New Foundations

2012-02-22T10:13:00.000-08:00

New Foundations

New Foundations is a small Christian Mission that is registered both in the UK and Nigeria, treating over 400 patients a month, without charge. The simple intention is to demonstrate the love of Christ, and deliver quality, evidenced health care. All paid staff are locally trained Health Care Workers.

In all things to God be the Glory.

Pesky Varmints!

2012-02-22T10:10:00.000-08:00

Communication has been problematic at the Clinic due to deliberately vandalised mobiles.

We use old fashioned Motorola models that still have the antenna socket in the back, not easy to find and mainly sourced from Ebay or from China (copies). The antenna wire is cabled tied up a 30 foot bamboo pole to a TV antenna that gets a surprisingly reliable signal. Fancy smart phones just do not work in the region. Think reliable VW Beetle versus brittle Italian sportster and you get the idea.

We did not , however, count on the wanton mischief of local rats who have both destroyed the current phone and managed to locate and eat the rubber keypad of the still packaged spare phone.

A livid Health Care Worker tells us he will 'mash' the culprit' once caught....

Distracted by the rats it was not noticed that the bats are back. Last year over a thousand had to be displaced, and turfed out of the roof space as the resultant guano was proving an annoyance and health hazard. Nets were packed into all the roof spaces but they have returned , eating through the mesh, and reclaiming the roof space...
A more Eco-friendly and conciliatory approach has been planned for the bats, to use solar lights inside each portal of entry, which hopefully will deter the critters, we'll keep you posted....

New Foundations

2012-01-30T05:25:00.000-08:00

In all things to God be the Glory.

Laboratory training and chapati's

2012-01-30T05:20:00.000-08:00

Oscar finishes his secondment at Padhar Hospital following two months laboratory training. With satisfactory completion of his consultant led placement he is returning to set-up the small laboratory at our clinic.

Cancelled flights and mis-information led to Oscar being stranded in Delhi on his arrival. We have to thank Mr Shomik who, virtually a stranger ( we chatted for two stops on the Delhi metro) kindly sorted out logistics to complete Oscar's journey to Padhar, over 1000kms south. Unanimously, Shomik has been appointed executive Asian Director for New Foundation!

Spencer, (pictured below), Dr Lisa Choudhrie and the whole lab team ensured a structured and relevant training program with regular assessements. Microscopy, slide preparation, various staining techniques, stool, urine, sputum examination and blood transfusion techniques covers the core requirements for a rural Primary Care Clinic.

It's always difficult integrating in a new culture and into a tightly knit team but Spencer, (pictured above), Dr Lisa Choudhrie and the entire lab made Oscar so welcome. Given Padhar is an Evangelical Mission Hospital the common unity in Christ gives all a common ground. Most nights house groups and prayer groups meet and Oscar's musical talents gave worship an afro-asian fusion.

Padhar has a strong emphasis on the house-church movement beside it's historic Lutheran basis, and even after a full day's surgery one of the surgeons travels the area to encourage believers belonging to the smaller house groups.

Thanks to Dr's Rajiv and Deepa Choudhrie for your hospitality and support for Oscar, and indeed for the opportunity to join the eye camps and share in how we can encourage each other to proclaim the Gospel of Christ in the context and provision of compassionate surgical and medical excellence.

Oscar will continue his training in Lagos in Malaria Microscopy in two months time.

2012-01-17T08:02:00.001-08:00

In all things to God be the Glory.

London 10km 2012

2012-01-17T08:00:00.000-08:00

Places are now open for the 2012 London 10km. New Foundations runners have taken part for the past five years. THIS IS THE LAST YEAR WE HAVE PLACES!!

12 places available with all the razamatazz of the olympics surrounding the event

To reserve a place we need a minimum of £50 to break even. This will include a coverted T-shirt and race entry pack. We have never set minimum sponsorship and most years the trustees have picked up the short fall as some have run but raised no funds (doh!). Still, its the taking part isn't it!?
Sooo, for probity and because we'd like to ensure costs are covered for this final race we are imposing this entry fee that can be made either on-line or by post (see contact page). Email us if you have any questions and we can help you set up simple sponsorship via justgiving or Virgin giving that utilises social networking to make the whole process painless!

2011-12-25T08:36:00.000-08:00

In all things to God be the Glory.

Satellite Base

The poignant unchanging view from a derelict missionary house in Onnebene, abandoned over 50 years ago.

Though we undertake satellite medical cmps in inner creeks to more isolated communities, 2012 sees the first initiative to train local health care workers to be based in a smaller outreach base.

We have been visiting a remote village called Onnebene over the past six months, a village only reachable by boat in the wet season. There have been no regular government intervention over the past four years and anecdotal reports suggest a 40% childhood mortality below 12 months.

There is no medical provision in the village. Current treatment for a feverish child includes swabbing in petrol, or urinating over the child. There is no local chemist and travel to the nearest medical outpost costs in travel alone £50 each way before medical costs, quite prohibitive.

There exists the skeletal frame of an unfinished government medical clinic slowly being reclaimed by the bush, in close proximity to a similarly unfinished school project, abandoned at foundation level.

An enthusiastic literate church member from the community is volunteering to undergo training at our Enekorogha clinic over the next six months. All travel and costs will be born by herself as is our practice until the end of this trial period. After this it is hoped she will be employed to deliver primary in her own community with regular support and mentoring from our senior workers.

We envisage a second worker joing us early next year, and over the next twelve months a permanent primary care program, locally run, being established in this, most needy of areas.

Improving diagnostics

2011-11-26T13:01:00.001-08:00

Diagnosis is difficult in primary care, relying much on a good history and examination, but oft-times treatment can be quite empirical to cover the risk of a worst case scenario, a common problem in the third world. This means many are treated inappropriately, risking side effects and the development of drug resistance.

We have set aside some funds to try and improve matters.

Oscar leaves on the 12th Dec for two months study at Padhar Hospital in India, for training in laboratory work and microscopy.

The clinic has become increasingly cramped and without any space for lab work we have taken half of our porch to be used for this purpose. Oscar has designed and with some help built the lab himself.

We will have rain harvesting tanks outside to give a reliable water source, the borehole we have been using now broken. This is perhaps not a bad thing as we had identified E.Coli infection in the water last month and had ceased to use it, pondering on the construction of a sand bio-filter.

We constructed the blocks with sand from the river and though basic it will amply serve the purpose.

The lab is secure with ironwork grills, windows and awaits decoration. We are hoping to attach solar power to the clinic (from the defunct borehole) that will power another fridge, microscopes, and bench top blood analysis equipment.

We are very grateful to Dr Choudrie at Padhar Hospital (MP) who has planned Oscar's consultant led training which is designed specifically for the environment in which we work, and pathology most commonly encountered, TB, Malaria, Gastrointestinal infection, both parasitical and bacterial. Besides Malaria microscopy we will be aiming for TB and HIV testing, Blood grouping and transfusion, blood count with white cell differentials, glucose, leprosy identification, stool and urine analysis.

news- gas gangrene

2011-11-03T17:53:00.000-07:00

Oct 2011

Three months after starting treatment this young lad is almost healed.

Initially his leg was rapidly breaking down, swollen and with audible small
gas pockets when pressed following the administration of an

injection from a local 'chemist' using a dirty needle.

The necrotic dead tissues were replete with maggots, debrided and cleaned.

He was on three intravenous antibiotics for two weeks.

Eventually clean and rid of the dead tissue healing seemed to miraculously start

and nutritional support was crucial.

The process has been long and for some time the mother seemed to

emotionally disengage with the child so encouragement to breast feed was

ongoing even when the child was discharged.

The amount of lost tissue should have necessitated skin grafting, but

this is beyond anything available in the riverine areas

Frankly it has been amazing to all of us how this young boy has recovered so well,

and it is a joy to see the family encouraged by his recovery.

Gas gangrene has a high fatality and often the extent of the disease results in

amputation.

Though scarred, young Godswill is getting back on his feet and doing well.

Appeal-Court, aka 'The Administrator'

2011-09-21T01:52:00.000-07:00

Replete with donated syringes from the UK swine flu program
(the epidemic that never was...) we have vaccinated over
500 children in recent weeks. The cohort of children receiving
the full schedule has rocketed since the start of the year,
in great part due to the efficiency of Appeal-Court who has
returned from a three year course in record keeping and has forensically
identified those who needed chasing for vaccination. He also runs
the stock control, patient records, and library with miltary efficiency.
Woe betide the dafaulter or late returner of any book...

As part of his drive for efficiency every new baby born in Clinic
is carefully recorded and home visitation arranged for education,
support, and vaccination.
These mothers all gave birth in the clinic over the past few months and
are regularly seen. Each mother has received a new Insect Treated Net (ITN)
from a new stock the State government has kindly donated to us.
Christere, third from the right is the Health Care Worker with
principal responsibility for following up all new mothers at home.

Heart Failure, a classic presentation

2011-08-30T14:20:00.001-07:00

An elderly man came to the clinic in crashing heart failure. In developed countries it is rare to still see such cardinal signs at presentation. The bulging external jugular vein signifies significant fluid overload, and venous back pressure fills the lungs with fluid, causing significant shortness of breath, tiredness and immobility. The heart is under strain and unable to pump efficiently, often complicated by associated lung or kidney disease.

The upper chest evidences a usually thin man, but fluid has built up from his feet to midway up his back and abdomen, his stomach taut and the abdominal cavity evidencing significant fluid collection. It's a struggle to lie back comfortably.

Even gentle pressure on his thighs leave deep pitting impressions.

Unable to lie flat, walk or even talk for long he had been like this for some months.

Heart failure has a prognosis worse than many cancers, and care is directed at symptom control. Diuretics and close monitoring of kidney function allows a gradual removal of the fluid from the body, with daily weight measurements evidencing a weight loss of 12kg over a week, equating to a 12 litre loss of accumulated fluid.

After eight days the jugular vein is no longer engorged and the strain on the heart has been relieved. Able to lie flat and with better sleep this gentleman was discharged with suitable medications to live a better quality of life... a health care worker will check him at home periodically as he lives outside the community..

no need for specsavers!

2011-08-03T02:05:00.000-07:00

New Foundations has received generous gifts of new reading glasses allowing us to undertake several poor vision camps each year. Five of our Health Care Workers have been specifically trained in community eye care in Calabar and undertake visual acuity testing for each patient.

The reaction to new glasses and visual clarity seem to engender various expressions of sobriety, joy or surprise, reactions that always give vitality to the clinics.
During triage we identify more serious cases , cataract , glaucoma, trauma, cancers and infections that are referred to hospital or treated where possible. We are looking toward cataract surgery for several identified with cataracts in late September.

For some being able to read again is joy, for others it allows access to work and study.

For some, the Word of God is once more accessible, each pair of spectacles costing £1.

quackery!

2011-07-19T10:37:00.000-07:00

Whilst famine is declared in Somalia, and its attendant suffering in the main beyond the blame of man, (accepting civil conflict has destroyed the infrastructure to help),we frustratingly continue to treat pointless acts of barbarism that stem from casual indifference or ignorance, resulting in quite needless suffering.

This lady suffered with simple toothache and sought the help of a local village chemist ( someone who sells prescription drugs and treats without any medical training) who bizarrely injected her just above her right eye, into the socket with an undisclosed medicine.....

Over four weeks this injection site has now developed into a discharging abcess with extensive spread down into the maxillary sinus and nasal cavity destroying bone and tissue as seen below. She has both fever and unremitting pain.

Though she improved with a week of IV antibiotics her son took her home before we could facilitate a surgical review ( though a health care worker commented a prior patient with the same complaint regrettably died during surgery)

Our clinic diaries are replete with similar cases and toe-curling photos, all needless and difficult to treat.

The challenges of East Africa's current plight are acute and mainly logistical, getting crucial aid to the point of need quickly and triaging those needing priority intervention.

In the Delta the challenges are chronic and lie at the societal level. Education, prevention and primary care remain pivotal. Already we have seen a surge in mothers delivering at the clinic following extensive educational programs and the involvment of the women's committee.

Avoiding these pitfalls of money driven quackery is a hard nut to crack however.

Relentless love and relationship building builds trust, trust that has for many resulted in preferentially seeking out the care and programs we offer in service from the clinic. We pray that in seeking our help they will also come ultimately to the soul-saving knowledge of Jesus Christ, without whom there is nothing that makes any sense in this world.

Outwith the Clinic

2011-07-08T12:47:00.000-07:00

Many, for often spurious reasons do not come, or bring their loved ones to the clinic. This 'over the shoulder' peek follows the Health Care Workers working in the community, visiting a palliative care patient, an elderly man with advanced Parkinson's disease, and a remote immunisation camp.

looking to turn the tide..

2011-06-21T13:52:00.000-07:00

June has provided enough rainfall to allow us to get the boat through a tiny creek to a small community we have been trying to reach for some time. With rainfall and a high tide we managed to make the journey to a remote community with no access to health care or immunisation.

The childhood mortality is high and confirmation from the local government officials that the vaccination schedule had not reached this area has made us think how we can make some regular visitation possible.

Certainly our pastor's able punting skills prove useful when it's too shallow to use the engine.

Sadly it's often the case that after both time and money spent getting to these small communities, the medical camp itself is often without serious illness. Certainly de-worming, treatment of skin and respiratory conditions, malaria and gastroenteritis is valuable, but few have life-threatening presentations, and there's a feeling that attendance is more opportunistic than timely. It seemed we were treating the healthy residue, hopeful that we could prophylactically prevent future illness.

The high mortality is because there is no care at the point of need, and without such, most children requiring help have died. The seriously ill adults infrequently attend these types of camps and concerted house visitation over days or weeks is necessary to overcome stigma and build trust. Even after four years at Enekorogha we find patients alone and suffering who don't feel able to reach out for help.

Knowing that only a trained and resourced Health Care Worker in the community will effect real change the camp demonstrated that there was a willingness on the part of the community to explore this further. Over 70 patients were treated, 40 patients were fitted with glasses and the Gospel of Jesus Christ preached to all.

The community seems responsive and if partnership is possible (which one can never assume) then training up a local worker would be the logical next step...

from whence comes my help...

2011-06-06T03:13:00.000-07:00

This man is fortunate to have survived a stabbing following a brutal assault.

Though deep, major vessels were spared and the injuries treatable at the clinic.

The gentleman below however suffered a vicious machete attack when robbers broke into his house. The macerated wound was infected and the underlying bones broken. He had travelled some distance for treatment unable to afford care at the hospital.

Cleaned, the debridement of the wound complete the arm is dressed and follow up arranged, though the arm, and hand will be of little use due to the extent of the trauma, and having presented two weeks after the initial assault, the wound grossly infected and painful.

Humanly and medically speaking these types of patients cause despair,frustration and an inadequate response when complex specialised surgery is required but never an option.

As humans we reach our capacity very quickly in this region, and it is only then that we can lean on the strength that comes from Jesus Christ to love, manage and 'treat the untreatable'.

It is without exaggeration and from the witness of our eyes that we see patients recover who should have died (indeed in our frail faith and frank honesty we expected nothing less), and hope restored to patients who respond to the intimacy of care that comes with wound dressing day in and day out,as the love of Christ is made manifest to them, Praise His Name!

a tight squeeze....

2011-06-02T05:49:00.000-07:00

Prior to the recent elections candidates have been randomly donating equipment and drilling boreholes in a blatant attempt to curry favour with the voters. One such project was started outside the clinic, half completed and then abandoned. The gantry (minus water tank) is to the right of the picture. The crucial borehole had been drilled, lined and lies full of water. With the dry season coming to an end, and the rain tanks empty the we approached the community council to see if we could use the borehole for the clinic.

With permission granted we have capped the pipe,and with pump and some piping have secured a constant feed to the clinic.

Laundry is a major problem and we hoped this would solve the water problem, not so, the water produced is thick with sediment and turbidity.

Anticipating a costly solution we consulted a major well/borehole contractor in the UK.

'Ladies tights Sir' was the quick reply to the conundrum posed. A simple solution, and one we plan to implement this month, with a sand and mosquito net mesh filter of our own device ...and of course some ladies tights.

The new sluice area awaiting roofing, and yes the bats are sorted (see below)

unwanted tenants....

2011-05-04T02:28:00.001-07:00

All seems quiet in the clinic courtyard...beyond the solar panels for the vaccine fridge in the foreground, two rain harvesting tanks stand below the overhanging eaves.
Over the past six months areas of rotting fascia boards on the eaves have provided access points for several hundred bats to take up residency in the roof space.

In one sense these small carnivorous bats are helpful in keeping the mosquito population at bay, but the by-product is a thick, and ever deepening sheet of bat guano that covers the ceiling tiles.
Within the droppings more insect life abounds and small worms and maggots have been dropping from some cracks between the asbestos ( sadly yes, asbestos) ceiling tiles.
Having employed two cleaners in March to improve the hygiene of the clinic this has come as an unwelcome development and this weekend three workers climbed into the roof space to lay nets to catch the bats as they flew out in the evenings to feed. The roof space was swept and the next step is to forensically plug every gap around the building, probably an impossible task.

The guano is offensive and copious, and the movements of the bats a constant disturbance at night when both staff and patients try to sleep.
Bats above , and termites below its a constant battle to maintain standards, but until we are in a financial position to consider the building in more detail, Dettol, elbow grease and a zero critter tolerance seem the only option....

community eye health training

2011-04-21T10:29:00.000-07:00

Five of our Health Care Workers travelled to Calabar this week at the invitation of the Tulsai Chanrai Foundation, for training in triage and community eye health management.
Perhaps not the best week considering the current round of elections the trip was without incident and all enjoyed the program.
The training was in preparation for a triage camp in Delta State,not to far from where we work. The camp is at the invite of a Local Government Body and the patients who are suitable will be transported for surgery to Calabar to the East, in Cross Rivers State where Tulsai Chanrai run a free cataract service and eye program at the General Hospital. Do check the link to see what sterling work they do.

Rose and Victory have already benefited from Primary Health Care Training, another arm of the Tulsai Chanrai Foundation, attending a three month course back in 2005.
The Foundation kindly provided the program so we can be an active part of this camp assessing patients triage and education. Having this link with the free service the Foundation offers means we can transport patients we identify in the creeks by road, a lot less hassle and expense than trying to set up remote surgical camps in the creeks.

Besides the training it was a good chance for the team to have a chance to get away from the demands of the Clinic , and like all who visit Calabar, to marvel at the clean roads, lack of litter and generally chilled atmosphere that contrasts so dramatically with the gritty tension that pervades much of Delta State ...

senseless waste...

2011-04-11T09:44:00.000-07:00

This little boy came to the Clinic, his mother complaining that he was suffering from nosebleeds, and coughing up blood.
Well nourished and cared for, this was a rather surprising complaint, especially as his mother stated he had only been unwell for three days She had not treated the boy but consulted a native healer, who told her the child was suffering from a throat infection, and subsequently 'treated' him.

The boy was floppy and pale, the normally pink conjunctivae paperwhite.

His ashen hands confirmed profound anaemia and testing showed his Haemoglobin was less than 4, indicating he badly needed a blood transfusion having lost a significant amount of blood.
The native healer had cut out the tonsils using a razor blade and without anaesethetic.
Checking inside the mouth the tonsillar remnants were continuing to bleed and we urged transfer to hospital for a blood transfusion, and further treatment to arrest the bleeding. He was now passing dark bloody diarrhoea.

Unfortunately the baby died before help could be given.

The ability to transfuse is critical in remote settings, as infant death from trauma, and indeed malaria often results from the complications of severe anaemia. We are starting training this June so our Health Care Workers can identify blood groups and transfuse from the patients relatives.
Reflecting on the header 'senseless waste' someone close pointed out that this barbarism is not without sense. The belief in fetish medicine and the power of the native practitioner is deep and reflects a spiritual bondage that is endemic and hard to break. These beliefs are rooted in fear, control and wickedness, resulting in so much preventable suffering. It is salvation through Jesus Christ that breaks these bonds, sets the captives free and allows both spiritual and physical healing. Persisting testimony to this truth and witnessing to those in such bondage in love is as vital as any transfusion.

finally, almost fit for purpose

2011-03-23T05:53:00.000-07:00

For three years we have had one donated bed from the State Primary Care Department. This has been occupied by a long-term burns patient and means that other patients are relegated to a mattress on the floor, unacceptable but unavoidable...
As Christians we want to provide the very best we can, the best care, the best equipment the best medications. It has pained us for a long time that we have been constrained by our situation. Just as Jesus washed the feet of the disciples we want to serve those with the very least, with the very best. They deserve no less.
This photo shows the situation up to last month. A girl of fourteen has just delivered a baby. She and her mother sleep on the mattress (her mother a grandmother at the ripe age of twenty-eight). The other mattress belongs to another elderly lady just discharged. The walls had just been painted and the roof sealed from leaks. As for the slight subsidence in one corner....well you do what you can do..
Finally we have new equipment donated by Perth Royal Infirmary and Addenbrookes Hospital Cambridge, which we shipped mid- January.

A long awaited phonecall was received confirming the container of equipment to furnish the clinic had finally arrived at Bomadi bridge. Problems with local youths demanding 'fees' meant we had to find an area of waterside outwith a local community from where the equipment was loaded onto a barge.

Men from Enekorogha along with the health care workers had spent two days awaiting the lorry from Port Harcourt, but the wait was worth it as now the clinic has both full equipment for both our small in-patient ward and out-patients.
Raising the game a notch has wider implications as we now have to better plan waste disposal and water procurement at the clinic, tasks which are underway and will be posted as developments move forward.

when all is not what it seems.....

2011-03-08T07:46:00.000-08:00

Following the previous post where Michael Jackson's finer moves are better versed than simple addition and subtraction in the young, you may be forgiven in thinking these fish are locally caught, this village being technically an island and some 40mins by boat to a shanty trading post...wrong..
These are in fact frozen Norwegian herring (known as ice fish) cooked on the river front as local fish stocks have been decimated by overfishing and oil pollution. The logistics of transportation and importing still somehow makes this a viable proposition.

Though there is no drinking water or electricity in the village nevertheless a full program is available on satellite TV (generator powered).

In this society little can be taken at face value. The gospel of Jesus Christ, that is in essence Love is rejected by many in favour of the 'white garment' prophetic churches that blend a cocktail of dominance, control, cruelty and hierachy.
Many find the unity and equality of all in Christ unsettling , preferring a dominant 'prophet' who they allow financial, psychological and oft-times physical control over their lives.
It's true that some independent Pentecostal churches in west africa are similarly without regulation and cynically exploit their members. Steering a course through the melee of abusive, avaricious and manipulative ministries is sobering and sad when the knowledge of a Loving Saviour underpins all we, and others, are trying to do. It demands scrutiny of ones own intent, and actions, daily and in every decision, lest apostasy or hypocrisy supervene.
The atheist at this juncture confirms the innate error and cruelty of religion. Indeed, how true, when man corrupts the Gospel, confusion, self seeking and wrong will triumph. This should drive the Christian deeper into the arms of Christ to love and to serve Him, and to demonstrate that the ground before the Cross is level, be you black or white, rich or poor, illiterate or educated.

The prophet's chair, bell and whip to hand.

Steve and Pete Throwdown

2011-03-02T11:17:00.000-08:00

Keeping it slick in the delta.

extortion and millipedes

2011-03-01T15:32:00.000-08:00

Last October we met Godswill, a young man with chronic cough, weight loss and clinical Tuberculosis confirmed on testing, with no clinical breath sounds audible in his right chest. He was commenced on DOTS (Direct Observed Treatment) to ensure compliance to over ten tablets daily.
He soon ceased from attendance and two weeks ago he was visited at home to see why he defaulted from follow-up. A local healer had seen him and performed massage therapy on him removing several large millipedes from his stomach which he evidenced to him (hidden in his hand after some vigorous pressure to his abdomen) causing much consternation, not surprisingly.
Ascertaining his gullible nature and advancing illness he pronounced various conditions he should meet and of course money was extracted in increasing amounts through fear, control and threat as he further advised cessation of medication.
With little eye contact and obvious fear he listened as we explained this was unsound and he was being cynically and cruelly manipulated. The gospel of Jesus Christ is a simple exposition of unconditional love. We again offered our support, prayer and our desire to help, and allowed him to reflect on his choices as he was due to see the 'magician' within the next 48 hours.
The next day he appeared at the clinic and confirmed his intent to restart treatment.

The african millipede can grow to over 10cms, and delivers a nasty bite.

Feb 26th, doing well, relaxed and confident.

a new addition to our pharmacy

2011-02-26T00:18:00.000-08:00

Now three months on after a near fatal flash burn from an exploding tanker this man is slowly recovering. The sole survivor from a bus he was lucky to survive with almost 30% burns. He initially went to a local hospital who demanded 500,000 Naira ( £2155) up front before any treatment.Unable to pay he travelled to our clinic. Despite the obvious and extensive need for skin grafting the wounds are slowly recovering, though we have had some severe infections on the way. The dressings taken from the UK were quickly exhausted but helped establish a cleaner surface to the burns.
Recovery is as much dependant upon increased food intake as it is good clinical care, so some lateral thinking with body building supplements seemed a reasonable idea, as he was not getting adequate protein from his diet. Chocolate protein shakes and protein bars, initially viewed with caution eventually proved quite compatible with cassava and banga soup.
Check the photos below to see how things have improved from last months post...

The back is almost fully healed, and in detail below you can see how the wound size is gradually shrinking as new tissue grows from the edge.