Post conflict Sierra Leone. That is how it is still categorized 7 years after the last of the UN peacekeepers have left; many agencies and companies will pay you an extra stipend for coming to Sierra Leone, so I am told. But in the ‘town’ of Mokanji, southeastern Sierra Leone and in the heart of rutile and bauxite mining lands, at least on the surface, the conflicts seem to be confined to the water wells and pumps where some older kids feel the need to ‘flog’ a smaller child in line to fetch water or under the plum tree where 5 kids battle for one or two juicy plums that was knocked down after 30 minutes of stone throwing or ‘stoning’. But in a society that still holds on to primitive farming techniques and venturing into the ‘bush’ for most necessities, cuts, lacerations and puncture wounds are a daily occurrence and often lead to major infections and even debilitating complications.
Once the word got out that ‘pumwae doctors’ (not sure how I feel about being referred to as ‘white’ although on a few occasions I have wished I was, but that will be for another post) were in town, they seemed to come out of the woodwork. Two week old machete wounds with gangrene, month old wounds with frozen joints and contractures and more than one injection site abscess from local practitioners whose answer to all maladies involve a ‘shot’. They all had the same story, “I having drinking the potion that the local medicine man has been giving me but I not getting better”. Or worse, “if I go the Freetown (the capital city) they will just amputate” The exact truth of this is unclear but I am sure it is somewhere in the middle with someone who went to the capital and ended up getting an amputation and the family’s reluctance to come up with the money needed to pay for the cost of transportation to the city.
It was our second week in Mokanji and my pregnant, yet eager and very OCD, wife decided to tackle and inventory the ‘Men's Ward’. For those who are not familiar with this place (and that would be all of you), it is part of the building that will eventually be the Men’s Ward and where most everything is stored, medical and otherwise, and we were eager to get a handle on what kind of supplies we had on hand. And that is where I discovered the nearly 500 single use packs of …that’s right…Surgilube, that very nectar of the Operating Room, that essence of sterility, that bacteriostatic potion that has saved the reputation of many a wayward surgeon.
Wound care has taken on a whole new dimension in this ‘rustic’ setting. Cleaning and keeping them clean is a monumentous task where ‘keep it clean and dry’ is not only easier said than done, it is often lost in translation. It is cost prohibitive and logistically impossible to do daily dressing changes, and semi-sterile conditions to do dressing changes, well it only exists in my dreams. So… Surgilube to the rescue.
Soak and thoroughly clean the wound as best you can and lather on the Surgilube. Apply dressing and tell the patient to come back in 3 days. It is a beautiful sight to see a clean wound on the first dressing change and granulating tissue with the second dressing change on a wound that was all dead tissue and pouring with pus just a week ago.
Two inch injection site abscess with tunneling? No Iodoform gauze? No problem. Pack every three to four days with gauze soaked in… you guessed it…Surgilube. Three to six weeks and it is all filled in. Ten days of PO antibiotics doesn’t hurt either.
As my fame spreads to nearby villages, there is a down side...I am running low on Surgilube.
On a more serious note, please be praying for a 4 month old baby girl I am treating with a huge abscess from an injection to the right buttock (administered by local untrained ‘practitioner’ and an inappropriate injection site for a 4 month old) that was initially treated at a hospital 2 hours away but asked to find continuing wound care closer to home.
|1 month old infected machete wound|
|One month later, thanks to a course of oral|
antibiotics, frequent dressing
changes and Surgilube