Jason Connell’s Elective – Macaroni’s

I recently completed my elective in the Mentawai islands in Indonesia, where I spent a couple of weeks based at Macaroni’s, at the Macaroni’s Resort. I had a great trip – we scored really fun waves with an off-season crowd, and I got to practice a different style of medicine to what I was familiar with.

The Surf

This place is Goofy paradise! Within the first 3 days the crew had scored epic Greenbush and 4-6 ft Macca’s…. everyone was frothing. Greenbush left us all awe-struck; we pulled up to see perfect, hollow freight trains, and after seeing a rogue 7 ft bomb a few of us had to change our boardies before paddling out. From reports it is a relatively fickle beast, and we were pretty lucky to score at this time of year (we surfed it with a crowd of 6!).

Macca’s is exactly what it cracks up to be. Such a fun wave, even when it is 1-2 ft. On some of the bigger days the outside section would double-up and throw solid round barrels too, so it had a bit of everything. I had some concerns about going during ‘off-season’, but these were quickly laid to rest as we only had a couple days when the sets were smaller than 3ft. We had a couple charter boats rock up around New Year’s, with each one bringing around 10 Japanese surfers, but the crowds were still super manageable and everyone was really casual. It also made for some classic pidgin English displays; on New Year’s Day one of the Aussie’s asked a Japanese surfer, ‘do you guys celebrate New Year’s Day on New Year’s?’. After being laughed out of the line-up he still maintains that he hadn’t confused Chinese and Japanese culture, and that he just thought New Years was ‘an Aussie thing’

This stint provided me with some valuable learning opportunities. As the only medical person on site, I had good exposure to a range of issues. The majority of my time consisted of managing common surfing ailments (mostly reef cuts and chronic musculoskeletal issues), but I also had the opportunity to consult with guests, staff and locals. My favourite experience was stitching up an Aussie fella’s ear lobe after his fin left it flapping in the breeze – he was a champ about it and thankfully didn’t care too much about the final aesthetics.

Other presentations included viral illnesses, some GI complaints and a dog with recognisable tinea. Tropical diseases like Malaria and Dengue were always in the back of my mind whenever someone complained of a fever, and I gained a quick appreciation for how different and nerve-racking remote, tropical medicine can be.

In terms of procedural info and logistics, there wasn’t a whole lot in place. Given this, part of my role was to create basic instructions for the management of different medical scenarios in a remote setting. As far as supplies go, the infirmary was a total mixed bag. Apparently, people had been leaving behind various medications and supplies over the years; whilst this had its obvious benefits, it also posed a few risks. To give an example, during my stay one of the Aussie guys surfed himself silly and ended up with sunburnt eyes. One of the manager’s found some eye-drops and told this fella to ask me before he put them in, but unfortunately, I was out at the time so he put a few drops in anyway. At lunch, he was complaining that he had lost his short sight. As I turned to look at him, it became fairly obvious what had happened. He had used homatropine eyedrops – a cycloplegic and mydriatic agent that leaves the pupil maximally dilated for 12-24 hours. Luckily everyone saw the funny side of the situation, and after wearing sunnies for the next 10 hours he woke up fine.

Outside of the resort, I gained an appreciation for local Public Health issues. Pretty much everyone smokes. On questioning about why smoking is so common I received some different answers – some fail to connect the loss of family members from cancer to smoking, and some justify their habit by taking the filter out because they believe that this is the part that actually contains the chemicals. Sanitation is another issue, with plastic waste often bobbing through the line-up, which is pretty grim when you think about the remoteness of where we were surfing.

In more exciting news, a foundation has been laid for a small clinic next to the Macaroni’s Resort, which will apparently have a room set-up for the resident medic – no doubt this will be a hotly contested spot in years to come. To finish off, I’d like to express a huge thanks to the staff at Macaroni’s Resort – they do a great job, and to Judy, Mark and my supervisor Dr Phil Chapman for making my elective happen. Trip of a lifetime!

Jase Connell
University of Western Australia

 

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