Note: Dr Brand put a lot of effort into this piece of written work, and it’s great. So good in fact, that we have split the post into two installments. This is part 1, and part 2 will follow shortly.
Macaroni’s 2018 by Dr Eghardt Brand (Pt1)
I did a holiday at Macaroni’s resort in January and February this year. The resort was amazing and the waves were great. We could surf every day. Maccas is an amazing wave, working on all tides, any swell direction, any swell size and any wind direction. We had 3 good swells while at Maccas. 5-6 foot perfection. I surfed for 8 hours a day on the days when Maccas was pumping.
During the holiday I also did some medical work. Mostly Maccas guests, but also Charter boat clients and locals from the nearby village, Silabu.
There are no doctors in the southern Mentawais, and I mean no Indonesian doctors.
I am always grateful that I did my pre-specialist medical training in South Africa and Namibia. We were exposed to so much trauma and pathology as students and junior doctors and we also learned how to work with the minimum or no diagnostic equipment. In Africa, I learned how valuable proper questioning and examining a patient for a clinical diagnosis is. And how to treat a patient with what you have available.
I studied medicine in South Africa. Worked as a state hospital Medical Officer and a GP in Namibia for 4 years and after that I trained in Queensland Australia and then London to become an Intensivist and Anaesthesiologist. I have worked as an anaesthetist and intensivist since 1997 in Australia and the UK and also in Namibia.
The last time I have worked as a GP was in 1996, so it was quite interesting to basically be involved as a GP and an Emergency department doctor while I was at Maccas.
I have seen and diagnosed and treated a variety of cases while at Maccas. All diagnosis were made on history and clinical examination alone because I had no diagnostic equipment available and treating was based on what the resort had available, because the surfers leave their unused medicine and stitches behind after their holidays, and also with the medicine the visiting surfers brought with them on their holiday.
Cases I have seen and treated were kidney stones, abdominal cramps, diarrhoea, middle ear infection, allergic skin reaction, cellulitis, infected reef cuts, fungal scrotum infection with secondary bacterial infection, cystitis, knee meniscus tear, infected cyst, conjunctivitis, rib fractures, sunburn, concussion, leg haematoma, coral penetration under the big toe-nail, lots of reef cuts and of course I have stitched fin cuts and reef cuts on heads and noses.
I had to rely on what I had, so, as an example. The scrotum infection looked to me like it was originally a fungal infection according to the patient history and how it looked clinically. I thought there was a definite secondary bacterial infection after the scratched scrotum become infected in the tropics. I started the surfer on oral cephalosporin antibiotics, and mixed a cream with roughly 40% Bactroban (staph aureus specific antibacterial cream), 50% Lamisil (anti fungal cream) and 10% cortisone. I told him to use that at night after showering and cleaning and drying his scrotum. I also cut an aloe vera leaf and told him to wipe it as many times as possible in the day and to stop scratching his balls! I told him to wear speedo’s or underwear under his boardshorts.
His scrotum was healed in 2 days. He and I were both stoked and relieved!
A surfer from New Zealand, and his 2 mates also visited Maccas. On his first day he wiped out and injured his knee. I diagnosed a medial meniscus tear and his cruciate ligaments were intact. I told him I’m going to give him a diclofenac injection for the pain and inflammation and strap his knee. Then he must keep on taking anti-inflammatories for a week and rest his knee for 2 days. We looked on YouTube how to do kinetic strapping for an injured meniscus knee and he surfed for the rest of his 10 day trip after 2 days.
When I gave him the injection in his bum, I suggested that we do it in his room for privacy. He said it’s cool if we do it downstairs in the lounge and he also want one of his Kiwi mates to take a video. He pulled his pants down and lied on the couch and I cleaned the injection site with an alcohol swab. I noticed a torn piece of toilet paper hanging out of his bum, but said nothing. His Kiwi mate with the video camera said, “mate, you’ve got toilet paper hanging out of your arse!” He said,”Really?! I felt the toilet paper tearing earlier…” Everyone laughed a lot, and I gave him his injection.