school here in Nkhoma. She is a petite, beautiful girl with a contagious smile. An amazing success story and amazing this has all occurred since I have been here, unbelievable really!
In this picture she stands next to her caring Go-Go. When I asked the grandmother if she remembered me she said...'Jennifer!' I couldn't believe she remembered my name after all these years!

Saturday, June 19, 2010

Why Burns Occur in Malawi...

Many people ask me, 'why are these burns happening so frequently in Malawi?' The sad truth is that it is a harsh consequence of living in poverty. According to the World Health Organization, 95% of all burn injuries occur in low income countries. Many Malawians live as farmers, making less than $1 per day. The majority of the population live in mud huts with grass roofs that were originally made over 100 years ago, passed down from generation to generation. To this day only 2% of the population has access to electricity. Families consequently heat and cook by open flame fires. Children will often hover around their mothers, clothes easily catching flames, or small children may be attended to my other children not old enough to have this responsibility. 63% of all burn victims we treat here are less than 6 years old.

Unfortunately, when these burns occur there is rarely a clinician who knows how to treat these injuries. Hence, the need and purpose of our program; to teach local providers on how to care for these patients, giving victims the best chance of survival and quality of life.

Reflecting on Month One

The first four weeks of work have been wonderful here in Nkhoma. As the burn program here is now entering it's 5th year of existence, local staff are taking the lead in caring for the burn victims needs on multiple levels. I am absolutely impressed on how the patient attendant (tech) staff have been performing the wound care for the burns. As always, the operation team has been top notch, the donated equipment is impeccably maintained, and I am well pleased concerning our operative outcomes for patients.
We have had our first Malawian Committee meeting, where staff nurses and clinicians are enthusiastic to be leaders and advocates for the burn program.
Continuing our good fortune, we are incredibly excited and thankful that a Dutch group has graciously donated funds for a newly constructed burn unit will be completed in the next 5 months!
A big thank you is deserved for the Malawi Mission Work Team and the Bosrand Malawi Work Team for making it possible for our patients to have a suitable, modern unit to be housed during their lengthy admissions.