Bio Hazard

After several weeks of medicine and other goings-on in the pacific including encounters with sea snakes, volcanoes, coral reefs and mildly narcotic root products it’s time to set the tiller for home.

Considering I’ll be going home via Sydney, the Dr’s on the ward have asked me to do them a favour.

Due to the limited blood tests that can be performed at Vila Hospital, anything more complex than basic U&Es or full blood counts have to go overseas, which is where I come in.

I’ve never been an international courier before, so my first time was with a box that I did not pack myself and is explicitly marked with a big BIO-HAZARD logo on the side. I was beginning to doubt the wisdom of my good natured agreement to take the bloods to Australia.

Leaving Vila international airport was no problem, things changed in Sydney, it went a little like this.

Customs: anything to declare sir?

Me: yes, some human blood in this box (proudly holding my additional luggage)

Customs: excuse me? What?

Me: human blood in small bottles, not sure how many, I didn’t pack it myself!

Customs: pardon? Animal blood you say?

Me: No, human blood, not sure how much though.

Customs: I think I need to get my boss (looking a little pale).

Customs boss: So, animal blood in small bottles?

Me: (starting to enjoy myself) No, Human blood, but don’t know whose though!

Customs boss: Your blood sir?

Me: No, not mine, don’t have a clue who I belongs too.

Customs boss: How much blood sir?

Me: ………….

Three customs officials later, and a bit of explanation, I’m finally let through with my little parcel, which I duly pop in the post to a professor of haematology in Brisbane.

So, if you want to brighten up your next foreign excursion, take a box of biohazard with you, it makes customs a far more interesting experience.

Sick long suka

If you managed to follow the first master-class in medical Bislama, this second instalment should be a breeze.
Diabetes is a big problem in Melanesian (and Polynesian) communities throughout the pacific; the popular conception in the west tends to be that it is due to the McDonaldisation of these communities. Though this is partly true, Port Vila has no McDonalds, Burger King or Kentucky Fried Chicken (Horraaaaaah!!) but type II diabetes and obesity is a relatively common problem. The introduction of white rice (relatively high glycaemic index) as a substitute for yams and tarrow (very low GI) seems to be associated with the rise in diabetes as well as an overwhelming genetic susceptibility.
Mountains of cash have been poured into Vanuatu to try and managed the impending diabetes epidemic, but how well this money has been spent is anybody’s guess. Rumours around the hospital (rumours not fact) suggest that at least half a million dollars of funding from Australia and New Zealand disappeared along with a local private doctor and his nurse, neither they or the money has been seen again.. No clinics were set up, no long-term management strategy, no public information campaign. Just one big hole the same shape as a pile of cash!

On the whole the diabetes patients are well cared for, thought the range of pharmacological interventions is very limited compared to the UK. We tend to see quite a few diabetics on the ward and in the clinics, thought there is a dedicated nurse led diabetic clinic that runs all day on Tuesday and Thursday. Her objective tends to be managing the complications of the disease and preventing medical problems turning into surgical ones. (a New Zealand baby-doc working in anaesthetics has commented on the particularly low threshold for amputation by the local orthopaedic surgeon!!)

The picture above is a section of a diabetes information leaflet, at first glance I looks like a foreign language, but try reading it out loud and phonetically, suddenly you will hear the words form, and I’m pretty sure you will be able to interpret each piece of advice within a couple of minutes.
Quick reminder;
from/for Blong
at long
food Kakae
very tumas (as in too-much)

good luck, your test starts now, you have ten miunites………..

MENTAL

Medical terminology no longer uses 'mental' as a diagnostic term, it is derogatory and derisory in nature. There is now a long list of ICD10 classifications of mental health disorders for clinical classification.

However, in the common vernacular 'mental' has been taken on to mean 'very exciting', 'exhilarating', 'fantastic' or 'really rather good'.

To take things one step further, going up mount Yasur, an active volcano on the island of Tanna was "f**king mental" (sorry mother, but the word does have a place in this context).

Message ends.

I hope the video clip plays for you

Limitations

Everyone has their limitations, and i guess that knowing where yours are is pretty important.

If you don't push your limits, you stay in your comfort zone, but ultimately stay in the same place as you started.

Sometimes limitations are put upon you by the circumstances.

This x-ray defines a few limitations

The poor girl is about 12 and is very very underweight. For some reason she appears to be malabsorbing. She also has a consolidated right lower lung, clinical signs show it to be pretty much solid.

What's going on with her is still any body's guess, at home you could run her through a CT or MRI, you could scope her bowel to look for a cause of the malabsorption, you could run blood tests for SLE, Coeliac or tumour markers, biopsies could be taken and histology reports would be written and treatment plans devised by the MDT.

Unfortunately the limitations of the hospital mean none of these things can be done, she creates the same amount of concern and interest as she would at home, but the prospect of getting to the bottom of her problem may take much longer.

Fortunately we have managed to send some bloods to Australia to rule in/out SLE and Coeliac, but we are still waiting for the results. It could be TB and a treatment trial has been started but there are a few other clinical things that don't fit TB being the only problem.

We are all limited by our experience (or lack there of), our knowledge, our skill and the available medical technology. Unfortunately this may end up limiting this girls chance of seeing old age.

Wot ain't we got?

My version of 'South Pacific'

We got sunlight on the sand,

We got moonlight on the sea,

We got mangoes and bananas

You can pick right off the tree,

We got ECG’s and Xrays

And a lot of funny names!

What ain't we got?

We ain't got waves!

We get referrals from the surgeons,

We get x-rays with no dates,

We get speeches from our skipper

About patients all unwell,

We get patients in with typhoid

We get dizzy from the smell!

What don't we get?

We don't get swell!

This part of the island chain seems to sit in the swell shadow on New Caledonia, so all the pumping swell that marches out of the southern ocean and hits fiji doesn’t wrap into Efate unless the conditions are just right.

There needs to be a number of coincidences to ensure good surf here. It needs to be around high tide, as the reef pretty much dries out at low, the high tide needs to coincide with the morning, as by 9.30 the trade winds have picked up and blown everything out, there also needs to be a hefty and quality swell coming out of the southern ocean to force it’s way past New Caledonia and make it up to Efate. I’ve seen photos of the reefs looking amazing here, but those days are few and far between.

I’m flying down to Tanna next week, an island that is one of the most south easterly of the chain and appears to be exposed to much more swell. I’ve toyed with the idea if heading to Fiji for a week at the end of my elective to get some quality waves, but the cost is prohibitive and time is limited.

To keep myself occupied I’ve been swimming in the harbour most mornings, there are a group of swimmers that call themselves the “master-bathers" a looses association of swimmers that meet and swim a few mornings a week.

I tend to swim a little earlier than the group, as I have t o be on the wards by 8am. However swimming from 6.45-7.25 over a coral reef the stopping for a coffee in the ‘nambawan’ café before starting ward rounds is a pretty good way to start the day.

The route goes out from the northern end of the quay, round the floating helicopter (master mix blong Jesusu Christ) landing pad, down the reef, round an exposed coral head and back again.

Not sure I’ll be doing the same thing next month when I start my rotation in Torquay!

I Got Crabs

On Wednesday afternoon I was wandering through the market (no clinics, so it’s an afternoon off) and a new delicacy has appeared on one of the sellers stalls, neat little bundles of crabs, all trussed up in twine.

Between my broken Bislama and her broken English I was pretty confident they were edible, and just needed boiling, just like preparing fresh crabs at home. I gave the lady 200vatu and off I wandered with my neat parcel of new friends, they seemed pleased too, as they kept waving their legs at me.

As I walked back towards my accommodation I notice a lot of the locals looking at me with either incredulity, disbelief of just unbridled humour. Old ladies would look and smile, young girls would point and giggle, everyone else just stared!

I had a number of theories circulating in my head

1) These crabs were the worst tasting critters ever to walk the earth

2) They were a form of traditional medicine for impotence

3) Seeing a white fella carry a bale of mud crabs is just plain funny

I was hoping for the latter.

Luckily this day was one of the wettest so far, as cooking the crabs and picking out the meat took up the remainder of the afternoon. By the end of it, (with the assistance of my fellow student Laura) we had a small bowl of crab meat, a pretty poor reward for an afternoons work.

To bulk it up we decided to make crab cakes; here is my recipe.

Unidentified crab species crab cakes

Some crabs (6)

Some sweet potato (2)

Juice of half a lemon

Fresh ginger (about the size of your thumb)

Chilli samble (chilli sauce)

Mix, Mash, squeeze, shape, dust with plain flower. Fry. Serve with green beans. Crab cakes; done!

I can report they tasted fine and had no aphrodisiac qualities.

Medical communication

The national language of Vanuatu is Bislama, a pidgin/creole language including local dialects, English, French and a splash of Spanish too.

The practice of medicine is many things to many people, but one of the central pillars is communication.

Without good communication between clinician and patient you stand little chance of getting to the bottom of a patients problem, let alone understanding the wider impacts of a disease on their life and well being.

So from my first 4 weeks I’ve picked up the following gems of communication.

Breath in Pull-a-wind

Dizzy Head-e-spin

Injection me stickum you

Menstrual period sick long woman

Pass urine piss piss

Pass stool sit sit

Diarrhoea sit sit wota

Chest pain chest e sore

Out of breath short wind

Vomiting tro-out ‘trout’ (throw-out)

Child pikanini

Food kai kai

Penis rod blong man

Vagina rue blong bebe

Uterus basket blong pikanini

Back to normal e-come good

I have stomach ache Belly belo me is sore

Your Blong you

And my personal favourite

Helicopter Thunder Chicken or Master mix blong Jesus Christ

That’s almost enough to survive a ward round, but not quite enough to get through a clinic, though discussions about helicopters rarely crop up in every day conversation.

Strange Brew

Walking down a dusty track I start to glimpse the wood and tin hut nestled between the bushes and trees high on the hillside above Port Vila. Entering the hut, my eyes begin to adjust to the change in environment, there is a counter, behind which a large dark lady stands stirring a large tin cauldron, blue rubber gloves providing protection from her noxious concoction.
Approaching the counter, the lady raises her head from the task at hand to reveal eyes that neither look at you or through you, they are just there, paired, dark and distant, cholesterol rings only highlight the darkness within. 100vatu (75p) buys you 2 ladles of her potion in a small plastic bowl.

Vanuatu Kava differs from the kava of other Melanesian islands in two distinct ways, the lack of ceremony and the presence of strength.
My companion for this experience advises me not to drink the concoction at the counter, as the possibility of vomiting or at least needing to spit is considered poor etiquette and rude to your host, which is understandable.
As the ladles are emptied into the bowl, an indescribable smell wafts through the evening air, it’s acrid enough to hit the back of the throat, it fills the nasal cavity and only acts as a mild warning to the taste buds of the assault they are about to experience. We retreat outside, bowls in hand and stand around a cinder dust pit, the reason for it’s presence is about to be revealed. The only way to consume this fowl smelling concoction is in one hit, if it’s not down in one, you will be unable to raise the bowl to you lips for a second time.
Jaw muscles tighten and eyes narrow in anticipation, the brew is raised to ones lips and I mistakenly of take a sniff, imagine over boiled brussel sprouts mixed with compost heap and litter tray and you’re halfway there.

Mouth open, head back and the deed is done. Within seconds the saliva comes, filling ones mouth and swilling the gritty green sludge into all corners, introducing each taste bud to this new, most fowl of experiences. The smell does not betray the peppery nature of the drink, nor does it hint at the approaching numbness the invades the lips, tongue and throat. I spit out a mouthful of saliva and sludge, and return to the counter to buy a warm beer to wash away the taste.
We settle at a ramshackle table to sip our beers and enjoy the view, within minutes the numbness starts to fade but the taste will remain etched in the memory for days. Halfway through the beer a strange ‘weightlessness of mind’ descends, an enjoyable and foggy buzz resonates around my head, everything is nice, everything is funny, the sunset mesmerising but there is no lack of control or loss of decision making for a single second.

It’s like floating on a cloud, but the cloud has got breaks, a steering wheel and a seat belt, it’s just up to you if you decide to use them or not.

I steer my cloud back to the hut and buy another bowl full……..I love my cloud………..

Seven point Six

This post was going to be a summary of my first couple of weeks on the Medical ward, discussing various interesting medical cases encountered including TB, SLE, Typhoid, Dengue, Liver failure and various stages of renal failure however nature abhors a vacuum, and mother nature has stepped in with a far more interesting turn of events…….

………..4.30pm: clinic had just come to an end, and I was in the ward office with the chief physician and an Australian doctor, we were looking over some interesting x-rays of the clinic patients. Without warning I became aware of feeling a bit wobbly on my feet, then very wobbly. At that point the look on the face of the other two told me something was definitely going on, then the roar started to build.

The next thing I knew, everything was shaking and the sound of crashing came from everywhere. Within seconds, all three of us were dashing for the door and tumbling into the open air. Once outside, the earthquake continued and the sound of oxygen cylinders falling over resonated around the ward. People were screaming and the shaking continued.

I can’t be sure how long it went on for, but my adrenalin levels were probably the highest they have ever been.

Patients and visitors spilled onto the grass, those that could run or walk came first, then patients on beds were wheeled out of the surgical ward. Everyone looked either terrified or elated, or a combination of the two. A follow up shock hit about 5 minutes later, but was much less violent than the first.

As soon as the initial shocks had died, we tried our best to get the moveable patients to the relative safety of the outside courtyard, fearing this may be a prelude to something bigger.

Fortunately our worst fears were allayed, and over the next half hour, patients were moved back their beds and the debris was cleared up. No structural damage was visible, but one oxygen bottle discharged it’s contents in the paediatric ward, and a couple of bottles on the medical ward had their outlet valves bent.

That evening I went down to the town and harbour to try to find an internet café to send some e-mails (after the tsunami all clear, I’m not that stupid). The town was pretty much deserted, all the café’s were closed, and just a few security guards roaming the streets. I became aware of a most intoxicating smell, like the most wonderful flower garden. I had just walked past a duty free store, and peering through the window, the contents of the shelves were smashed all over the floor. The consequential perfume slick was filling the evening air.

On the harbour side, things looked unusual. The horizon looked like a new town had arisen from the ocean floor, small specks of light where open-ocean was usually dark and uninterrupted. I then realized that there were far fewer yachts in the bay. I assume the skippers had sailed into deeper water in case of another quake and risk of tsunami. In the deeper water I assume the wave would wash under them, rather than gathering into the crashing monster that would develop as it entered the shallow harbour.

Aftershocks continued almost every hour for the next 24hrs, and then became less frequent over the following few days, though there was a little shudder this morning as I sat enjoying my coffee after a swim in the harbour (Saturday). It was so slight, running for the hills would have been a little inappropriate!

Time Travel

International flights distort physics, this is a fact.

Stephen Hawkins may have you believe otherwise, and ramble on with his voice synthesizer about event horizons, zero points and string theory, but I know differently, you can distort space and time!

Try this at home if you like, it’s an interesting and disturbing phenomenon.

You will need:

• 1 small cramped seat ( a childs high chair will suffice)
• 1 small confined space (think wardrobe)
• a significant amount of stress (hand out all your inernet banking details to strangers in the street)
• an electric heater
• 50 or so hours of spare time to waste
• A very dark room

Method

1. hand out the card details to raise your stress levels
2. remove your watch so you have no record of the time
3. place the high chair and the electric heater in the wardrobe
4. turn on the heater
5. climb into the highchair and cram yourself in
6. close the wardrobe door and remain seated for 32 hrs
7. get out of the wardrobe for 8 hrs but stay in the dark room
8. get back into the wardrobe for a further 5 hrs

Now go and rejoin civilisation

Results

You will be incapable of making any sense of things for about 48hrs, time will speed up and slow down at random, you will feel sick, dizzy, disturbed and generally shit!

Welcome to my first two days in Vanuatu………………

By the way, things get MUCH MUCH BETTER very shortly……….

Baggage

I’d like anyone reading this to understand a couple of things…..I’m going on a Medical elective to WORK………I’m not going on HOLIDAY.

However………

My baggage may tell a slightly different story, Qantas have allowed me 23kg in exchange for my 1800 quid, and it breaks down something like this.

Surfboard + bag 7kg

Snorkelling kit 1.5kg

Fly fishing kit 1kg

Other Fishing kit 2kg

Sunblock 0.5kg

Small bottle of gin (medicinal) 0.5kg

Books X4 2kg

Laptop + camera 2kg

Clothing 3.5kg

Wash bag 0.5kg

1 box of examination gloves 500g

Oxford handbook of clinical medicine 20g

Stethoscope 10g

I’ll save you the calculation, it’s a 40:1 ratio by weight of toys to medical equipment (about 200:1 by volume) but I’d like to reiterate, I’m not going on holiday. I even left one of my surfboards behind to make room for the box of examination gloves, the self sacrifice is unending.

I’m writing this as the Devon and Somerset countryside slip past the train window, cows heads are bowed to the pasture under a slate grey sky and the woodland has that dark green you only see in mid summer. There is plenty of purple buddleia on the sidings to break up the green but the butterflies are in short supply at this time of the morning.

Fortunately the scenery is taking my mind off the fact that I’m cutting things a little fine with the connection times between trains and aeroplanes. If everything runs smoothly I’ll be fine, if it doesn’t, well I’m screwed. My 20kg bag of fun will still be in Heathrow as Mr Qantas buggers off to Sydney without me. Everything that can be crossed has been crossed, all bits of wood have been touched and if I had a lucky rabbit foot, I’d have rubbed the little furry totem bare by now……….

Who am I?.....Where am I?

Two questions usually reserved for Saturday morning, but on this occasion they are rhetorical.

I'm a mature medical student at Peninsula Medical School. My hairline is retreating faster than the French infantry, needless to say i now require more sunblock to cover my face, and less shampoo in the shower. What I used to declare as laughter lines around my eyes have now taken up permanent residence regardless of my mood and my fellow students often ask me what it was like to live through the sixties, I'm in my 30's (the wrong side of 35) but they seem to find it hilarious!

Four years ago I embarked on my lifetime ambition to study medicine, and I'm now just 12 months from graduating (exams permitting). The journey has cost me my life savings, massive debt, one relationship, one car, hundreds of hours of lost sleep and a second mortgage............however it has been worth it (well sort of, but it could have been a little less painful to be honest).

I'm about to embark on my 4th year elective to Vila Central Hospital, Vanuatu, South Pacific, I'll save you the time of digging out a dusty Atlas and describe it as half way between Fiji and Papua New Guinea .

My selection process for an elective destination involved the following criteria;

Somewhere it wasn't Winter. (rule out Aus+NZ)

Somewhere that was marginally English speaking. (rule out South America, China, Japan etc)

Somewhere with surf. (rule out anywhere without a coastline)

Somewhere that wasn't America (rule out America)

Somewhere remote.

Somewhere non Westernised

That left me with either the Isle of Lewis or Vanuatu (and I've been to Lewis)

Decision made, Vanuatu here i come, I fly out on July 31st.

Come along on the journey, It could be interesting.