Peace Corps - The Wound Clinic

I was invited to sit in on the wound clinic after two months of observing consultations, enduring the wails of children subjected to pricks and pokes, and obviously becoming bored with the monotony of rainy season cases.  I didn’t know I was going to sit in on wound care that particular day for two reasons: my French wasn’t good enough at the time to understand what I was about to witness, and the label on the door to the wound care room was faded beyond recognition.

I was directed to go into the room by the head nurse, so I cheerfully knocked on the door, and was cautiously admitted. Inside were the nurse in training, three other older men I had seen in the community, and a young child–all with grim looks on their faces. My smile faltered when the young boy was told to remove his pants and lay down on the patient bench. His gentiles were wrapped with gauze, and I immediately felt sick to my stomach.

As the nurse started unwrapping the dressings, I became more and more nauseous as the gauze became dirtier and dirtier and the child fought more and more against the arms that were pinning him down (thus explaining the utility of the large men in the room). I was pretty much blacking out and about to throw up by the time the last of the gauze came off, so I quickly excused myself from the room, only to run outside and put my head between my knees to get some blood back to my brain.

After overcoming a near fainting spell, I acknowledge two things: one, that I would never become a doctor, and two, that I needed to sit through the rest of the cases that day in wound care. This was the first time I was getting to witness work done at the health clinic beyond prescribing antibiotics, and I knew that in order to understand the population I was living with, I had to understand all aspects of people’s health problems and the care they received.

The situation I so unceremoniously ran out of before I fainted was a dress changing after a circumcision. I learned that several boys from the same family, ranging in age from four to twelve, had all undergone the same procedure that day, and would return every three days to have their dressings changed until healed. All patients undergoing wound care were instructed to follow this three day schedule so the clinic could monitor the healing process.

I got back my nerve, and re-entered the wound care room, but this time, with a chair. The next patient was a teenaged boy who’s ear had been ripped away from his scalp. I didn’t understand how much worse the pain would become for this child until I realized the boy would not be receiving any localized anesthetic for the pain. He sat there, stone-faced through every stitch. Not making a single noise or wincing even once. As his ear was stitched back to his scalp!!!

The final, and most memorable case I saw that day, was an elderly man who waited all morning, after all of the younger patients had been seen, before he entered the room. He was bent, frail, and his skin loose and fragile looking. Again began the unwrapping of the dressings. This time, around the old man’s arm. As layer after layer was peeled back to iodine stained and then blood stained layers, I became more and more internally horrified. This man’s skin, we are talking epidermis and dermis, was burnt down to the tendons on his hand and wrists. A massive flesh wound from his fingertips to his elbow showing layers of skin I had only seen as drawings in text books. Again, with no pain killers, this man’s dressings, which had become fused to his moist and exposed sub-skins, were peeled off. The wound was washed in iodine antiseptic, and covered with Neosporin, then rewrapped. I can’t even begin to imagine the pain this man endured week after week as dressings were removed and replaced. All without expression. All with so much gratitude for the nurses healing him.

As patient after patient suffered through stitches and cleanings and pain beyond my worst imaginings with no way to manage it beyond a blank and resolved face, I realized something truly important about the Burkinabé people. They were born into an extremely harsh and unforgiving world, but they would always rise to meet the challenge with an endurance and a tolerance for suffering that is absolutely unmatched. In the wound clinic that day, I saw the steel Burkinabé were forged from, and grew to appreciate and admire them greatly for it.

But for me, something else lingered beneath the strength and the steel of these people. In learning about global health, the problems that people in villages had to face, and how we should go about saving lives, I was never taught about the lack of local anesthetic in rural clinics.