Wounds, wounds and more wounds!

This is me...this picture was taken by one of the little boys I have been caring for for weeks. He had never taken a picture before, but after a quick lesson (difficult since he speaks no English), I think he took a decent picture.

People here are absolutely amazed by digital cameras and crowd around me to see the instant images I take of them.

I just loved this couple. They have been together for 54 years. The husband was the patient and presented with the severe heel wound seen in the next picture and his sweet wife never left his side.

This is what his wound looked like after several weeks of debridement (removing dead tissue), deep cleaning and casting. I know it looks gross, but this wound is doing very well in this picture. All of the pink tissue is healthy new growth and shows no more infection. We placed a cast to keep him from bending his foot and damaging the healing that had taken place. The wound did really well, healed and he was released.

This 56-year old man came in with a very distended abdomen and was in Septic shock. Dr. Richard Kajubi and I operated on him emergently on a Saturday about 4 weeks ago. He ended up having a giant intussusception, which is when the intestines telescope into themselves, cutting off the blood supply to the portion of the intestines that is inside the telescoping. After a period of time, the intestine dies and becomes gangrenous and causes perforations of the intestine.

When we opened his abdomen, we washed almost 2 liters of pus away and we weren't sure he would survive the day. He had just waited too long to get treatment. He did survive, but needed another follow-up surgery to clear out the rest of the infection. But...because we couldn't get his type of blood, he never was operated on and he died last Friday night, February 12th.

This little boy was so cute and so scared to be in the hospital. He initially had a small wound of his lower leg, which became infected and eventually invaded the bone.

In order to treat the bone infection, we have to be really aggressive. The wound is opened and all the dead and infected tissue and bone must be removed. It's then packed with gauze and sutured loosely back up. Each day, he had to endure one of us removing the soiled gauze, pouring full-strength Hydrogen Peroxide into the wound (which burns very badly) and then re-packing it with sterile gauze. This goes on and on until all the bad tissue and pus is gone and it's replaced with healthy, pink tissue. Sometimes a bone graft or skin graft is necessary to replace all that was lost, but in this case, we sutured him up and he was eventually discharged.

This picture really doesn't do this condition justice, but this is necrotizing fasciitis or the "flesh-eating bacteria" that attacks skin, muscle and connective tissue. According to statistics, it has a mortality rate of 75%, but the docs here tell me they have never had a patient with this, survive!

This girl is 15 and presented with a small wound, that resembled a burn. Nasty microbes enter and go to work, eating all the healthy tissue in its path, until the patient becomes septic with a systemic blood infection. The dead tissue must be quickly debrided (removed), but it's almost impossible to get it all. Her leg was so grossly affected, that we didn't even try to debride this. Her family just didn't get how seriously ill their girl was and pressured us to release her from the hospital. We finally did, after trying to explain to them that this condition is fatal. They never did believe us, thinking she just had a minor leg wound.

This is Ronald. He had been involved in a RTA (Road Traffic Accident, as they call it here) or MVA as we call it in the States. He was unrestrained, as everyone is here. No one uses seat belts and I have never seen one car seat or infant carrier.

When he first came in, he had terrible road rash all over his body (see next picture below) and a probable skull fracture. He was unconscious and bleeding from one ear (bad sign) and had multiple fractures.

This picture was taken after he had been on Surgical Ward being cared for, for weeks. He is holding one of the Crayola markers I gave him to write with. He couldn't speak English, but once he was better, he imitated everything I said and did it quite well (although annoyingly).

Ronald had multiple fractures and lacerations and had such bad wounds, we placed him under a cage, so the sheet wouldn't touch his body and hurt him.

This sweet girl was on our Surgical Ward for weeks. She too, has Osteomyelitis and had the same treatment as everyone else...open the wound, clean out all the dead tissue and bone, suture it loosely, pack it with gauze, endure the horrible burning of Hydrogen Peroxide being poured into it every day, followed by re-packing with more gauze.

She was tough and never complained, but every day, she sobbed as we cleaned her leg. I hate cleaning wounds because of the pain we inflict. The little kids scream when they see us coming with the surgical instruments. They don't understand that we are trying to help them.

This is an up-close look at her leg. She eventually did much better and was allowed to go home last week.

This little girl is very unhappy with Brian, as he removes the dressing from her infected foot and inspects it for healing and infection. He casted it to prevent her from bending the foot and damaging the healed areas.

After weeks of hospitalization, her foot did very well and she was discharged from the hospital.

Children come in with these abscesses around the ear, jaw and face all the time. We take them to Surgery, sedate them, drain the abscess, pack it with gauze and then clean it with Hydrogen Peroxide on Surgical Ward for a few days, until the wound is clear of all infection.

This is another view of the same abscess. She did very well and was discharged after several days of treatment.

This is the back of a lady who has terrible scars from previous assaults. She has the type of skin that forms abnormal scar tissue called keloids, instead of normal scars. I never did get from her why she had been assaulted so much, but she had these giant keloids all over her back and chest and they were totally disfiguring.

This is how her chest looks. Very unusual.

This little boy also had an abscess. I actually won a bet with Brian about this little guy. Brian thought he had swelling of his parotid glands (tonsils), but I knew he had a big abscess. They drained a ton of pus out of this in Surgery and Brian still has to pay me my Fanta orange drink. lol

A side view of his abscess. After surgery, he did very well and was discharged to home.