On my way home from the hospital I saw one of my little friends on Chicken Road. She is 4 years old and had a gaping fresh wound on her arm that was covered in flies. Oh the glories of humidity—the flies were all out feasting. I asked her aunty if it was ok if I came back with some medicine and plaster (plaster=band-aid) for her. She said yes. I trotted home, my scrubs sticking to me and the stench of the hospital rising in steam from my whole person. All I wanted was a shower. But I threw my backpack down and retrieved my first-aid kit and what looked like the right size band-aid. Then I had a flash-back. Julia gets scraped and needs a band-aid. Sam wants a band-aid too. So does Jeffrey now. Tiny crumbs of lunch on the arm or little scratches are suddenly wounds in need of band-aids. And if Jeffrey has a band-aid Aiden wants to talk about it but Eli wants one also and down the chain it goes…I wondered: Are children here subject to the same Rule of Band-aids? I grabbed a handful and stuffed them in my scrubs pocket. I pulled some gloves out of the stash I brought with me and shoved them in there too. And I headed back up the road in that sticky heat.
I figured she would be crying by the time I returned. I never met a 4 year old with an actual injury that wants it to be cleaned up. She was there, a puddle of tears and snot. OK…strategy time. I needed to have her see me put one on someone else. I sat down on a wooden pallet which is on the ground. It felt good to sit after the long day, even with my scrubs sticking to me, even in the heat. I opened the first aid kit and put the bandaids on top of it. And there he is, the answer to my prayers. A 6-year old who is showing me his sore and asking, “plaster?!” A-ha. Ok. I look at the target of my visit and say, “none for you, one for him.”
This is a strategy I learned from watching Dr. T Berry Brazelton do a well-visit on video. He sat on the floor and hid from the child’s line of sight behind the mother. As he was hiding he was talking to the mother about why she was there and collecting a general history. As the child looked around the mother’s shoulder he would duck the other way. And then he looked at the camera and he said, “if you want to see a child in a medical setting the easiest way to go about it is to make them want to see you.”
I put some bacitracin on his sore, and say “goodbye germs!!” which he fondly echoed with his own dramatic flair, “oh, ta-ta germies, goodbye bye!” I feel little parts draping on my back. I feel the comfortable press of kid against my sides. I look around and am I surrounded by children, packed in as for a Scram in rugby. (haha that is right I can now use Rugby analogies because I am figuring that game out!!) They are holding out their arms and legs and showing me their sores and all talking at once. “OK,” I say, “Who wants to be one doctor when they grow up?”. A hand shoots into the air and I hear “Me! Me!” and a boy of about 10 presses himself so he is seated next to me. “Good, you are my assistant now.” I hand him the scissors and we proceed to patch up dozens of open festering wounds and half-healed wounds, and old scars that obviously are just begging for plasters. I ask each child to tell me the story of their sore. These kids play hard. That is about all I can say. I listened as I was cleaning out debris and brushing away flies and congratulating them on their hard-earned sores. I am lost in a chorus of child jabber and enthusiasm. We cut gauze and tape and I give appropriate gasps at the sights they are so eager to share. I have two small children leaning on me from behind to get front row seats. And there is the 4 year old, with her big eyes still streaming tears. But she steps forward and I gently clean the wound—it is so nasty but I just do it—and then put the bacitracin on and a big plaster and I give her a warm hug and have my assistant do the same, because “as a doctor you must always be kind and gentle”. He takes this seriously and proceeds to hug every child we patch up. Some of the wounds are healed over but I can see there is something in them. They have developed tough round scars and I leave them alone…the body has taken care of the wound on its own and isolated the offending material so that it has no access to the blood stream.
The whole time there were two self appointed triage nurses who assessed the wounds on each child and then lifted shorts or skirts or shirt sleeves or feet to show me where the damage was. At the end they said “Halle has one big one”. I look for Halle. She is a sweet shy girl, about 12, who is smiling at me and holding her hands behind her back saying “no, no, I’m ok.” I tell her the choice is hers or I can give her a plaster to put on herself. She smiles and sways. The kids are urging her, “come Halle, get one plaster! ok Halle!” I start quietly chanting, “Halle! Halle! Halle!” which is picked up in a wild ruckus of hopping and cheering. Hearing the name she shares with one of Julia’s friends I thought of home and Julia and her friends and I missed them so much. Halle came forward and gave me her leg. There was a deep sore on it that was clearly so so wrong. I cleaned it slowly and carefully until it looked like wounded flesh and not a festering mass of something I can’t even describe. I had my assistant cut the gauze and tape and we patched her up really good. I told them all their plasters would probably fall off soon but that was ok, it was good to have them on for a little bit and let the medicine kill the germs. I told them I tell my kids something when they get hurt playing which is that when you get hurt playing, it must have been a great game! They loved that. I said I had one more game for them. “One Game! One Game…” they chanted. I pulled out my extra gloves and began blowing them up and tying them. First I tucked it under my chin and made like a rooster which was so impressive to them. Fits of giggles are always a good motivation : )
I popped one blown-up glove over the clothes line and said “beach volleyball”—a game that is well known here as Vanuatu has a women’s beach volleyball team going to the Olympics and it is a big deal. We played volley-glove for a bit and then I finally could not stand it anymore and opted out for a shower with promises of returning with more gloves and games.