Tuesday, 31 August 2010
Limitations
Sunday, 29 August 2010
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.
Friday, 27 August 2010
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.
Monday, 23 August 2010
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
Sunday, 22 August 2010
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………..
Saturday, 14 August 2010
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!
Saturday, 7 August 2010
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
- hand out the card details to raise your stress levels
- remove your watch so you have no record of the time
- place the high chair and the electric heater in the wardrobe
- turn on the heater
- climb into the highchair and cram yourself in
- close the wardrobe door and remain seated for 32 hrs
- get out of the wardrobe for 8 hrs but stay in the dark room
- 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………………
Monday, 2 August 2010
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……….