Wednesday, May 27, 2015

Tropical Ulcers (Mostly a completely medical post)

Tropical ulcers. Pretty much a small epidemic in the wet seasons here. Stage One- a pustule, or neglected cut. It seems that any tiny wound like a blister or deep scratch which flies are immediately attracted to will become an ulcer. Stage Two- progression of the pustule to form an acutely painful ulcer with a raised, thickened, and slightly undermined edge. This ulcer grows rapidly for several weeks. A bloody discharge covers the grey slough on its floor, the skin around it is dark and swollen, and muscle, bone, and tendon occasionally lie exposed in its base. Yuck! After about a month or two, the pain, swelling, and discharge improve, and it either heals, leaving a thick scar or it goes on to the next stage. Stage Three- it becomes chronic, and resembles any other long-standing indolent ulcer which over time can cause permanent physical problems. 
Most of the kids in Lormoruchbae (and I would be so bold as to say most of Karamoja) have at least one of these and, like the photo above, some have four or more. I really believe it has to do with the flies. Poor hygiene contributes to the problem but I've had two of these wounds and I use antibacterial soap. However, I don't always get little cuts or blisters covered right away and within minutes the flies on it are enough to drive one insane. I've learned these ulcers are disproportionately painful for their size and I now have a lot more sympathy for my patients. I've also learned (through trial and error on myself mostly) that wet-to-dry dressings are the most effective. (And before any of my nursing friends start to leave me a heated note in the comments section I would like to say I am actually aware that improving practices are telling us that there are much better alternatives to the old school wet-to-dry dressing but please keep in mind that I live in a place where most people still consider penicillin injections to be revolutionary and I don't have access to better options.)  But these dressings need to be changed at least twice a day. When I started doing just a few bad ones last time I was in Lormoruchbae I did 29 wounds before I ran out of supplies. And that was just one morning! 
So, I went out and bought gauze and tape by the kilo. (Literally. You can't get 2x2s or 4x4s here. You get a 1, 2 or 5kg roll of gauze and cut it how you need it.) I packed sterile saline squirts, antibacterial soap, and everything a person needs for a week of dressing changes in a bag. I haven't gone back up north again yet but I plan to run all of this by the VHTs and see what can be done about this little epidemic. It may be a complete flop but it might work.....

Now I spend my free time making 2x2s for wet-to-dry dressings for legs. 

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