Poor Zara has become the first victim of biting bugs and things tropical. We have generally been devoured by Mozzies here despite our best efforts and precautions, but thankfully Malaria is reasonably rare and now with the weather cooling down a bit we may be ok. She did however get a visit from another bug…cutaneous larva migrans or ‘sandworm’, the larvae of the dog tapeworm! Poor Zara has had an excruciating itch and wandering weals that hopefully will respond to mebendazole. She recalled that perhaps they had infected her when she was ‘a Buddha’ buried up to her neck in the beach sand at
Ilda’s energy never fails to amaze me. She is doing remarkable things with the girls and their home schooling is spectacular and rich, although Zara seems to test her Mum somewhat. Our home becomes more of a zoo by the day and we frequently babysit a kitten called Cindy and now have 2 hamsters called Bibbi and Nibbles and a large glass ‘terrarium’ which holds all manner of creatures. Unfortunately the praying mantis ate the antennae off the moth today so that the moth earned his freedom. Hopefully his navigation will be ok.
We have all just had a good break away from here to recharge batteries and taste ‘civilization’ again. I stopped off in
It was like one of those theoretical fellowship exam questions…’you are a solo practitioner in a remote rural hospital when you get a call about the imminent arrival of 10 severely injured passengers from a truck rollover…..discuss’. It was quite surreal and fortunately we were able to clear our tiny clinical area of non-critical patients and I was fortunate to be able to call on 2 colleagues to help but then the fun started. They came in dribs and drabs, mostly talking and reasonably stable, but covered in lacerations and blood. I thought that we did ok; in a department with about 2 cervical collars (size small), no idea what a log-roll is, micro-droppers for resuscitation and no light to see what one was suturing (I had a nurse holding a torch for me to replace a woman’s scalp and control her bleeding) we stabilized them all and shipped them off, in a fleet of ambulances, to tertiary and private hospitals.
It scares me how quickly this all becomes normal; outpatients teeming with expectant faces, the wards bulging with skeletal frightened patients, the suffering, desperation and then death. The early morning call from ward sister is frequently ‘the client is gasping’ and the futility of it all is poignant; give oxygen and keep her comfortable…..no fancy ventilators, no heroics, no CT’s or MRI’s, just a slow, agonizing, inevitable end to a ruthless disease that continues to wreak havoc here, 20 years on. But don’t get me wrong. It’s not all doom and gloom and we frequently do get to write a discharge note instead of a death certificate and what a joy it is to see a patient packing up his meager possessions and walking out the door with a grateful smile.
Obstetrics is still my nemesis and does wonders for my baseline heart rate. Last week, at last, I cut my 9th section but my first without someone holding my hand. Of course it was 02.00 but thankfully the indications were fairly clear; 6cm dilated, heavy meconium staining, fetal distress and contractions that had gone off the boil. Thankfully I had a colleague to keep an eye on mum and after doing the spinal performed her section, memorable only for the fact that we had no water in the hospital so had to wash my hands under a bottle! Her urine was slightly bloodstained but cleared nicely, much to my relief. The only other notable surgical challenge was my first orchidectomy shared with a colleague, one ball each, as it were! Poor chap had metastatic CA prostate with bony secondaries and chorda equina with paralysis of his lower limbs. Removal of the testes provides hormonal manipulation of his cancer reducing pain.
