Medicine for the Outdoors
Medicine for the Outdoors

Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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Running the Sahara, Part 3

by Jeffrey S. Peterson, MD

By the time our expedition left Mauritania, it had become a daily experience to return to camp from both the morning and evening legs of the run, and find between five and 10 nomads, who had often arrived on camels, awaiting me in hopes of medical treatment. Word travels fast in the Sahara.

The run clearly now had momentum, and we literally flew through Mali. Our team was traveling eastward near the Mali/Niger border when John Davidson, the driver of our supply truck, radioed us that he had been stopped by a Tuareg woman, who'd run out of her tent carrying a baby as he'd passed through the camp. The baby had some pretty awful looking burns on its feet, John said.

We turned back to rendezvous with the supply truck. The baby, perhaps a year old and now held by its father - a Tuareg in traditional blue bubu robes and head-wrap - was horribly burned on its feet and shins. It had been burned by an overturned pot of boiling water. The water, the father explained, was from a nearby well, and they had been boiling it render it potable. The accident had happened four days earlier. Becausee of the lack of clean water, the severity of the burns, and the blowing sand, the burns were now covered in scaly, sandy, and pus-laden scabs. The burns with blisters had progressed into abscesses surrounded by cellulitis. My first thought was that this was one sick kid and likely to become even worse without aggressive management of the abscesses and treatment of the spreading infection.

I quickly went to work, creating a work area on a sheet, and had the baby's father sit with him. I then began to clean the baby's burns. It was too slow. The baby, uncomfortable with this strange man helping him, began to shriek and cry. Realizing this would take far too long, I dumped some light saline solution into a disinfected bucket, put povidone-iodine into the water, and decided to place both of the baby's feet and shins in it simultaneously to wash them. The baby, however, seeing a tub of red water (probably not all that different from the one that had burned it) began screaming bloody murder. Eventually, through a bit of manhandling, the feet went into the bucket, and the child calmed down. Forty minutes later, I could debride the dead skin (which had to be peeled off the baby's lower legs and toes), clean the wounds on both feet, and get them treated with ointments and covered with gauze.

I then gave the boy multiple intramuscular injections of two antibiotics and a tetanus shot. Through an interpreter, I showed the father how to clean and treat the wounds two to three times per day and administer the oral antibiotics that his son would need to take for two weeks. However, I still wanted to monitor the child's progress for a day or two. After 20 minutes of heated debate about whether John and I would stay behind to monitor the child's status, the father ended the discussion by saying “I'm an intelligent man, you have shown me this, I can do it. Please go with my thanks.” Realizing that we had done what we could for the child and that we were obligated to respect the father's wishes, we continued on and caught up with the runners.

A few days later, having crossed into Niger, our camp was entered by some local Tuareg herdspeople, this time four young girls. They said that their mother had given birth during the past two weeks, but was still so sick and weak she was having trouble nursing. She was becoming more dehydrated every day and could not keep any fluids down. We traveled the mile distance to the family’s camp, where I was required to obtain permission to enter from the male owner of the camp. Once granted access, I learned that the victim was subsisting on nearly-spoiled camel’s milk. Using an English-speaking Tuareg guide from our camp, I took her history and then—after politely explaining to both the male and female adults what I might be able to offer as help—was granted permission to perform a brief exam.

The woman was suffering not only from severe dehydration, but endometritis, which is a severe, post-delivery infection of the reproductive organs requiring very strong antibiotics for treatment. I returned to the camp, treated her with a battery of four antibiotics, plus some powerful anti-nausea medicine, and multiple liters of Gatorade. By the next morning, when I returned to check on her, her status had turned around. She was nursing the baby normally, and her color and skin tone had returned.

More in Part 4…

photo by Jeff Peterson

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About the Author

Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.