by Kelly N Patterson
Don’t worry-- I am not going to post every clinic visit here at the Operation Safe Drinking Water Base Camp (only the interesting ones!) However, because this was my first clinic visit since I arrived; and an excellent example of the unique challenges of health care out here; and recently, I predicted an ER visit from the exact location of today’s injury (remember the slimy submerged dock photo at Bahia Grande primary school?), I am posting about it. I am also hoping you get a better idea as to what challenges we face out here, as healthcare workers, in the remote islands off the coast of east Panama.
Ermelinda happens to be the wife of one of our local MacGyver’s around here named Benerito; he has been working with Operation Safe Drinking Water for over 2 years now as a general handyman/laborer. Benerito and Ermelinda have 3 kids and go to an evangelical Christian church EVERY night. Their children attend the very same primary school in Bahia Grande that I visited a few days ago with Maribel (Operation Safe Drinking Water has installed 2 rain catchment water tanks at this school—I have a whole photo album up on Face Book) as part of evaluating and monitoring the water tanks, and as part of my local community needs assessment.
Anyway, Little Benerito, aged 4, apparently slipped on that filthy, submerged (and no doubt germ/scum infested) dock (which is full of trash) and cut the very bottom of his heel-- and of course, it is infected; and of course, he has no shoes. Shoes are a luxury here (that is why Centro Infantil Cristiano was delivering shoes to children in villages outside of Changuinola; visit http://operationsafedrinkingwater.org/blog/volunteering-in-bocas-del-toro for the blog about this trip!) And of course, both he and his mother WALKED to my house.
And of course, the parents could not tell me when this happened exactly, nor if it involved metal, glass, wood, or what exactly cut him (if it was a rusty metal, we will know very soon and there will be a trip to the hospital for a tetanus shot and then some!)
So how do you clean and dress a deep, infected heel cut (a) for an active 4 year old; (b) a kid with no shoes, who basically lives on a swampy island; (c) people with no medicines at the house; (d) people you know are not using clean water to clean their bodies or home—people who use a river or the ocean to bathe; (e) people with no bathroom, so they go out in the bushes (stepping in other people’s poo); (f) people who do not know “Wash your hands” is the universal law of health—you see where this is going right?
It is not as simple as clean, dry, antibiotic cream, and bandage—how do you keep the bandage dry in these conditions? Even if they wanted to BUY shoes, there is not a shoe store on this island! How do you prevent the further spread of this infection to the boy and his family?!!!
Well, while Little Benerito was bravely soaking his heel in warm soapy water (the only time he shyly teared was when I applied a liquid antiseptic to the wound area—I knew it must be burning), I went through the treatment with both parents several times, which included—“before you clean his wound, wash your hands; after you clean his wound, wash your hands.”
Stressing that they had to soak his foot; clean it (I showed them how); dry it; apply antibiotic cream; and bandage it twice a day—an elaborate ritual that I sincerely hope they will follow. I tried to explain staph infection to them, showing them it would move up his leg to his heart (I think they got it.) I am pretty sure it is not staph infection, but I wanted the parents to know that I was serious about the treatment ritual—if they do not use clean hands and clean cloths, etc. then there really will be staph infection among them all.
“Make sure the cloth you use to clean his wound is CLEAN, with boiling hot water, and then clean the cloth again when you are done. “
I ended up giving Little Benerito one of my rainbow socks as a cover to the bandage (he loved it!) I told the parents to make him wear the sock over his bandage, take it off every night and clean it in boiling water, and let it dry while he sleeps—he will have to wear the same sock the next day.
And since my first clinic patient happened to be related to Benerito-- who is truly a hard-worker, always helpful and patiently teaching me Spanish daily (murcielago= bat), I ended up making my fave African dish (my curry tuna, spinach pasta dish) for Ermelinda and Little Benerito because they spent their lunch hour at the clinic.
During lunch, when not asking a million questions about Guaymi/Guomi customs and rituals, I amused them with photos of Africa. Benerito loved the photos of the animals (some animals he could not identify—they had never seen a gazelles, baboons, or ostriches); and Ermelinda was very interested in the local women’s market (something I have not yet seen here.)
I have chalk, so I let Little Benerito draw on my porch while I continued to learn about the local culture, or lack there of—according to Ermelinda, there is no traditional Guaymi/Guomi clothes or costume; and no traditional wedding ceremony (I showed her photos of a Zulu wedding to illustrate this); and there is no traditional “dance” (like the Honduran Garifuna “Punta”); etc. Interesting.
Every day I learn about 40 new things—from Spanish words to how to outsmart the bats to how to plant cilantro without the crabs eating it all.
