I didn't come into children's nursing to cause pain and
distress to children. Quite the reverse. And yet that is exactly what I've been
doing this morning. This is something I'm struggling to get my head around.
It's just not ok. And yet, in the situation I felt I had no choice.
A 5 year old girl came into Chikwawa hospital with a
significant burn to her hand. She had accidentally knocked the cooking water
pot off the fire in her small hut. The injury happened yesterday. She did not receive first aid. Cooling the
burn under cold running water for 20 minutes immediately as we would at home is
simply not an option. Nor did she receive pain relief, and it has not been kept
clean. She's burnt from her elbow to her fingertips. In the UK she would be
seen by a specialist burns & plastics team and go to theatre for the wound
to be properly cleaned and dressed in a sterile environment. Here, that is not
possible.
The function of her hand is at risk, and I know that we must
clean the wound and get rid of the blisters. I also know this will be agony.
There is little pain relief available, and nothing particularly strong. We have
a little sedation which will keep her a bit calm and hopefully affect her
memory of the procedure. We wait for the sedation to work but even with that
she's crying and screaming. She's in pain and great distress. Pain that I am
causing.
We do our best to treat the wound but I know she can't take
much more. And neither can I. We dress
it with what we have available. It's not ideal but hopefully it'll be good
enough. I'm aware that others on the ward are witnessing this - privacy is hard
to come by here - and I worry that we are destroying all trust in our team.
The child drifts off to sleep in her mother's arms after the
procedure. I go outside for a few minutes and cry. Tears for the pain of this
child, for the compromising of my standards, for the lack of fairness in the
world.
The team support me. They remind me of the lack of choice,
the need to be cruel to be kind. Later,
one of my team mates tells me she has just seen the child playing and having
lunch. Her mother smiled at my colleague. Perhaps her mother understood and
accepted. Perhaps the child has forgotten.
Hopefully I will too.