Monday, September 27, 2010

Monday morning...

I don't have any pictures to go with this post but I have to post to share with you how my morning (and Monte's) went yesterday. It goes back to last night when we went to visit one of the families from church. The mom (not going to name any names here) had called earlier because her son had a problem with his skin and she wanted to know if we'd bring some antibiotics. We have access to the group's medical supplies so it's not uncommon to have people come and ask us for Tylenol or Benadryl for headaches or colds. But if they need antibiotics I prefer to refer them to the clinic. Currently we don't have any antibiotics for children, anyway, but I said we did have antifungal cream if it's a skin issue. (lots of problems with skin fungus right now it seems) So we went to check things out, thinking I'd call one of my nurse friends to fill them in and get a phone consultation.

When we arrived what was a 'skin problem' was actually a large boil/pimple/sore on her son's behind. It was approximately 2 inches in diameter and raised nearly an inch from the surface. It was hot to the touch and quite red. It was screaming "infection" to even the untrained eye and he had missed 3 days of school from it last week. I called Nurse Marcy for a consult and she said that he needed to go to the clinic, preferably that night. Mom didn't want to go to the clinic for several reasons. She said her son gets very nervous about the clinic and was afraid to go, she didn't want the doctors to get mad and ask her why she hadn't brought him sooner, and she thought that she could have a man from church come over and apply pressure to "pop" the sore open and drain it. We answered these concerns with telling her that: she is the mom and if her son doesn't want to go she has to take charge and make him go, the longer she waits the more questions the doctors will have about not bringing him in sooner, and do NOT allow someone to come in and 'pop' it--draining it in the clinic is done with clean tools and doing it at home is not safe and can further the infection.

Finally, she agreed to go Monday morning but only if Monte and I went with her. Partly she said she wanted Monte to be there to help restrain her son if he needed an injection and partly I think she wanted us there because she thought if the Americans are with her she won't get chastised by the doctor so much.

She arrived almost two hours after she told us she would and tried to tell us that he didn't need to go to the clinic because after some warm compresses Sunday night the sore opened and drained on its own. She then showed it to us and it had drained somehow but was now weeping yellowish clear fluid. I told her that she still needed antibiotics for him to take care of the infection and that it needed cleaned and covered and that needed to be done by a doctor, so she agreed to go.

At the clinic the doctor diagnosed it as an abscess and did, indeed, ask why she'd waited so long to come to the clinic. The doctor wrote three prescriptions and then sent us to the other side of the clinic where the 'pharmacy' and treatment rooms are. Mom was the only one allowed to go back with him for treatment and we soon heard a lot of yelling coming from him as they treated it. During this time Monte and I waited in one of the waiting areas and observed several things.

1. A couple kissing and groping each other in the doorway and later the waiting area of the clinic.
2. A random dog that walked back and forth through the waiting area multiple times that no one ever once tried to 'shoo' outside.
3. Numerous babies that were only a couple of weeks old there for their shots--most of them with teenage mothers. (one told me she was 16.)
4. One toddler with a croupy cough whose mother evidently knew one of the aforementioned teenage mothers of the infants because she came over to let her croupy toddler see the new baby and proceed to cough on the baby as he looked at it. No one once tried to shield the infant from the coughs.
5. A teenage boy with a hand wound of some sort that was wrapped in a blood-soaked paper towel and continued to try to text with his 'good' hand.
6. A woman made an attempt to mop the floor with a mop made from old towels at the end of a wooden handle. It was only wet enough that about 30% of the floor behind the mop was wet as she passed by. But at least it was an attempt.
7. When the nurse came out of the 'emergency' area and called for the next patient, the boy with the blood-soaked towel on his hand tried to get up and go in but the nurse told him to sit and wait his turn and called back an elderly woman who had a gauze-covered wound on her leg and sent him back to his seat.

We're still not entirely sure what the treatment of our boy entailed but it seems it involved more draining of the sore as well as cleaning and covering it with gauze. Everyone in the waiting area could hear the wailing going on. Then mom came out to get the prescriptions filled as he needed an injection of penicillin and she was sent to retrieve it. Unfortunately, the hospital pharmacy didn't have any so someone needed to go to a pharmacy in town to buy it. Monte and I grabbed a mototaxi and went to get it and were able to get a mototaxi driver who didn't mind waiting at the pharmacy and taking us back to the clinic. The cost of 5 days worth of penicillin injections was $6.75. Yes, 5 days worth--he's going to have to go back once a day through Friday for another injection.

When we arrived back at the clinic, though, the hard part was beginning. The boy did NOT want to receive an injection after the treatment he'd just received and began throwing a terrible fit in the lobby. He was hollering and pulling away from Mom and started to hit her when Monte laid a firm hand on his shoulder and told him, "No." His pulling continued but he did not hit mom. He did try to knock the medicine on the ground and they were finally able to take him back for the injection and Mom looked at Monte and said she needed his help so he went back with her. I stood in the waiting room feeling rather obvious as "the American lady with that screaming kid that's back there," as everyone stared towards me and the door I stood beside. I exchanged smiles with a sweet old lady who then laughed and told me that, "He's just afraid of shots." The lady next to her then commented as well that, "They hurt when they give them to you there" and rubbed her backside. To use the word loud to describe his hollering does not do it justice. He was wailing for all he was worth.

Monte later told me that it took three of them to hold the boy down so that one other could give the injection and that it took two tries to give it to him because he was fighting and too tense to inject it. One man held his feet, Monte held his back/torso, and mom held his head/arms. After it was all over, the boy did say Monte was still his friend and that the injection hadn't hurt as much as he'd expected it to. As we headed home, the boy was walking pretty slowly so we called the friendly mototaxi driver we'd encountered earlier and had him give mom and boy a ride to their house.

Remember, we still have 4 more days of injections to go. We're hoping today's injection goes a little bit smoother. One morning of drama is enough for a week, right?

By the way, the boy is back in school this morning (Tuesday). I saw him before school started and he was smiling and said he's feeling better today.


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