Case study – Amy (nine years old)
|Amy is in the paediatrics ward with a skin infection, which has spread to her eczema. She struggles to sleep due to the eczema and symptoms of sleep apnoea, making it difficult for her to concentrate at school.
Amy is nine years old and has been hospitalised twice before for infected atopic dermatitis (eczema). This time she has been admitted to the Paediatrics ward for a suspected Staphylococcus aureusinfection (cellulitis) which has spread to her existing dermatitis. She has received flucloxacillin intravenously.
Amy lives with her mother, her siblings, aunt, uncle, cousins and grandmother in a house rented by her aunt and uncle. She shares a mattress in the living room with her sisters, with the children sharing blankets, pillows and sheets. Amy also shares a towel with her sisters, which increases her susceptibility to infections. During the winter, her mother and cousins also sleep in the living room and warm it with a small fan heater. The house has one bathroom with a shower but no bath, which means that Amy is unable to use the bath oils recommended by her GP to treat her inflamed dermatitis. The treatment is not funded by PHARMAC, and is too expensive for Amy’s mother to purchase without a prescription.
Amy is overweight for her age and height, and she has symptoms of obstructive sleep apnoea, which causes her to snore and breathe heavily during sleep, disturbing her siblings. She has trouble concentrating at school as she is tired from poor quality sleep, as well as itchy from her eczema. Amy is a frequent target for teasing and bullying from other children due to her dermatitis. There is no computer or books available to assist Amy or other children in the whānau with their learning and homework, and there is no quiet place to study.
'It’s itchy and sore and red. It’s hard to sleep in hospital because the eczema is all over my back and my knees – there’s no way to sleep so it doesn’t hurt. It’s on my face too, and in the morning there are flakes of skin on my pillow. The eczema is feels hot and puffy. Yellow-green pus oozes out of the sores on my arms.
The nurse came and put the injection in my arm and attached it to a bag of clear liquid. The doctor said that its stronger medicine, stronger than the creams I put on at home to make the eczema and the itching go away. Sometimes the itching doesn’t go away, and the sores don’t get better. That’s when I have to go to hospital.
There is nothing good about hospital except I get my own bed, and I don’t have to share with Shae and Mikayla, because they always steal my blankets in the night, and they kick me because I snore a lot.
I put my own cream on the eczema when mum can pay for the medicines, because I am nine and a big girl and I want to show her I can be responsible. She’s always busy with Shae and Mikayla, or Nana, or Aunty Tania, or she’s at work because she goes to work after I come home from school. So I try to put the cream on myself. I can reach some places, but not all of them. When the eczema gets bad I cry because it hurts so much. Mum tries to take me to the doctor, but there aren’t any appointments.
The doctor said that baths are really good for the itching, but we don’t have a bath in this house and the medicine was too expensive. I share my towel with Mikayla, and she sometimes leaves it wet on the floor, so it is hard to dry myself. Mikayla’s only five though.
Kids at school make fun of me when I have eczema on my face. They call me names and I cry. I don’t want to go to school. At school I am always tired, and my skin itches under my clothes. I can’t focus on what the teacher is saying, and I can’t understand the work. We don’t have any books or a computer where we stay.'