Rhett’s Blog

Interesting Case

What an interesting case that came in today. A 17-year-old boy came to the ER with severe burns on the soles of both feet. He was a paraplegic from 2 months ago when he fell out of tree. He has had no sensation or motor function below his chest since then. The family is from a local village and fairly poor. They took him to a type of “witch doctor” last week on Wednesday to see how he could help. His idea was to “shock” the feet in a way that they would be shocked into functioning again. In order to do this, he placed the boy’s feet into scalding water. They where bandaged and sent home. That had been nearly a week ago and there had been no medical care or changing of bandages since then. When they brought him in his feet were covered, but I quickly saw the extent of the injury when I removed the bandages. Luckily, he only had second degree burns, but both feet were infected and in some serious need of attention. I have had little experience with caring for burns so I consulted with Dr. Gamero and he explained what needed to be done. The nurses helped me get things ready for cleansing and debriding the feet. With anyone else we would have had to do the procedure under general anesthesia, but with him being devoid of sensation in his feet that wasn’t a worry. I cleaned the feet as best I could with iodine solution, and scraped and cut away layer after layer of dead skin. I was having a lot of fun doing the procedure even though it was pretty gross. His feet looked a lot better when all was said and done. We bandaged him up and admitted him to the hospital. They don’t have a burn unit in Belize unfortunately so there was no where to transfer him. I wrote the admit note and orders and I put him on some heavy duty antibiotics and did some labs. He also had a raging UTI from having the same catheter in for 21 days so we changed that too. For a country in Central America, Belize has a fairly good health care system, but the case showed me the cost of poverty in a developing nation. This family was poor and had no money to get proper medical care. They went to who they could for care, but this ended up making things much worse. Luckily, the father worked for a local Mennonite community and his employers where kind enough to pay for his current medical care. They don’t have the funds for him to stay very long in the hospital, but we will have to train the parents on how to properly care for the wounds and that will have to do. In such a poor country, a lot of times we don’t have a lot of choices with what type of medical care we can give. If you think Medicare in the U.S. is bad, we are much more limited in what testing we can and cannot do. It’s probably the most frustrating thing about working in the hospital here.