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.