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The charity had established several different projects around the Nkope area to benefit the local population. The main ones I was involved with were 2 wound clinics, and a home-based care group.
The wound clinics were probably my favourite sessions. The first one took place at a school in a village by the Lake called Nkhudzi Bay. The village was slightly more affluent than Nkope where we were based, and the children at the school seemed better dressed than those we were used to seeing in our village.
The idea of the wound clinic was that it would be manned by volunteers from 8am - 11am 3 mornings a week and would provide free wound care to anyone who needed it regardless of age. When I first heard I was going there (initially on my own) I was slightly apprehensive to say the least. First off I hadn't dressed a proper wound for years and secondly I am quite squemish when it comes to gore and guts!!
My first session was on a Monday morning and being as Nkhudzi Bay was a few miles from our base I was dropped off in the charity minibus by the driver
Sam at 8am and left to my own devices until he returned for me at 11am. I had been told that the wound clinic was supported by another charity and that I didn't need to take any supplies with me. There would be bandages and other sundries there that would help me dress the typical wounds that I would be faced with. Also I was told that a lady called Alice was there to support me and would help me if I needed a second pair of hands with anything tricky.
Two things not quite accurate about the above paragraph:
1. Yes Alice was there to help me but she turned out to be a 15 year old with limited English. Her purpose seemed to be to hand me the limited resources she had in her cupboard and to write the names and ages of the people who attended the clinic.
2. Yes this particular wound clinic was supported by another charity and they did provide supplies. However, the main man only came to visit the clinic from oversees once a year - in June. This was mid May and I was told that there was very
little in the way of decent supplies left because he wasn't due to arrive for another 3 weeks. OK - so I only had a few paper-thin bandages and a bottle of iodine, I would just have to do my best and hope nothing major came my way before the end of the session.
Enter Vincent age 6 years, a pupil at the school who had a particularly nasty wound on this left heel. He was already crying before I even touched him and at that moment I knew I had a problem that simply wouldn't have been any trouble back home. Vincent had an open gash right across the back of his heel, made worse by the fact it was caked in dust and dirt because he was bare-foot. Like a lot of the children in the school he didn't have any shoes and so was walking with his foot directly on the ground. He had got the injury 3 days before so you can imagine how dirty it was.
I could feel myself panicking slightly as I tried to think of the best way to sort this problem. Alice provided me with a bowl of water
and some cotton wool so I sat on the floor with Vincent and tried to wash the wound as best as I could. By this time Vincent's teacher had arrived and I asked her if she could try to calm him down whilst I washed his heel. The teacher was called Nancy and she had decent English. Over the next week or so me and Nancy kind of became friends and she was a useful translator for me at the clinic. She is pregnant, but that's for another story!
Vincent was distraught and this added to my own anxieties. Luckily I had a lolly in my bag and a little yellow stretchy man thing I had brought from home. I gave him both of them but he couldn't be distracted that easily. He continued to cry whilst I tried my best to wash as much dirt off the gash as I could. Virtually impossible with cotton wool since the fibres were clinging to the wound and I knew I was hurting Vincent even more because I needed to put a bit of pressure into my cleaning to try to remove the dirt that was stuck to the wound. I
managed to remove a decent amount of crud from the heel only to find a small layer of pus underneath. Iodine seemed like a good idea (especially since it was all I had to clean the wound with). I dabbed it on and tried to get as much pus off as I could. Vincent went through the roof - he was beside himself and at that moment I felt distraught myself and wondered whether I was doing more harm to Vincent than good. I applied a small piece of the thinnest gauze I had ever seen on top of the wound and wrapped an almost useless bandage round his foot, realising that it was probably a total waste of time because Vincent didn't have any footwear and I had no tape to effectively secure the bandage in place. Luckily he stopped crying and started sucking the lolly. His little face broke my heart - he was tear-stained and snotty but he smiled at me when I shook his little hand and asked Nancy to thank him for being so brave.
When Vincent went back to his classroom with Nancy I went outside and cried at the unjustness of the
situation I had just been in. I really questioned whether I had helped Vincent and was appalled that there was such a lack of basic supplies to help such a relatively minor problem. Alice must have thought I was a complete loon - crying over a small wound, but it was more than that and at that moment I decided that I would bring my own supplies to the clinic when I came back next time and would never be compromised in that way again. I owed it to Vincent and would make sure that he was treated properly the next time I saw him. In fact I saw Vincent again that morning when I was invited into his classroom to hear him and about 60 of his little mates sing a song and recite the months of the year in English. His bandage was still just about on and he was clutching the yellow man. His lolly however was being sucked by someone else!
The next time I returned to Nkhudzi Bay Wound Clinic was 2 days later and this time I wasn't alone. Dave (newly qualified doctor) was with me and we had a bulging bag full
of everything and anything that would make our job easier. I had bandages that an orthopaedic hospital would have been proud of, proper gauze, antiseptic wash, tape and a variety of useful dressings that Clare and I had brought from home donated by generous reps.
Vincent was our first customer and I spent a long time cleaning and dressing his little heel. He didn't cry this time and he left with the best bandage I have ever put on anyone. Probably a bit over the top as you can see from the photo, but I needed to make sure I had actually helped him this time rather than making things worse. To make things even better Clare gave me a pair pf flipflops for Vincent which I put on his feet just as he left to go back to his classroom. His face was an absolute picture as he ran off back to his friends. That brought a tear to my eye again, but this time a happy one!
I returned to Nkhudzi Bay Wound Clinic several more times during my stay in Malawi and each time I saw Vincent his wound was obviously healing well. I dressed
it a couple more times and by the time I was due to leave it didn't need covering up anymore. Hopefully it will heal fully and all he will have to show for his trauma (and mine) is a pair of flipflops! A child's resilience was also demonstrated when I saw Vincent cart-wheeling across the playground after his wound was re-dressed the third time!
Other things I saw at the clinic included sports injuries (Dr Dave did an expert job of assessing, diagnosing and treating without any diagnostic equipment and with basic communication), cut toes, blisters that had turned funny, leg wounds and ulcers that needed dressing. It was an amazing experience and probably the highlight of my work in Malawi. I learnt to adapt to situations that would be classed as basic at home but which totally tested my clinical skills and decision-making there. I also made a few new friends, but more about them later.
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