Child Amputee Programme: Ebrima's Story

This year we are also supporting The GLOVE Project's child amputee programme

https://www.gloveproject.life/child-amputees

The profit from the Christmas card sale is currently supporting 4 child amputees.

One of them is EBRIMA, who's had a long journey of suffering.
This is his story.
This post is very long you say? Just imagine how endless this ordeal was for Ebrima.
Still, please take the time and read it, and consider contributing to his and other children's treatments and rehabs.

Warning: Graphic images below

August 2022:

Ebrima is as happy and smiley as ever despite the obvious pain and trauma he continues to go through. He continues to need "masses" of iv medication to keep the infection under control. His medication alone today cost D1300 to last until the team return on Friday.

EBRIMA it seems may be needing further skin grafting as the area over his exposed leg bone does not seem to be healing.

04 December 2022: The Wet Room at Jackie's house has been dug up and re laid and tiled (to make it wheelchair accessible) so now Ebrima can move in tomorrow with his brother.

As you can see from the second 2 photographs little Ebrima has been left to live in a room on basically a building site with no toilet or bathroom facilities in the care of his 16yr old brother. His father has had to return to Basse under threat of losing his job if he did not return. There is no mother on the scene to help care for Ebrima and he is scheduled to return to hospital for an out patients appointment in 2 weeks. The GLOVE Project has funded his life saving medications on the ward for almost 6 months thanks to amazing supporters.

However, the area of his thigh where the skin graft was taken is still not healing and is weeping through the dressings. We clearly can not leave him to live in these terrible conditions whilst he needs to much medical care and nutrition hence the decision to move him to Jackie's house pending his next hospital appointment.

Tomorrow Jackie and Baboucar will take him to a nearby hospital to have his dressings changed and check his wounds and also an xray of his leg to see if the bones are healing or not as this external fixation has been in place now for 6 long months.

December 2022: EBRIMA now safely at Jackie's house with his elder brother. Jackie took him to Dr Ding for wound dressing as this had not been changed for 5 days. The poor child was screaming hysterically before being touched.

This wound is from where they took the skin graft 6 months ago, it is not healing and is infected (microscopically confirmed).

The dressing needs changing daily and luckily one of Tilly's friends (Sophie) is visiting from UK who is a nurse and also attended the hospital with the child today. Sophie has undertaken to do the daily dressings for the next week and we shall see if any progress is made.

EBRIMA now has a wheelchair donated by David and Linda Chambers and we have been showing him how to move himself around. Sadly, there is so much muscle wastage even to move himself in the wheelchair is a problem.

A large part of the lack of healing, according to Dr Ding, is very poor nutrition and total lack of physio therapy for a very long period of time. This little boys condition is just heart breaking.

Jackie and the team will do their very best to try to improve the situation and the general health of Ebrima but this is going to take a very long time.

DRESSING CHANGES FOR EBRIMA are traumatic and difficult though absolutly crucial. The wonderful nurse Pierre who Jackie had previously met at Ndemban clinic, came to start to take over from our visiting nurse Sophie who will be leaving The GLOVE Project soon.

Pierre will be changing Ebrimas dressings every 2 days and has today taken the stitches out which had been in far too long.

Although extremely painful and traumatic for Ebrima you can see from the photographs he quickly returns to his happy smiley self.

There was a discussion with little Ebrimas Consultant after Jackie saw this Xray of this little one's leg. The Consultant confirmed they had attempted to put a 'spacer' in place but this didn't heal / was rejected. It seems Ebrima's immune system is so low any healing is a major problem. The Consultant is considering doing what is known as a fibula transplant. Taking part of the thinner bone (fibula) and using it to fill the gap in the thicker (Tibia) bone. Will this work ???

Jackie has been asked to bring him back to the Consultant in 2 weeks time.

January 2023: 
Young 12 yr old Ebrima has been at Jackie's house (with his 17yr old brother) since the 6th December after he was discharged from hospital into a small room on no more than a building site with no bathroom or toilet facilities. The father had to return to his work in Basse under threat of losing his job. There is no mother around.

Ebrima broke his lower leg but was not taken for treatment, massive osteomyelitis set in and ate so much of his little arms and legs. His right foot was so badly eaten away that a significant skin graft was taken from his right thigh back in early June to cover his foot. At the same time the surgeons tried to save his Tibia bone and placed the external iron fixation.

7 months later the donor graft area has still not healed and a nurse is being paid to come to the house every 2 days to change the dressings special dressings are also needing to be purchased and Ebrima remains on expensive oral antibiotics as well as a high protein diet. This regime and a clean environment is making all the difference to his wound healing and as you can see there are now significant improvements.

Unfortunately the orthopeadic surgeons have had to cut out a substantial part of the tibia bone due to advanced disease and infection and their plan now is to attempt a fibula transplant. This is substantial surgery with a very long recovery period.

Jackie is having significant problems getting to see the consultant with Ebrima and has been told today that he will not be back in clinic for another 2 weeks so we do not even know when this next surgery is going to be likely.

The GLOVE Project has funded Ebrimas iv antibiotics on the ward for many months, he can not return with his father to Basse as he is not fit to travel in his current condition nor will he get the medical and nutritional care that he needs to give him the best chance of healing, to save both his legs.

An awful situation for this little 12 Yr old boy, we just do not know what the future holds for him but we are sure you agree that we really do need to help him, to give him the best possible chance of recovery.

Currently Ebrimas medical care, feeding and additional staff is costing in excess of £300 each month (this includes the brother too )

20 February 2023:
AT LONG LONG LAST EBRIMA'S THIGH WOUNDS FROM HIS SKIN GRAFT ARE HEALING.

The first photo (in blue shorts) was taken in early December.

The 2nd photo was taken this morning, almost 3 full months since Ebrima was moved to Jackie's house to receive appropriate care.

Thanks to donors The GLOVE Project has been able to fund specialist wound care dressing changes every 2 days by a qualified nurse throughout this time. Ebrima has received a good high protein diet and supplements, too and has been kept in a clean environment where he has thrived.

We are sure you will remember that this skin graft was taken from him in June 2022, almost 9 months ago. When he moved to Jackie's the wound was in an awful condition and was infected, Ebrima was also hysterical when it came to changing the dressing requiring 3 adults to hold him so the nurse could clean the wound and change the dressing.

The GLOVE Project is also happy to report that this hysteria has now stopped (after the first 5 to 6 weeks) and Ebrima now takes his own bandages off and does not need anyone to hold him. It is fantastic that the team have been able to give him this psychological support to overcome his fear and trauma.

The British Surgical Team will be in Gambia on 3rd/4th March and will review the next surgical options for young Ebrima.

A big thankyou to UNISON East Lancs Health Branch Office and Jane Aitken who have been instrumental in funding Ebrimas care, which as you can imagine, has been expensive.

08 March 2023: 

"As you can see Ebrima was up sat in a chair this morning for a couple of hours following his first physio session. He screamed and cried despite good pain relief at 8am. No doubt he has pain following such major surgery, he also has a large degree of fear from the awfully traumatic 10 months he spent in hospital previously. This trauma is still clearly evident in him on the ward. Xrays and bloods were also done today and he managed to eat a yoghurt and finish a fortisip drink.

Regular decent pain relief is very important for Ebrima if we are to manage his past trauma without causing him further mental anguish.

Sadly all is not well on that front in my humble opinion. Despite his British consultant prescribing regular tramadol pain relief for a few days this was changed this morning by a Gambian Dr whose name was refused to me.

The only pain relief Ebrima is now allowed to have on a regular basis is a paracetamol tablet. He can only have a tramadol injection 'when needed' (and who will decide when that is)

When I questioned this I was told by the Dr. "If you continue to question these nurses they will refuse to treat this patient and rightly so"

Again Drs name withheld. This was said very loudly in front of many nurses who ALL agreed with the Dr and actually thanked him, and infront of a ward full of patients and their families. Another Dr present totally agreed and went on to say Ebrimas father had already been given todays prescription and unless that is found there won't be another one . . .  Ebrimas father had not been given any prescription.

The Hospital Matron came and 'smoothed' things in his usual very kind way, he also pointed out his office to Ebrimas father should any issues arise. This is a pretty horrifying situation and one I do not find easy to write about as there will no doubt be repercussions for me and potentially for Ebrima too."

21 March 2023:

EXACTLY 14 DAYS AGO THIS AFTERNOON, EBRIMA HAD A FIBULA TRANSPLANT DONE

NOT ONLY IS HE WEIGHT BEARING ON HIS 'GOOD' LEG BUT HE IS MOVING.

He can not weightbear on the leg that has received the transplant for 6 months and this is the first time in more than 17 months that he has been able to utilise his other leg due to horrendous joint and muscle eating infection.

Walking with crutches does not seem such a big deal but for this 13yr old boy it is an absolute MASSIVE achievement, let us explain.

EBRIMA has been absolutly riddled with a bone and joint eating infection called osteomyelitis, a large part of his tibia bone in his left leg was infected and removed and he was left in an iron fixation for more than 9 months. He was terribly malnourished when he was placed with Jackie on 2nd December 2022. He could not even move himself in a wheelchair, he had no strength at all.

Ebrima has not been "upright" for more than 18 months until recently. He has progressed through learning to use a walking frame, to under arm pit crutches to what you see today thanks to the determination of Jackie and the team. It has not been easy, Ebrima had a 2 week period where he seemed to have decided that he wanted to stay in a wheelchair and not regain any independence but with the perseverance of the team this was over come and today we are so happy to share this amazing progress.

A little boy who was at high risk of losing a leg, who really was not likely to ever leave a wheelchair, to be forever dependent on others for his mobility. The dedication of the team is clearly demonstrated here with Ebrima who has lived with Jackie since 2nd December 2022, whose nutritional status is now normal, a little boy terribly traumatised is now thriving. His skin graft donor site continues to heal and we are all so happy for him.

He will soon be having xrays to see if the fibula transplant has taken and we will then be clearer on his future.

29 April 2023: 

Today Ebrima had his xrays done some 7 weeks post fibula transplant to see if the transplanted bone was starting to 'take'

Unfortunately for Ebrima Dr Marenah is not in the country so he was not able to be reviewed so we shall await the outcome regarding "what next" with bated breathe.

Has the transplant worked ?

If not then amputation would be the only option.

If it is working should the plaster be changed ?

Kept at full length or reduced to below knee?

Hopefully the xrays will be reviewed remotely and we should soon find out more.

The bone is clearly still in alignment though very fragile and continues to need a lot of 'protection ' and good care, no weight-bearing for a very long time yet.

20 May 2023: 

Little EBRIMA has now progressed from a full leg POP to a below knee plaster and he is absolutly thrilled. 4 to 6 more weeks then the plaster can come off and he can then start (partial) weight bearing in an orthopaedic boot on this leg which is where he had the fibula transplant in early March.

He celebrated with a hair cut and a big fat sticky donut and why not?

SADLY the news is not so straight forward with regards to his active osteomyelitis. The xray does not give a definitive answer and was reviewed immediately by Dr Marenah who recommends an MRI scan as the infection could he in his upper chest area. An MRI scan will definitely be able to confirm where this infection is sitting, so they really need to get this done which will of course cost ...

This little lad has been through so so much, he has come so very far and made so much progress, at times even "against the odds" but he still has so far to go yet and the fact the infection has reactivated really could be a huge issue. Until we get the MRI things will continue to hang in the balance.

25 June 2023:
YESTERDAY WAS A MASSIVE MILESTONE FOR EBRIMA as well as for Jackie and Baboucar. 

AT LONG LAST Ebrima has had his plaster cast removed and is now able to stand on his own 2 legs with the aid of an orthopaedic boot, for the FIRST time in over 2 years this little boy is now relearning to walk.

His body was ravaged by the terrible osteomyelitis infection that has eaten a lot of his tibia, ankle, wrist, elbow and shoulder. He had a massive skin graft and the site would not heal. He had several operations and was left with a massive metal external fixation on his leg for over 9 months with no hope of removing it until Gam Med stepped in via Dr Kebba Marenah and undertook a fibula transplant to give this boy some hope for the future.

It has been a very long haul for the team who has been involved with Ebrima since last June. He has been at Jackie's house since the 2nd December and the cost for his 24hr care, all his wound care and medical care has been very significant for this small charity. The dedication and commitment from the team has been above and beyond what anyone would expect considering the ongoing home visits, monitoring and residential rehabilitation of the child amputees that has continued throughout.

Ebrima has battled against all the odds and to now see him up on 2 legs relearning how to walk is just overwhelming and soon he will be able to return to his fathers care.

15 June 2023:

We posted earlier that the large wound on his thigh has at long last fully closed.

The damage to Ebrimas body has been caused by an infection called osteomyelitis which really has ravaged him. The infection seemed under control and he was 'dry ' until there was a rupture at the top of his arm towards his chest wall where poison has poured out for weeks on end. Of course he has been medically reviewed, an xray was clear that the infection was NOT in his arm or shoulder. An MRI scan was done 2 weeks ago to see if the site of the infection could be found. Jackie is STILL waiting for the MRI report which has been greatly delayed due to the relevant staff being on a workshop.

Jackie has been informed, "maybe next week"

On a brighter note, just one more week and Ebrima can have his plaster cast removed which has been in place since his fibula transplant by Gam Med on 7th March this year.

Once out of plaster Ebrima will wear an Orthopeadic boot and will, at very long last, be up on 2 legs again.

15 September 2023:

EBRIMA has been back for his outpatients appointment at Banjul Hospital travelling all the way from Basse. Unfortunately, Dr Marenah was not in clinic so he has been given another appointment for the end of September to be seen.

The team was a little disappointed that Ebrima's walking has detiorated since leaving the project house on the 1st July. Baboucar had a long chat with both Ebrima and his father reminding them how crucial it is to continue the exercises and walking practice if his mobility is to be improved.

30 September 2023:

EBRIMA HAS ATTENDED HIS OUTPATIENTS APPOINTMEMT TO SEE DR MARENAH.

Unfortunately, Dr Marena was not in clinic and Ebrima was reviewed by A Cuban Professor who has recently taken up post in Banjul from Farafenni. Unfortunately Xrays are showing there is a "bit of an issue" with the transplanted bone since Ebrima has returned to his home in Basse. As far as we can understand, this is not critical at the moment but as a precaution Ebrima has been asked to revert back to using 2 crutches in order to lessen the weight bearing on this leg.

The amazing Gam Med team who carried out this bone transplant are returning to the Gambia in November and will hopefully be able to review Ebrima and advise on the situation.

Baboucar spent considerable time talking to both Ebrima and his father and advising them on taking care of this leg. Ebrima was also given a good supply of nutritional drinks to supplement his diet, thanks to Mary French for donating these drinks which make such a difference.

14 November 2023:

"POOR EBRIMA. Today we received this xray of Ebrima's leg which recently underwent surgery by the Gam Med team. The xray looks as though the bone that was transplanted in March of this year has been removed although we are not Drs of course. We also know you will all have many questions such as,

"has the transplanted bone been removed"

"if so why"

"what is the surgery scheduled for 6 months time for"

"what is the prognosis for Ebrima's leg"

"would it not be much better in the long run for Ebrima to have this lower leg amputated and have a prosthetic"

"where is he going to live and who is going to care for him"

Sadly, we are not able to answer the medical questions and Jackie has messaged the Gam Med team several days ago to try to get more information so that we are better placed to offer Ebrima the most appropriate care that we can. This is with the full permission of Ebrima's father, we understand Jackie is still waiting for a reply from the Gam Med team."

24 November 2023:

EBRIMA HAS LEFT HOSPITAL AND IS NOW AT THE PROJECT HOUSE WITH JACKIE.

This little boy has gone through so much yet his smile touches your heart. He has so far to go and so many surgeries ahead of him it is just unimaginable. Yet STILL he smiles...

Once Ebrima was settled and the dogs had finished their greetings, Jackie and Baboucar say down with the father and explained everything the surgeons had said in their recent message to Jackie Church regarding Ebrima's leg and all the future treatments and surgeries that he will likely need as well as how long this will all take.

Ebrima's father apparently cried, he was so distraught to hear this news saying "How can I put my child through this, I just can't do this to him and watch him suffer over and over"

"He has already had so many operations and has suffered so much this past 2 years."

He went on to say that he "had absolutly no idea of any of this"

and that his understanding was

"that the iron has to stay on Ebrima's leg for 6 months and then a operation to take it off and all will be fine with his leg."

Ebrima's father states he is eternally grateful to The Glove Project and the care they have given and are giving, to his young son stating, "I could not have done any of this without GLOVE, I am not even sure Ebrima would have survived without your help"

Jackie and Baboucar will give Ebrima's father the support he needs and will care for Ebrima to the best of their abilities.

As well as needing 24 hours care and support Ebrima has lost a lot of weight and looks like an 8 or 9 year old child not a teenager of almost 14 years. As well as intensive medical care Ebrima also needs a high protein and high calorie diet along with heaps of TLC.

24 January 2024:

Ebrima, the little boy ravished by osteomyelitis as he was not taken for hospital treatment following a broken lower leg. He did not receive appropriate treatment for more than 6 months, likely nearer a year. He suffered the most terrible neglect followed by numerous surgeries and 8 months in hospital. His life was saved but his trauma was not finished.

Drs and surgeons have gallantly battled to save Ebrima's life and his leg including the British team Gam Med and Dr Marenah. Ebrima spent 8 months at the project house last year, he has been back there since Jackie returned on 23td November having had further surgery by Gam Med. The bone transplant that was undertaken last March had failed, several more surgeries have been planned, likely taking a good 18 plus months. Ebrima is suffering, his father is a single working parent and their home has been at the opposite side of the country where Ebrima can not receive the medical or home care that he needs. There is no extended family in Gambia, his father is a none Gambian.

There are no effective social services, child care facilities or the likes in the Gambia, what a terrible situation.

EBRIMA'S leg is infected, he is in a lot of pain and was taken to Ndemban Hospital on Monday morning where antibiotics and strong pain killers were prescribed by Dr Marenah and his team.

Yesterday, Dr Marenah met with EBRIMA'S father, Jackie and the project manager and the difficult decision was made for Ebrimas leg to be amputated.

Ebrima has suffered terrible trauma during his lengthy stays in hospital, the very nature of the damage and open wounds caused by his body being ravaged by infection making all dressing changes extremely painful. Because of this, and in order to reduce further trauma and reawakening terrible memories the decision has been taken that the amputation will take place at a private hospital. We are sure you will agree that this will be far better for Ebrimas mental health.

The surgery is scheduled to take place on Saturday, 3rd February.

02 February 2024:

A SHORT BUT SWEET MESSAGE FROM EBRIMA AS HE LEAVES TO GO TO HOSPITAL WITH Jackie Church .

TOMORROW HIS LEG WILL BE AMPUTATED.

03 February 2024:

EBRIMA IS PAIN FREE AND DOING WELL.

We can finally report that Ebrima's surgery is over and has gone well. His amputated leg has been buried by Baboucarr Sonko and Ebrima's father in line with their religious beliefs and Ebrima is wide awake, full of smiles and full of good pain killers.

05 February 2024:

EBRIMA IS RECOVERING WELL.

Jackie Church has continued to be by Ebrimas side and as you can see from the video he is up and about and doing physio.

Pain free and now taking oral pain killers he will hopefully be back at the project house tomorrow where he will receive the best possible care ..... and be spoilt a bit.

06 February 2024:

EBRIMA IS OUT OF HOSPITAL.

He has had a lot of vomiting today due to pain meds so is not his usual bright and breeze self though that will soon pass. As Ebrima himself says, a Very BIG Thankyou to Dr Marenah.

11 February 2024:

7 DAYS POST AMPUTATION.

Ebrima is doing fantastic within himself, he has no pain, is no longer requiring any pain relief, is eating well and in good spirits. Tomorrow he will be having a hair cut which he is very much looking forward to. Sadly, Ebrima had to be taken back to Hospital for an addituonal review by the wonderful Dr Marenah yesterday as his dressings were soaked and the smell was terrible. As you can see from the photo, the wound has started to reopen / breakdown. This has absolutly nothing to do with the quality of surgery nor the stitching which were of course, excellent. This is more to do with Ebrima's complex history of massive chronic osteomyelitis as well as the recent very high temperatures and humidity.

Ebrima's healing capacity is significantly compromised, we expected poor healing and no doubt this wound is going to open further and his healing will be slow. The team, along with Dr Marenah will continue to do their very best.

29 February 2024:

Ebrima has been reviewed By Dr Marenah this evening and he is pleased with his progress. The wound from the amputation is not pretty but, surprisingly it is not deep and is not now infected. It is definitely better than was expected. Ebrima will continue to require wound care and dressings changed every 2 days and the team has a good wound care nurse to visit the house to do this thanks to your donations.

Ebrimas leg has to remain with a back slab and he is to remain none weight bearing for a further 4 weeks when further xrays and review will take place. The high level 24 hour care for Ebrima is going to be needed for at least the next 2 months and the decision will be made at the next review regarding surgery on the knee of his remaining leg.

Despite all of this, Ebrima is back in good spirits and full of smiles.

Taking care of Ebrima and his complex needs is very demanding but Jackie Church and the team in Gambia will continue to do the very best that they can.

We'll keep you updated on Ebrima's and the other children's progress.
If you would like to send a donation to this project or specifically Ebrima, please let us know (reason for transfer). We'll make sure all these donations will reach The GLOVE Project.

ABOUT THE CHILD AMPUTEE PROGRAMME

Here in The Gambia those with disabilities are frequently marginalised, ostracised, socially isolated and many (children) are abandoned. There is no Government assistance and generally the cultural and societal belief is that these people can achieve little more than being street beggar’s.

This is the harsh reality.

The Glove Project's Juvinille Amputee Programme started in February 2019 when they came across 15yr old Dembo. Child Amputees are frequently not at school, being deemed unworthy of the expense of uniform, books, shoes etc in a Country where money is a scarce commodity. Why spend scarce resources on a child  deemed unlikely to become anything other than a street beggar.  These children are frequently neglected and hidden away.

THE PROSTHETICS

Are old and cumbersome, heavy and ugly frequently the children sizes are not available and the team have to cobble things together. Whilst these are free the sockets to fit the stump have to be molded and made to fit the individual and it is these materials which have to be paid for as well as transport to and from the prosthetic centre in Banjul.

HOW THE GLOVE PROJECT DOES THIS

"Spend time visiting the child and care givers at their home, the children are rarely with their mothers and fathers, rather  with extended family, frequently living in abject poverty.

Purchasing the fitting of a prosthetic leg and rehabilitation onto that leg.

Ensuring the child has a place at a school, funding uniform, books and all necessary equipment. At times including school feeding if under nourished which most are.

Purchasing bicycles to promote mobility and social standing. To have a bike is a considerable achievement here and quite a status symbol for a child.

The distances to school are frequently too far to walk on the old prosthetic legs that are available and without a bicycle, attending school would not be an option for most of these children.

Supplying sacks of rice which is the staple food, to the family so as the child is seen to be of some value and to promote improved nutrition.

When donations allow clothes and shoes are given.

We undertake regular home visits to monitor the child and to encourage acceptance and value by the family, promoting love and involvement by the local community.

We find and fund apprenticeships for the older children.

We monitor growth and fund replacement prosthetic fitting as the child outgrows their limbs. New prosthetic limbs are needed approx. every 6 to 9 month depending on growth rate. We monitor for bones growing through the amputation site and arrange and escort for Orthopeadic reviews. This may mean re amputation or trimming of the growing bones is necessary and timely intervention is required along with intensive post operation care."

Text and photos mainly by The GLOVE Project