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Monday, 01 May 2006

Volunteering in Lesotho - Page 3

Written by Devon Rossetto
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The early morning sun shines brightly; I hang my wet clothes to dry on the clothesline, hoping it will not rain before I come back for lunch. Ever since the water pump has broken and there has been no running water, simple chores like washing clothes takes infinitely more time. As Tarra, a visiting PhD student said to me, “you haven’t been to Africa until you’ve experienced the joy of bucket showers”. I wonder if my experience is even more enriched since our bucket showers come from our rainwater tank, which was also the home for a colony of small red worms that found their way into the buckets and thus, in our showers.

 

 

 

My heart breaks for the orphans here. Some are taken care of by their aging grandparents, others in orphanages of varying quality, others live with other orhans; the older ones taking care of the younger ones. This is an after effect of the AIDS epidemic that has swept the country. Lesotho has one of the highest rates of HIV/AIDS in the world, at 30% of the population. While I don’t keep hard statistics, I am on average diagnosing HIV/AIDS in one child each day.

I am happy today because all the children are alive. There are two babies with acute gastroenteritis and dehydration. One is HIV+, and the other one we haven’t tested yet since the mother is afraid the baby is too young. Counselors talk to the mother of the HIV+ child daily about new medications that can prolong life, but the stigma here is still high. We eventually diagnosed him clinically with AIDS because his condition has deteriorated so much. When we enter the room, the mothers and grandmothers rise from their foam mattresses (on the floor next to the cribs) to tell us how much the babies are drinking of the oral rehydration solution, a low tech life saving drink of electrolytes and sugar. We move from the gastro ward to the general medical ward.

The malnourished toddler is crying and the young mother straps him to her back and begins to walk around. The baby is edematous or puffy from lack of protein, has lost pigmentation in his hair and his skin is covered in sores from vitamin deficiency. It is a sight I only used to see in textbooks but now it is staring me in the face: irritable and miserable. We see another baby with pneumonia, another being treated for meningitis, and yet another who was admitted yesterday with seizures. It is a typical day on the wards and after rounds I head to the clinic. Outside, rain begins to pour and I sigh as I think of my clothes hanging outside on the line.

The stench reaches my nose even before I walk into the exam room. There has to be pus somewhere. The other doctors in the clinic begin poking their heads out of their exam rooms. What is that smell? That smell belongs to a twelve year old boy, his arm bandaged up in a cast that hides the offending culprit. Trying hard not to breathe through my nose, I greet the boy and his sister with the few words of Sesotho I know and then, with the nurse acting as an interpreter, the cause of the stench reveals itself.

Two weeks before, he had been bitten by a donkey and suffered multiple skin wounds in addition to a fractured distal ulna. He had a cast put on his forearm at another clinic at the time of the incident. He now has serious wound infections that are causing pain, swelling, and a foul smell, which led them here to the referral hospital. Although I know nothing about donkey bites from my medical school training, I do remember the mantra of one particular surgeon at Boston Medical Center: “all pus must be drained”. Off comes the cast, revealing about seven deep lacerations around his wrist with green pus and black tissue, presumably necrotic or dead tissue. His arm is swollen and he is unable to move it. I wonder who on earth put a cast over this mess and set about to clean it up and see what was what.

image
a clinic in the mountains
I decide this is a case for the operating room. There is dead tissue that needs to be removed; pus that needs to be scraped out, and the boy will be more comfortable if the whole procedure were to be done under anesthesia. He is admitted to the pediatric wards, has his wounds debrided, his arm in a sling, and soon becomes a constant fixture on the wards, always smiling. He patiently waits through daily dressing changes and the wounds, some of which gape open at 4x7 cm, beginning to close nicely. Smooth pink tissue edges close in over the exposed tendons of his wrist. It is a success. After two weeks he is begging to go home, a several hour walk from the hospital. He wants to get back to school. Not all of the patients are so fortunate.

 

(Page 3 of 4)
Last modified on Sunday, 16 December 2012

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