Lice: plural of louse
Louse: 1. a small wingless insect that lives as a parasite on humans and other animals. There are sucking lice, for example head and body lice, and biting lice, for example, bird lice. 2. An offensive term that deliberately insults somebody’s behavior and attitude toward others (informal insult). Ha.
Now that we know what lice are, I want to take you to a little place in the world called rural Ethiopia and explain how much damage these little parasites can do when untreated for indefinite amounts of time.
In my last six months of working in Ethiopia I have come to understand that lice is a just a normal part of life that has little to no consequence to most people. I know my American-ness causes me to freak out at the thought of a diagnosis of a lice infestation on my head, let alone live with it for years, but come on….after seeing what I’m about to show you, one would think they would see the reproductions and at least attempt to rid themselves and their families of this destructive little blood sucker. Wrong. This unfortunately does not happen, so I have been left to deal with treatment of patients with a ridiculously long history of this condition, more often than not. I am working on educating for the purpose of prevention, but most people just aren’t lucky enough to bypass these little pests no matter how hard they try.
I have moved mainly to education of treatment and the importance of coming to clinic when it is a ‘small problem’ instead of waiting until it is a ‘big problem.’ I will be honest and say that nothing is more frustrating than a parent who lives very close to the clinic will not bring their child until their illness has become so bad the kid can barely deal with day to day living.
Case and point, a few weeks ago a small boy, around 8 yrs or so came in to the clinic with his mother. You could literally smell the kid inside the building when he was standing outside. He had his hood pulled up; covering his head but you could see a serious wound on the left side of his face.
I had to go through the line of patients already waiting before I saw him, so I had plenty of time to really appreciate the smell radiating from his head. Once I got to him, I said ‘bessa,’ which is a command form of ‘show.’ He uncovered his head to reveal something I could have never dreamt to see. I will see if I can explain this fully…
The entire top of his scalp (extending down toward the back of his neck) and a section on the left side of his face was a rough, scabbed, whitish yellow color that almost looked like his flesh was rotting off and little tufts of hair were holding things in place. I was at a loss in that very moment so I started with the basic history from his mother via a translator.
After a semi-short discussion I can to find out that he had lice, his head started to get small sores on them, but they really weren’t too bad so the mother decided not to bring him in. I will go back just a bit and talk about lice and what happens with infestations over time. In this area, there is a huge lice, malnutrition, and general hygiene problem. The lice bite the head so much that it becomes abscessed and full of open wounds. With a poor immune system and a lack of cleanliness, the problem is exacerbated and huge infected wounds result.
I asked the mother when this problem began and she said one year ago. I became slightly frustrated by my perception of the lack of compassion and action this mother had in regards to her small child and went in to a small lecture on the importance of bringing your child when the problem is small because now the problem is so big that it will take a long time to get better, there will be scaring and probably a significant amount of pain the child will have to go through.
She quickly responded, ‘I did not bring him because I was sick,’ and I just left it at that because I decided I truly did not know the situation, I would give her the benefit of the doubt, and I had already lectured her. I then moved on to deciding how to treat the child’s head at this very moment. I knew I would have to debride his scalp in a big way, but at that very moment in time I started with the basics of washing with soap and water.
I had the boy lean his head out the window in the building and I began to pour water over his head. The instant I started very lightly rubbing his head, copious amounts of puss began pouring out from under the layer of ‘co-sha-sha’ (garbage/dirt) playing the role of his scalp. I had him close his eyes right away and attempted to manually ‘express’ a majority of the puss out.
Along with the puss, small chucks of this ‘covering’ came off as well, exposing raw, pink flesh. This is, in one sense, good because there was healthy tissue below the bad, but in this environment, having that much exposed open flesh is asking for big trouble. I knew he needed all the bad ‘covering’ removed and I also knew it would cause quite a bit of pain (especially on the side of his face) and he would most likely need to be put under and then debrided.
I sent him home on Metronidazole (for the stinky infection), ointment for his head and instructions for washing once a day until the next time at clinic. We told the mother not to allow him to eat anything the morning of the ‘surgery’ because we would be giving him a medicine that would ‘put him to sleep’ and if he eats anything it could ‘cause him to die.’ Mary explained that this was the only way she can get them to understand the importance of not eating if they will be put to sleep.
Well, the next clinic day the child came with a belly full of food (this happens all the time) and so my next option was to soak the kids head for a while in hopes of softening the tissue and start cutting away the bad parts until the pain was too much to bear. It actually turned out quite well and the boy barely felt pain and I was able to remove quite a bit of the problem areas.
The smell was still potent at times and the pockets full of puss were quite revolting to say the least. I did not have the time to get everything, so we put ointment on his head, covered it with a clean baby hat and sent him off with hopes and prayers that he would not become more infected. He came back each clinic day and I removed more and more of the tissue. He is one of the bravest little kids I’ve seen and he sits so patiently as I remove his scalp. It breaks my heart when tears finally fall down his cheeks, so that is when I have to stop.
He has quite a bit of scaring at this point, but hopefully his hair will grow back to some extent, but most importantly, I hope he heals completely and does not have to deal with anything like this again.
I cannot tell you the amount of little kids that come in with this same problem, although this is, by far, the worst I have seen. I am working to educate the patient’s and their families on how to deal with lice and the problems it produces. I never liked lice, but these situations make me despise it to my core.
Here are pictures of the little gem and me removing his scalp…