“Take good care of your finger and they will take good care of you” (Akatungu)
A common way of keeping children on their best behaviour, is to threaten them with a visit to the hospital.
The hospital visit is perceived by many children as  punishment for misbehaviour.
I am often surprised at how many times, children getting injections will cry, “I have stopped, I won’t do it again”. Inspite of the fact that they probably did not do anything wrong except getting sick.

It’s not only children who dislike hospital, by the way.  Many people do not like hospitals at all. Nor do I exclude myself from that group.
This, is so,  for the same reason that many people do not like cemeteries.
It is a place that forces us to confront sickness, suffering and worst of all death.
For many of us it is an uneasy experience stirring up emotions we don’t really want to feel, like guilt and sometimes shame at our own privilege or indifference to the suffering of others.
I had, for many years, a dislike of hospitals so I can hardly blame anyone for this attitude.
The hospitals themselves, seem indifferent to this perception, and just carry on with business as usual. Probably presuming that the service is more important than the environment in which the service is provided.
The distinctive smell of disinfectants and antibiotics that permeates the hospitals makes it all the more uninviting.
When you walk the hospital corridors like I have for many year you become desensitised to it.
However for the casual visitor, it can be an intimidating experience.
Inspite  of this, one  thing that will get people into the clinic or hospital pretty fast regardless of all their reservations is pain.
The World Health Organisation has classified pain, into 10 levels, using a Visual Analogue Score (VAS).
This score has cartoon pictures showing increasing degrees of misery, so that even if a person cannot read they can point at the pictures to express their level of pain.
When you reach a score of 10, the picture has tears dripping.  There are not many things that will give you a pain score of 10.
One of the most common conditions that can give you pain that severe is finger nail pain.
The finger throbs like it’s on fire and you cannot think let alone sleep. People will blaze a trial to the hospital at any odd hour to find relief. The other is Dental pain.
For now we will discuss Finger Nail Pain. If you have had it, it is something you will not easily forget. If you have not had it, you will be praying that you never do.
1. What causes  Finger Nail pain?
2.How can I deal with Finger Nail pain?
3.What can I do to avoid Finger Nail Pain?
1. What causes finger nail pain?
One of my patients once told me she was a Cosmetologist. I scratched my head a bit, and thought, so you study the universe.
She laughed and said more simply, I am a beautician.
She elaborated by saying, she helped people look more beautiful. I have not realised before then, that   could be a profession.
I guess it was a sign of, how out of touch with the times I had become.
One of the things the beautician or Cosmetologist does, is a manicure. If you have heard of a manicure, then you won’t have any difficulties understanding where the finger nail is.
If like most men you don’t know what that is, it is the art of beautifying the fingers, particularly the finger nails. The finger nail, is the part of the  fingers  right at the end of the fingers and covers part of the  tip. There are at least two conditions that will give severe finger nail pain. These are a collection of  blood under the finger nail, which is called medically a Subungual hematoma and  pus under the finger nail or  medically called paronchyia or  “Akatungu” in Bemba.
If you have had your fingers slammed in the door way or while hammering a nail, have missed the nail and hit your finger with the hammer, then you know what a Subungual hematoma is.
If not, then consider yourself lucky.
A subungual hematoma, is a collection of blood under the finger nail or toe nail due to a sudden compressive force applied onto the end of the finger. It bursts the blood vessels running between the fingertip and the nail.
This area is tight and allows little space for expansion. So the sudden collection of blood causes sudden immense pain.
There is a dark red discolouration visible beneath the nail and a throbbing pain that makes the fingertip feel like it’s on fire.
This problems is also common on the toe nail, especially when you play “Madalas” football.
This is the type of football  usually played at social occasions by older men, nostalgically.
They have not played  soccer, for ages and are a bit unfit.
They will usually hit the ball with of their big toe “Chigondo” (like they used to in their younger days), but the toe which is now unused to the pressure gets injured and they get a blood blister under the big foot toe nail.
Paronchyia “Akatungu” on the other hand, is a similar condition, except, this time instead of blood you have pus.
The pus accumulates beneath the nail in a very tight space causing stretching of the tissues between the nail and the fingertip which is excruciatingly painful. You will have seen many people nibbling their finger nails when they are nervous, or perhaps you have done it yourself.
If you notice carefully, you will find that occasionally along the side of your finger nails there are little strands of stray nail/skin fibres.
Many people like to bit these off with their teeth in their spare or idle time.
Those who are wiser use manicures or nail clippers.
This act of biting or sometimes washing clothes with rather corrosive soaps, causes the spread of infection into the nail space.
Remember that the skin and the mouth normally have germs lying around.
So this fidgeting with the nail bed area pushes a few germs into the nail space.
The outcome is often not a happy one.
It starts with a bit of redness and itchiness on the nail side, it sometimes spread around the nail culminating in a throbbing and very hot fingertip.
2. How can I deal with finger nail pain?
I was once called up at night by a friend of mine who was in severe pain. I learnt on the phone that he had hurt himself while doing some DIY(Do it Yourself) work at home.
From the phone conversation I deduced that he had developed a blood collection under his finger nail (Subungal Hematoma).
I tried to explain what he needed to do on the phone, but he was just in no mood for it.
So we met up at the hospital which was half way between his place and mine.
I came prepared with 2 paper clips.
He was clearly very uneasy and was holding onto his finger for all it was worth.
We settled him into the casualty room, and preheated the tip of the paper clip from the hospital kitchen  stove.
I reassured him that the finger nail is dead and has no sensation, so the process was virtually painless.
He held on to my shoulders clenched his teeth and closed his eyes.
I gently pushed the hot tip of the paper clip through the nail close to its mid portion until it when through with a give.
The relief was instantaneous.
I repeated this on a second site to increase the rate of extrusion of the dark blood that was now seeping through the nail.
We clean it up and dressed  it with a small adhesive bandage.
He gave me a hug, and admitted he should have been able to do it at home himself. He insisted on paying, and I refused to accept.
The moral of this story is “never charge fees to a friend”.
Not quite, in fact the moral of the story is “take good care of your fingers and they will take good care of you”.
Remember that we all somehow make a living from our fingers.
So all you need is a hot piece of wire and the patience to drill through the finger nail, a process called trephining of the nail bed. The blood clot finds its way out relieving the pressure and instantly relieving the pain.
When the tip is hot it burns more easily through the nail, and avoids introduction of any germs into the nail bed.
Some pain killers like panadols, or indocid will be helpful afterword, but will be completely ineffectual before, because of the level of pain.
In the case of paronchyia  or “Akatungu”.
It starts with a little bit of irritation along the sides of the nail, after several attempts to bite off loose nail pieces on the sides.
Most people will blame the little sticking out fibres for the pain and irritation.
So they mistakenly assume that so long as they can get rid of these little loose pieces they will get better.
To compound matters they will use their teeth, which has all types of germs.
These germs then jump onto the finger nail and begin to spread infection under the nail.
The best approach is to keep the finger nail clean. Clean it with a bit of hand rub or antiseptic like Dettol or Savlon, using a soft cotton wool or gauze.
If you have an antibiotic cream rub it along the sides of the nail.
This will confine the infection and sometimes abort it. If the infection spreads and becomes established, you will see a whitish appearance alongside the finger nail or beneath it.
This is the stage to make the hospital visit.
A few moderate analgesic tablets (Panadols), will stand you in good stead at this point.
The hospital treatment will involve the drainage of the pus collection in the theatre and a course of antibiotics to prevent spread of the bacteria into the blood stream.
You will then be able to return to having a good night’s sleep.
3. What can I do to avoid finger nail pain?
The secret to this is summarised in the moral of the story state earlier, which is “ take good care of your fingers and they will take good care of you”.
I do not mean by this to advertise the services of my friend the Cosmetologist, and say have you hands manicured every weekend.
However you should be aware of the things that you can do to take better care of your finger nails.
These can be divided into 3 key elements
1.Diet
2.Exercises
3.Finger care
You will be asking how does diet affect finger nails. Well the nails are like hair, they grow from the skin.
So the healthier your skin is, the better quality nails you will have.
If you have strong quality nails they will not break easily and they will not get infected easily.
So a diet which is rich in vitamins makes for strong nails.
Be particular  about a good supply of the vitamins A,B,C and D which are especially good at making the nails strong and healthy.
These are abundant in fruits like carrots, oranges, bananas and apples.
Take white meat (chicken –without the skin)and fish protein  which are rich in Omega 3, good fats. You can add Zinc supplement  tablets which are important in forming the nail matrix.
Exercise sounds odd too, how does one exercise ones nails.
Well, if you do exercises in general at least 15 minutes daily, which will raise your pulse above 100 beats per minute that will improve the blood flow to the skin.
When the skin is healthy so too are the fingers.
When you use the fingers for their original purpose, which is as a hand tool, such as in grip of fine delicate work.
The result will be that your finger nails will be strong, and not soft or brittle.
Some special finger care tools are available for those prone to occupational finger injury.
Such as a thimble, which is a thumb or finger guard or shield for those who do needle work.
For those who do a lot of washing of clothes, they may use light work gloves so that the caustic agents do not injure the fingers.
Many housewives suffer from chronic fungal paronchyia from constant washing and dish cleaning.
If you are a mechanic  or a carpenter you should regularly clean your finger  after work to remove wooden and metal fragment which embed themselves around the finger nails.
Keep your finger nails trim.
This is required in many public professions, like Doctors and Nurse, and is a good thing.
Artificial nails weaken the natural nail and should be used sparingly.
They also break when glued and can damage the underlying nail.