Evan is an Australian doctor who has worked in emergency medicine and paediatrics. He recently returned home after working as the Medical Activity Manager in Bangladesh in response to the Rohingya crisis.
I can imagine the SPLASH! followed by a cry as boiling water burnt the young boy. This four-year-old on our examination table was perhaps just trying to be helpful when he pulled upon the pot, spilling boiling water down his left leg.
Big blisters have already formed; some have burst with skin hanging as they weep. At least five percent of his body, thigh and leg are partial burns. The fact that there’s toothpaste smeared over his leg is strange to me but it’s evidence of a well-intentioned caring hand.
"The Great Barrier Reef transfixes the boy while my Bangladeshi colleagues gently commence wound care. Burns are so sensitive. We don’t want to cause any more pain but our options here are limited."
We wet the leg with sterile saline, which helps dry the eyes. As carefully as possible in our crowded clinic we do what we can to comfort the boy with a good dose of simple pain killers. I hand him some lychee-flavoured lollies to help him relax and remain distracted.
Later, he is watching a clownfish, courtesy of David Attenborough on my iPad. The Great Barrier Reef transfixes the boy while my Bangladeshi colleagues gently commence wound care. Burns are so sensitive. We don’t want to cause any more pain but our options here are limited.
It would be so good if we could calm this boy with an anaesthetic, but unfortunately it just isn’t available at this clinic. Several firm hands support him; a sheet takes his leg out of his view. Gentle hands tend to the burns, while I try to keep his focus on the cracked screen full of tropical fish.
Only a few days earlier I was training this doctor in wound care. Today, he looks calm and on top of it, almost as though he’s been doing this for years. He washes the wounds with sterile, dilute iodine solution and then gently peels away the dead skin softly, with sterile gloves. The boy budges and wriggles but his cries are soft. A topical antibiotic is plastered onto the debrided patches to help with irritation and prevent infection. Then the gauze, then the bandage, then we’re done. Our brave lad is now fixated on the shark swimming swiftly on the screen in front of him.
"We want to make sure he keeps the dressing on, so our generous bandages make his leg look like that of a NASA astronaut"
We want to make sure he keeps the dressing on, so our generous bandages make his leg look like that of a NASA astronaut. Telling someone living in precarious conditions with muddy floors to keep their dressing clean and dry is not without irony. We want them to return for a dressing change in two days. The father smiles broadly with the result and shakes each of our hands vigorously, while the boy slurps down another lychee lolly.
I’m sure the patients can see that we compromise and improvise every day with such limited resources. But I hope they also see that we are trying our very best.
The boy waves goodbye; a good sign. I think he understands. I’ll add a few more lychee lollies to the stockpile for when he comes back.