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 2, and part 1 is here.
Macaroni’s 2018 by Dr Eghardt Brand (Pt2)
One day I was asked if I would see the chief at the local village, because he wasn’t doing too well. I agreed and took as much medicine with me from the supplies at Macas resort; and off we went with a boat through the mangroves. The tide was very low, so we had to push the boat through the mangroves and when we reach the open sea, we were good and we were boating to the village.
Upon arriving at the village, the man, about 65 years old had grunting laboured breathing. He was lying on the floor on his side. There were no beds in his house. His foot was full of septic sores and he had gangrene on all his toes. He also had cellulitis all the way up to his knee. He was oedematous and his pulse was very weak. He hasn’t urinated for a few days. Apparently he was also a diabetic.
I didn’t have BP cuffs or ECG’s etc. But it was obvious that he was in septic shock with acute kidney failure. His pulse felt like he was in a slow AF and his BP must have been very low. He was also in heart failure and his lungs were very wet.
The resort had some frusemide, so I gave him 2 tablets, hoping that he may urinate a bit to make his breathing easier. I also gave him paracetamol for his painful leg and keeled antibiotics and I did a betadine dressing on his leg. I sat him up against a few pillows to make him more comfortable.. I told the translator to tell him and his family that I am not treating him to cure him, I am helping to make him more comfortable and that he will not get better…and that sending him on a 14 hour journey by boat to Padang to go to a hospital will not help
He shook my hand and said “Terimah Kasih, Sampai Jumpa!”.. It means “Thank you, See you soon!”..
I said Sama Sama…Sampai Jumpa… It means, Pleasure, see you soon..
We left the village and nobody talked much on the boat back to Macas… Pak Ambu died a hour later..
Word spread quickly that there was a doctor at Macas resort. And 2 days later a 10 year old boy arrived with a blood stained T-shirt wrapped around his hand. He chopped his thumb off using a machete while cutting coconuts!
I gave him a ring block at the base of his thumb before removing the shirt to have a look at the wound. The kid was screaming because of the painful injections… when I removed the shirt arterial blood pumped and landed about 2 meters away on the floor. I had to tie the artery. The kid was not impressed with more needles and 4 people had to hold him down while I had to tie an artery on a moving, screaming target… I did a figure 8 stitch with Vicryl 5-0 that I Iuckily had in my bag. The bleeding almost stopped and the next figure 8 stitch did the job. It was hard to go under the artery because I kept on hitting the bone in the finger..and the kid moved a lot…but the end result was good.
I cleaned the wound, did a Bactroban dressing and cut off a latex glove thumb and taped it over his dressing. Because they whipe their bums with their left hands…
I gave the boy a hug afterwards and the Macas staff gave him and his sister a few Beng-Beng chocolates and a few muffins… he was smiling from ear to ear.
One girl in the resort cried. Another guest ran into the jungle, and everyone was a bit distressed..
I gave him an Augmentin course for 10 days as well as paracetamol and 2 days later I had a look at his wound, It was clean and pain free. The boy smiled a lot and said Terimah kasih. I did a new dressing and the boy never came back for his follow-up dressings and treatments…
His uncle told us that the boy lost both his parents a few months ago and that he was an orphan and he and his sister were staying with his uncle. Sad..
I also stitched up a boy and a few adults with cuts to their heads from fins and the reef.
On a previous boat trip a woman fell with her nose on her fins and cut her nose open! I could see into her sinuses. I offered to stitch her up but I did tell her that I am not a plastic surgeon and that she may need a revision of the scar by a plastic surgeon in the future. I stitched her nose with Nylon 6/0 that I luckily packed in case of a facial or eye lid laceration. The result was really good. I have attached a before and after photo.
Being a doctor with no medical assistance in the tropics, a 14-hour boat ride away from the closest hospital and days away from the closest first-world hospital is stressful and also rewarding. Going back to basics without all the fancy equipment that I’m used to; and making a real difference.
After stitching I was always asked by everyone, when may I surf again? I said the doctor answer is not for a week. My answer as a doctor who surf is; if I was you, I will wait 2 days, then surf. You are on an expensive surf holiday. But, clean your wound after every surf. Do a new dressing after every surf. Take your antibiotics. Keep and eye on your wound! But it’s your decision to surf or not, not mine
My answer was always met by a big smile. Everyone surfed again, Nobody got an infected wound.
Macas resort is in the process of building a medical clinic. The Pagai Foundation and Surfing Doctors are behind this amazing new venture.
Basically the doctor will do a stint of 3 weeks or more, and look after the Macas resort staff and clients. He will also do a couple of free clinics at the local villages per week and be involved in basic health care. Funding for medicine and stitching and diagnostic equipment is needed. The Pagai Foundation and donors will help. The plan is also that if charter boat surfers need stitching or medical advice and treatment, they will be asked to pay a donation towards the Pagai Foundation. That money will go straight into the villagers clinic fund and medicine and equipment needed to run the operation.