Cruel To Be Kind?

I didn't come into children's nursing to cause pain and distress to children. Quite the reverse. And yet that is exactly what I've been doing this morning. This is something I'm struggling to get my head around. It's just not ok. And yet, in the situation I felt I had no choice.

A 5 year old girl came into Chikwawa hospital with a significant burn to her hand. She had accidentally knocked the cooking water pot off the fire in her small hut. The injury happened yesterday.  She did not receive first aid. Cooling the burn under cold running water for 20 minutes immediately as we would at home is simply not an option. Nor did she receive pain relief, and it has not been kept clean. She's burnt from her elbow to her fingertips. In the UK she would be seen by a specialist burns & plastics team and go to theatre for the wound to be properly cleaned and dressed in a sterile environment. Here, that is not possible.

The function of her hand is at risk, and I know that we must clean the wound and get rid of the blisters. I also know this will be agony. There is little pain relief available, and nothing particularly strong. We have a little sedation which will keep her a bit calm and hopefully affect her memory of the procedure. We wait for the sedation to work but even with that she's crying and screaming. She's in pain and great distress. Pain that I am causing.

We do our best to treat the wound but I know she can't take much more.  And neither can I. We dress it with what we have available. It's not ideal but hopefully it'll be good enough. I'm aware that others on the ward are witnessing this - privacy is hard to come by here - and I worry that we are destroying all trust in our team.

The child drifts off to sleep in her mother's arms after the procedure. I go outside for a few minutes and cry. Tears for the pain of this child, for the compromising of my standards, for the lack of fairness in the world.

The team support me. They remind me of the lack of choice, the need to be cruel to be kind.  Later, one of my team mates tells me she has just seen the child playing and having lunch. Her mother smiled at my colleague. Perhaps her mother understood and accepted. Perhaps the child has forgotten. 

Hopefully I will too.

A Long Walk

I'm in a truck in a world I've never been in before; a world not many people like me are privileged to see. I'm beside one of the trustees of the Nana Foundation, and in the back is an 8 year old girl and her mother. The child is sick with malaria. We're in a remote village in Southern Malawi.

I spent the morning helping in the Chipwaila health centre. It's a small, simple building with two rooms that serves this very rural community. There is usually one doctor here for whoever turns up on the day. As part of our work, we support the clinic with manpower and resources. Many people were waiting when we arrived, one of whom was this young lady.

One glance told us she was sick. Semi conscious, dehydrated, and very hot. We established that she needed urgent treatment for malaria and intravenous rehydration. This is treatment that cannot be offered in the village. Her mother told us she needed to go home to collect her things. She was not clear about where home was. Fortunately, my Trustee colleague, a Malawian, recognised that there may be some distance involved. This child needs urgent treatment.

And now I'm about to find out where home is. We follow unmade tracks across vast expanses of dusty land. We see people walking, carrying huge quantities of sticks on their backs, buckets of water on their heads. The occasional bike. Dogs. Goats. As the tracks get smaller, so do the homes, changing from brick built structures to mud huts with straw roofs. At the beginning of our journey there was a small shop or two, selling basic items. Now those have disappeared. The dwellings are fewer and farther between. We see children collecting water at the pump. They wave at us. Many will not have seen a car; hardly any will have seen a white person.

We arrive. We're outside a circular mud hut. It's about 8ft across. There are one or two other huts within a few hundred meters. The child's grandmother comes to greet us. She grabs my hands, looks into my eyes. She talks to me in Chichewa. We don't understand each other's words but the meaning is clear: thank you for your help. Look after my granddaughter - she's precious. I will. I promise. I later find out that she has lost three of her eight children. She can't lose her granddaughter as well.

Within moments, children have gathered to say hello. They're intrigued by us. They wave, and the more confident ones come and touch my hands. I've been taking a few photos and they're excited by the phone, overwhelmed when I show them the pictures, especially the ones of themselves.

The child's mother returns. I'm struck by the tiny quantity of possessions she has collected. I compare this to the vast amount of belongings most UK families bring into hospital, even to the bits and pieces I carry around every day.

As we retrace our journey, I am struck my the distance. This mother and child must have walked for hours, over harsh terrain, the child in bare feet. This is the reality for many of the poorest people in one of the world's poorest countries. Hours, sometimes days, walk to reach any sort of healthcare. Is it any wonder then that people access help late, sometimes too late?

Context is everything. Today I've been granted a privileged insight into a world not many like me will see. It's an experience I won't forget and one which I hope will make me better at what I do.

Humanity in Healthcare: my experience as a patient

In honour of #ExpOfCare week I want to share my experience as a patient. 

“What do you need today?” my oncologist asked me. A clear signal that my goals would be his that day. 

I had breast cancer a few years ago. My children were still small and settling into their first term at primary school. I was determined that my illness would not impact on them any more than it had to. 

My wonderful oncologist had promised me he would do everything he could to make my treatment fit my life, not the other way round. 

I need to be able to stay upright without vomiting for an hour at 2pm this afternoon I told him. My children had their first assembly and I had to be there.