Frustration Station

narrowly escaped passing out in the burn unit today. My belief is that it was low blood sugar...or dehydration...Unclear. I have been chomping on "sweet and salty" granola bars all day (tribute to Europe tour 2007) and of course..my new favorite drink, orsaline.

Had a very long day today mostly because of the frustration I felt as I walked through the burn unit here in Dhaka. I walked into the hospital and was met with a blood curdling scream from a child who's dressing was being changed, frightening way to start the day. Secondly I was informed that this specialized burn hospital has 50 beds..and guess how many patients? 309. 110 of them are young children. The majority of cases I saw today were little children who had scald burns from hot oil or boiling water. The physician I was with today literally said to me, "we are understaffed here, it is difficult to look at the extent of the burns on EVERY child"...so the history is taken from the parent and they are treated accordingly. Many of the children I saw today were not immediately brought to the hospital, mostly because the parents couldn't afford the long trek from their village or the medicines they would require for their child. The difficult thing about this is that the most important part of treating burns is resuscitation with fluids. The first 24 hours is most crucial. The reason this is so important is that your skin not only protects you from external factors but also allows for your body to hold fluids and electrolytes so they dont just constantly leak out of you (which is what happens with extensive burns because your skin barrier is gone). Also, b/c that skin barrier is gone you lose a very important thing called albumin, a protein which helps keep the water where it should be in your body. Most of these children are already malnourished and their protein (albumin) level may already be low and now they have suffered another insult. In light of that the staff here encourages patients to eat eggs and Daal (a lentil soup high in protein) because most patients and their families cannot afford much more than that. Below a certain threshold (20 gm/dL of albumin) patients are infused with human albumin which can cost up to 4000 tk ($60)..this is expensive for the record!

Every child I saw was completely frozen with fear when they would see our rounding team approach. They would start crying immediately because any type of movement causes severe pain. Nalbuphine is a synthetic opioid which is used for pain management, it has the potency of morphine (which is not easily attainable here). I was practically brought to tears by this one little kid who just stared at me, shaking, then darting eyes left to right to see who would be the one to examine him. He sustained his burns from the fire that the family had started to keep warm...imagine that. A part of his clothing caught fire and no one could act quickly enough to save him. This situation happens quite often, especially with women because of the saris they traditionally wear.

Although I've seen very sick patients everywhere else the burn patients are the toughest to see-the burn itself is terrifying-looking usually and then the patients are just in themost incredible amount of pain they cannot help but cry, or scream or both...tough day.