Nappy rashes I have known

I should buy shares in Sudocreme. And Morhulin, and Metanium. We're quite fond of Waitrose "Bottom Butter" at the moment; smells good enough to eat. All vanilla and sweetness. Shame it doesn't do anything for the nappy rash really. Handy for dribble rash and dry skin though.

We get different rashes here. General overall redness, pretty little red spots, the occasional cracked and bleeding rash, and the horrible crusty ones. Thankfully most of the time it gets no further than the first two here. Which isn't bad, considering Mog is now on her second round of antibiotics and permanently on Movicol.

My hands smell either of Purell or of one of the many nappy rash ointments. Preventative mostly. We tried Drapoline a while ago, and I had flashbacks to my brief stint as a carer in nursing homes. Horrible times. Three staff, 27 residents, a weekly bath book, and hook as many of the residents up with catheters as possible to reduce the number of toilet trips needed. Doesn't do much to protect the skin though.

That was a horrible place. It was where I met my first bedsore - not just a sore but an open, festering abscess. I had to hold the old woman, confused and distressed (the patient, officially, although the same could have been said of me) whilst the one nurse in charge pulled yards and yards of stinking bandage out of the hole in this woman's buttock. The hole must have been at least six inches deep - I'm told it went from mid buttock right up to the bone, and was packed tightly with gauze bandage soaked in some healing unguent. As the nurse kept on pulling, I kept tight hold of the woman and tried to think of things to say to her. Aside from "I'm so sorry". One last week's dressing had been removed, a new gauze bandage was soaked, the wound washed out with saline, and then the new bandage poked, inch by inch, into the hole. Such pain. And so avoidable; if this poor woman had been turned regularly and cleaned and washed when required this need never have happened.

I don't want to end my days in a nursing home like that. I don't think anyone needs to end up in a place like that. Most of the residents just gave up, squatted silently in their assigned seat in the lounge or lay in bed in their shared bedroom, face to the wall. No chance of going on outings, National Health Service regulations stated that old people could not have their own wheelchairs if they lived in nursing homes, and the nursing home owners maintained they did not have the money to buy luxury items like wheelchairs. So the old men and women stayed still. Or were wheeled briskly from one room to another, deposited in the dining room whilst the wheelchair was whisked back to the lounge to collect the next resident. Dignity? Courtesy? Not likely.

This was my first "real" job. First job when I wasn't babysitting, first job where the work I did would pay the bills, put food in my mouth and a roof over my head. I had 30 minutes training, which consisted mainly of "don't put the nappies out until all the visitors have left; they don't need to see them". "This is the bath book, every resident must have a bath at least once a fortnight. Some of them will tell you they need one more often but they can't have them" and "They don't need to eat much, they lose their appetite when they get old". And that was it. My first task was to welcome a completely new resident, clean her up when she lost control of her bowels due to fright and disorientation, and show her to her new chair in the lounge. As I recall the loss of continence was clearly not a new thing, and her relatives had been struggling to deal with it for a while. She was sore.

As was "Edgar". A tiny little man, he preferred to stay in his bedroom rather than joining the others in the lounge. Evening came, and it was time to get it into bed. My first day, no manual handling training, just "oh he's light enough, you'll manage". So I measured up the distance between his chair and his bed, put one arm around his waist and the other under his knees, lifted him up as I would a baby, staggered over to the bed with him, and flopped down onto the bed with him - one of my arms still under his knees, the other still around his waist, my face therefore somewhere in the middle. "EEE lass", he said, startling me, since I didn't know he could talk "Tha's in't' reight place burra can't gerrit oop for thee". One shocked teenager putting the old man down and backing away slowly! How do you treat nappy rash after that?

Fast forwards a few years and I'm working in a residential school for children with profound and multiple learning disabilities. Here, we have one carer to every three or four children, and complain that the ratios are inadequate. They were, but I can't help comparing them to the nursing homes. We value children over the elderly, evidently. Here at least the aim of the school is to treat all pupils with courtesy, dignity, and respect. It isn't perfect. But it is a place where the majority of the people working there actively care about the people they are working with.

We get to do fun things, take the children camping and on days out, swimming and horseriding and trampolining (rebound therapy). The learning opportunities in the school are wonderful. And the many bottoms I wipe and clean and keep covered are, on the whole, in pretty good shape. We have one girl who suffers from a recurrent hot and itchy infection, and she finds it a great comfort (as well as hugely funny) to sit on a disposeable glove filled with cold water and carefully tied at the top. We have one lad with horrible eczema. But mostly, we manage, despite having some children living in plaster casts and body braces, to keep the many and varied bottoms all clean and rash free.

And now I foster. I've had children with the most dreadful rashes. We've had to sort them out slowly, over weeks rather than days. We've used air drying, we've used reuseable nappies and disposeables of different makes and models, we've used over the counter potions and high tech prescription ones, including a spray on second skin, we've used frequent baths and absolutely no water at all. All of which have worked sometimes and not at others.

Little Fish dribbles urine constantly as a part of her condition. She has a more or less constant little rashette if you will, it follows the line her urine takes before it's absorbed by the nappy and that's that. Mog has a bright red bottom, but no rash there. I plaster them both with more Sudocreme or Bottom Butter and wonder if I'm doing more harm or good. It smells better on my fingers than actual nappy contents though, so for now we'll stick with that.

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