Week 1 on Uliveo Island - the Doctor's tale
Position Lutes, Uliveo, Maskelyne Islands, Vanuatu
Date to Friday 12 June 2015 ish
(Apologies to Geoffrey Chaucer)
Working here in Uliveo I can only say is a complete contrast to Coggeshall surgery.
I was told that the dispensary/surgery here would be well equipped. Well am I glad that I was able to garner so many supplies from the World Health Organisation (WHO), the Presbyterian Church of Vanuatu and a little from the hospital. The nurse on the ground at the dispensary in the village of Lutes, Nurse Bambae Stephens, does an excellent job considering what she has at her disposal; she currently has no Paracetamol, Ibuprofen, basic Penicillin V or a supply of her most common drug for severe hypertension. On the dressings front she only has non-sterile gauze swabs, no bandages and will soon run out of tape to hold it all together. I have been happy to supply her with all of these from the supplies we have on board.
The array of patients seen has been routine plus the unusual, many children with sores to dress but these do not look like yaws, very common here. On the unusual front there was the young man with a large wound on his ankle who had walked with crutches the mile from Peskarus village. He sustained a stingray sting 10 days before and had treated it with Kustom medicine which involved heating sugar cane and pouring the molten sugar onto the sting and then covering with a leaf. The leaf may have been effective for the sting but not for the resulting severe burn which had become infected. Initial treatment was the application of iodine impregnated gauze and Amoxicillin. However on review 3 days later we saw that the infection was worse and I caused great amusement by sniffing his wound deciding the organisms required more aggressive therapy. So out with the English dressings, a change to Flucloxacillin and Metronidazole and a large dose of intramuscular penicillin. He knew I was not there on Monday so attended today, Tuesday week 2 and the wound is, to my relief responding wonderfully. I was extremely anxious as I felt my reputation in the community hung on success with this.
One of the largest contributions that I feel that I can make is by the diagnosis of conditions that will not respond to local medicine, be it western or kustom, and which can onmly be treated at the central hospital in Port Vila. We understand that the approach to kustom medicine varies from island to island. Here the two exist side by side with it having to be left to the patient, or more often the patient’s family, as to which they require. It appears on Uliveo that the kustom doctor will call upon the nurse to provide western drugs and she is obliged to treat as requested. This from my brief experience can result in tragic results. Understandably there is a resistance to be admitted to Port Vila Hospital as that involves a 3 mile trip in an open boat to rendezvous with the Santo Efate ferry, Big Sista, at 0300 on a Thursday morning, followed by a 30 hour trip to Vila
On the kustom front I have to admit an early failure with a patient whose family are sticking with Kustom treatment. Whilst out walking with friends from another yacht I was asked to visit a man with a foot problem. I approached the hut where a crowd of friends and relatives surrounded an elderly man whose foot was wrapped in a filthy cloth with flies buzzing around the wound. One look told me that he had diabetic nephropathy with no blood supply to the foot which was black and swollen with suppurating lesions. I asked to see any medication he had and was presented with a plastic carrier with various unopened bottles. I told the family that he needed urgent hospital admission and that I would return tomorrow. The following day Nurse Bambae was called to the mainland on an emergency so I arranged for the man’s admission to Port Vila hospital and returned with a referral letter as the weekly ferry to Port Vila Efate left that night. My efforts were met with a flat refusal from the spokesman despite my offering to pay for the ferry. At this stage the smell from the foot was even worse and there were flies crawling over it. I caused much consternation with the nursing aids who accompanied me as I wished to speak to the Chief, not perhaps a usual cause of action for a woman. Chief Gren was very gracious, understood the problem and said he would speak to the family but they maintained their position. In the following days Bambae has twice been instructed by the Kustom Clever (Local traditional healer) to attend to give penicillin injections. On each visit she tells me the smell is worse and further ulcers are present on the now very black foot. There is I regret only one inevitable outcome without urgent hospitalisation.
On Monday when we arrived the everywhere was closed up, the school, dispensary and the village shops as there was a funeral. Only later in the week did I learn from Bambae that the death was another case of kustom medicine not providing a cure. A 44 year old man with pneumonia that was being treated with kustom medicine. Bamabe had been in the final stages called to give antibiotics but unfortunately at that stage it was too little too late..
Meanwhile other patients are happily treated at the surgery and today I have really enjoyed antenatal clinic great to palpate pregnant abdomens again and realise I have not lost my touch. Lack of Uristix means no urine testing is currently available and means there is difficulty in diagnosing toxaemia and gestational diabetes. I was delighted to be reacquainted with Rina, the bride whose wedding at Pellonk we attended last September, apparently an arranged but happy marriage. She is expecting her first baby next month aged 40! No question of a hospital delivery here! Deliveries by the nurse take place in the back room of the dispensary. There is a fee of 3,000 vatu ($US30 £22) and the family have to take away the sheets and towels and launder them after the event.
The dispensary is next door to the school and at break we have to shoo away crowds of curious children come to look at me. They are all happily curious and shout the usual “Hallo, how are you, what is your name and where do you come from”.
A 10 month old baby attended for weighing, her mother is 17 and her father is away working in New Zealand. The baby was very underweight and still only being breast fed; mum is eating only bread and rice. We made a follow up home visit the next day with suitable foods and baby milk from our supplies. A further visit from Aebeline revealed that the food is being hungrily devoured by the baby, so a good result. I will follow this up when we next visit.
Martin and I have both together and separately made visits to see Daisy, a six year old girl who has a healthy twin brother. As a baby she contracted malaria and the result was severe brain damage leaving her completely disabled. We met Daisy with her grandmother last year and struck up a rapport. We had specifically brought items of clothing and equipment for Daisy which we were able to give to her wonderful family who are doing so well looking after her. We have come away with a shopping list for additional items that we will purchase in Port Vila and bring with us on our next visit.
Daisy with her grandmother, holding a cuddly toy from New Zealand
I appear to be getting on well with the nursing staff who assure me they are keen to learn from me so that is good for job satisfaction. As a team building exercise we celebrated the end of week 1 in Uliveo by having them aboard for tea and biscuits. This proved a hilarious and very entertaining afternoon for all concerned and Martin eventually returned them to terra firma just before dusk fell.
All aboard the Skylark for trips around the bay. Bambae, Aebeline holding Bambae’s son Sten-Dave and Martine