When it Rains it Burns...and Turns Violet

It is June and already the rains are beginning to pound the coastal countries of West Africa. We have been in Sierra Leone for just over 3 months now. When we arrived in late February, the climate was akin to Chicago or New Orleans at the peak of summer, hot and humid and on some days…very hot and very humid.  The rains are a welcome change for many reasons, the biggest of which is, you guessed it, water. The lines at the water pump tend to be shorter since the rains have begun. The children seem to spend less time at the wells pumping water as the rains can fill all the containers at home to overflowing.  The air is also less smoky now that the rains put an end to farmers who, in the 21^st century, still insist on burning to clear farmland and prepare for cassava planting. But the rains also bring a few hazards with those refreshing showers, and I am not even talking about the cobras and vipers or the surge in pediatric malaria cases. I am talking about purple children. Purple children?? you ask? Well, let me explain.

The rains force the children indoors. The children who spent their entire day and sometimes a significant part of the evening outdoors wandering, collecting water, gathering firewood and sticks, ‘stoning’ mango, plum and other fruit trees for food, and otherwise foraging in the ‘bush’ find themselves having to spend more time closer to home or worse, at home.  It also means getting closer to the fire and being home when the piping hot food comes off the fire. Yes, here the cultural norm is cooking over an open flame. The stove is three rocks and a pot is placed over it. Some houses have a hut they cook in but it is still open flame cooking. The children who get burned often do from either reaching into the pot still on the flame or from the piping hot food spilling on to them. The story often gets lost in translation but the result is still the same – children with first and second degree burns covered in gentian violet.  Yes, that mainstay of wound care in many an impoverished and resource limited setting, gentian violet. While gentian violet has some great antibacterial, antifungal, and antihelmintic properties, there are better (and less messy) things that can be used. But here, if it is skin related then it calls for some purple haze and for burns and blisters, it is a whole lot of Hendrix. We had wounds that have healed long before we were able to wash off all that dye off the skin.

We currently have at least four children aged 1 through 6 that we are treating for burns. Thankfully all have been manageable within our scope and ability, meaning none of them worse than a second degree. And all are slowly healing with the help of frequent dressing changes, silver sulfadiazine, and the occasional application of Surgilube.

Before starting treatment. The burn is covered in gentian violet and black/purple eschar, so it is hard to tell the extent of the burn.

After about a week of treatment. Almost all the gentian violet has been cleaned off and there is good tissue starting to grow. The worst part of the burn is on his shoulder, but is healing nicely.