In my last post, I wrote about Happiness, a young girl I treated while working in a Tanzanian clinic. My second story is of Neema, another young girl I helped treat there. Neema, a beautiful five-year old, timidly approached me at the triage table with her mother and four young siblings. Her head was wrapped in a colorfully printed yellow, burnt orange, and red kanga, a commonly worn traditional fabric in this part of the world. When her mother motioned to her, Neema unwrapped her kanga revealing a severely infected burn-wound that covered the whole left side of her face. She looked me in the eyes for a reaction as I knelt down. I gave her a big, cheery smile, asked her name, and said some silly muzungu phrases to make her laugh. Upon examining the wound more closely, I immediately thought, “skin graph”. I worked hard to keep my smile from turning into an empathetic grimace; I could see that her wound was covered with a tough scab, colored red not by blood but by the ubiquitous rust-colored dust that covers everything here during the dry season.
Burns are all too common here, especially among children, as firewood is the primary source of fuel for cooking and heat. They are often a result of people suffering seizures and falling into fires, and are occasionally the primary presentation of epilepsy, which has a curiously higher rate in regions with high prevalence of malaria. Neema’s mother told us she had burned herself while trying to eat scalding porridge directly from the pot, and hadn’t been able to eat since. I wondered why she wasn’t brought to a clinic earlier, and asked the mother if she had ever been treated for the burn. The mother said she had pulverized some old penicillin tablets and sprinkled the dust onto the wound, in the hopes that it would heal it. An interesting combination of western medicine and traditional practices, I thought.
We ushered Neema and her family into our ‘critical care’ room, where we dressed wounds and saw our sickest patients. I entertained the kids with bubbles and coloring books while the doctors formulated a plan to clean the wound and coordinated with the regional hospital in Arusha for surgery the following week. The lead doctor in our team was trained as an anesthesiologist and was able to sedate her for what would otherwise be an unbearably painful procedure. Another doctor did an excellent job of clearing the wound and dressed it with sterile, silver-embedded dressing to fight off infection for the week she would have to wait for plastic surgery.
While Neema was being treated, Neema’s mother asked if we could also see her other children. Their labs came back and assessments were made: Joseph, who was four, had malaria, James had pneumonia, and Pascal had shilingy (ring worm) on his arms and back. I wondered at the difficulties that the mother faced daily, managing this playful and rambunctious crew, all clearly struggling with these nagging and potentially devastating diseases. And to think, she came to the clinic only for Neema.
Previously, Triage in Tanzania (part 1): Happiness
Next, Triage in Tanzania (part 3): Tough Questions