5-29 Health and Sanitation

We spend a lot of time keeping our bodies in good working order. I’m not talking about exercise and stretching or eating right like I would in the states. I am at a more basic level. Everything grows well here, including mold, bacteria and all forms of illness and infection.
Tool of the trade
In any given week, I will likely put at least two minor holes in my feet, legs or hands. Jason does fewer holes but does them deeper. Any break in skin is a valid place to start growing bacteria, I mean scratching a mosquito bite or a broken blister is enough to start your own bacteria lab. Our nearest neighbor got medevaced to Vila in December for Impetigo after a bug bite got infected on her foot. We are trying to learn from her experience.

I think we spend about half an hour a day playing with hydrogen peroxide and bandaids. Here is the routine: Ask the other person if it looks infected, if no feel a little relief, if yes consider the option of calling the Medical Officers. Don’t bother to call. Pull out the peroxide, iodine, bandaids, triple antibacterial ointment, athletic tape and cotton balls. Go wash the affected area with soap and water. Try to keep it clean while going back to the porch. This is often a challenge since the most common cuts are on the bottom of my feet. Dump or dab peroxide on. Try not to swear for the audience of people watching from the community store. Repeat. When peroxide only foams up for about a minute, switch to dabbing iodine. Peroxide kills everything, including skin cells. The iodine is to counteract the peroxide and keep it from continuing to burn away the skin. Let it air dry while opening the bandaid and putting a dot of triple antibacterial ointment on it. Cover the bandaid with athletic tape to make it stay for more than fifteen minutes. Re-start the process on the next hole.

I think one of those signs of a Peace Corps Vounteer is when peroxide feels good. It feels like not infected today!

5-2 How Jason tried to get Medevaced

After hearing of my exotic adventures in foreign health care, Jason’s subconscious thought it might be fun to go find some kangaroos, too. Luckily for him, his body had other intentions.

The weapon and victim

On Good Friday, we had a lovely picnic on the beach with Jason’s family. We went snorkeling and Jason got to try spearfishing for a bit. He didn’t catch anything because he was too noisy, though he says it was because the rope was too short. (The spearfishing is done with a “gun.” The harpoon has a rope attached so when the fish gets speared, it doesn’t swim off with the harpoon. The rope is about 9 feet long, which is the distance the elastic or spring mechanism can shoot underwater with accuracy and force. Jason would like it pointed out that the gun he was using was shorter than 9 feet and the man who’s gun it was also didn’t catch anything. I think his manhood is hurting. Now he is glaring at me.)

As we were getting ready to head back to Melsisi, Jason decided to make a potty run and feed the cats while he was at the house. We hadn’t been home in a day and we weren’t planning on coming back that night, so we gave the cats some tin tuna. It keeps them happy, though they are such good hunters they don’t really need the supplemental food we give them.

While opening the tuna can, Jason cut his left index finger. He didn’t think much of it then, he just rinsed it out quick and stuck some cotton balls and tape on to staunch the bleeding and got back down to the boat. We were already running late.

We went through the rest of our day without any further incidents. Jason’s hand was thoroughly taped up, so I didn’t give it a second thought. It got to be bed time and I went to go shower. I came back from the shower to find Jason sitting on the front step saying, “uh oh” and looking pale. I asked him what was wrong and he looked away before showing me his hand. Please keep in mind, I just got out of the shower, which means I am holding a sarong around myself with one hand and my towel in the other. I was not in a state to deal with a large, fainting man or blood.

I told him to apply pressure and stop thinking about it until I got some clothes on. He did that and I got dressed. Then I took a proper look at his hand. The cut ran from one side to the other and looked pretty deep. No bone showing and only a little bit of fatty flesh I could see, but there was blood still coming out. That probably wasn’t helped by him pulling the cotton balls off.

Jason is not a squeamish person. He wouldn’t survive living with me if he were. He isn’t squicked out by poop, menstration, vomit, or any other gross things. However, he is very, very firmly convinced that his blood belongs inside his body. He is in fact, so convinced of this that he has fainted when giving three vials of blood for tests. The blood coming out of his finger really didn’t sit well with him.

While he stuck his head between his knees, I tried to figure out how I was going to get it cleaned up and whether or not I needed to call the Medical Officers. Jason being woozy finally convinced me to call. I put him in the shower to rinse off everything except his hand and went to call. I couldn’t get through, because our reception is that great.

I pretty much bathed Jason, because he was holding onto the wall. I tried the Medical Officers again and didn’t get through. This was Friday evening, which meant that if Jason was going to get Medevaced, he would be going on the Saturday morning flight. I knew I needed to get through to them, but I also wanted to get the cut cleaned and dressed.

For the sake of not trying to pry him off the floor, I decided cleaning and dressing first. Jason has lost a lot of weight here, but he is still a big guy and I didn’t want to try to move him if he fainted. As soon as I unwrapped the bandages again, he started complaining of dizziness, light-headedness and general fainting symptoms. I gave up.

I soaked three cotton balls in iodine, unwrapped his hand, put the cotton balls on and covered it in gauze and tape. It applied cleaning solution and he didn’t faint. I figured I’d either clean it better in the morning or he’d be heading to Vila where they could find someone his size to hold him up.

I did finally get through to our Medical Officer, who decided that since he had sensation and movement, he could stay on Pentecost. She put him on antibiotics, because things grow at a really impressive rate and told him to call in the morning after I’d re-dressed it.

The next morning, he did much better. There was less blood involved, which helped. We got it thoroughly rinsed with iodine and held shut with steristrips. Those things are awesome. Now, a little over a week later, he is wearing only a bandaid and not complaining of any pain.

2-20 Setting the Healthcare Bar or Am I a Rich American?

Part of my struggle with this experience of being medevaced has been the ridiculousness of it. The cut is superficial. The damage is to a very small part of my nervous system, and it isn’t even a really necessary part. The back of the thumb is not nearly as important as the front.

I do understand that the risk of serious damage from infection is there and that Pentecost is not the place to avoid infection. I understand that nerve damage is not to be scoffed at and it could get worse without treatment. I didn’t say it was useless, just that I feel dumb.

Part of that feeling of dumb comes from a sort of shame or guilt about receiving this level of care. What have I done to deserve this? The only reason I have this is because I was lucky enough to be born to middle-class American parents.

I know that no Ni-Van would get this kind of care. No one on Pentecost would be flown out to Vila on a chartered flight and then sent to Australia for surgery. These are the people I live with, this is my community, yet they would never expect the kind of treatment I’ve been receiving here. When one of the men in the next village over broke his leg on New Year’s Day, he was left at the Health Center until the next flight came and then sent to Vila where he is staying with friends until he can walk again. This is not the same caliber of care.

My struggle here is multi-faceted. Part of it is guilt about having access to high-quality care. Part of it is frustration that I have pulled myself out of my community and proved that I am not one of them when I have been trying so hard to be one of them. Part of it is shame that I did this, that I called, that I asked for help even if it was appropriate. Part of it is shame that it is so minor a thing that is having such an explosion of expense and activity. Part of it is shame that I am taking Peace Corps funds away from more useful things and spending them on something I shouldn’t have done in the first place.

Behind all of that mess, is a building rage, too. Yes, I am receiving top of the line care. But shouldn’t this be the standard across the world? Not the first world, not the lucky few who can pay for it, but rather shouldn’t this be an option for anyone any time this sort of thing happens? Isn’t this “appropriate care” that we talk about as being the lowest level of what everyone is entitled to?

I don’t think I should feel shame for having access. I think this level of access should be every baby’s birthright.

2-24 Brisbane on Foot

Brisbane Ferris Wheel in South Bank
After my adventures at the Koala Reserve, I spent the day wandering the city. I like to see a city on foot. My favorite method has been to get a few recommendations of good places to check out and then just start walking. I ask directions along the way and stop to take pictures of anything that catches my attention. I did exactly that through the late afternoon in Brisbane.

These guys are like the seagull
equivalent in Brisbane.

I was told to go check out South Bank and the Kangaroo Point Cliffs, particularly at dusk. So, I started walking in that general direction and made it to South Bank around 4:30. I stopped along the way to get things like dinner and a beginning guitar book. It was interesting to walk through a city again. It feels so unnecessarily large, but in a comfortably anonymous kind of way.

One of the big differences between Vila and a Western city is in how anonymous, or not, it feels. Walking down a busy street in the West, you are just a drop in the river of humanity. Chances are you don’t know anyone around you and it would take a lot of work to find the six degrees of separation. In Vila, you will bump into people you know every block, the person standing at the bus stop next to you is your cousin-brother who you haven’t met yet. It is a very different feel. It was nice to be anonymous for a day.

I love found art. These were made more awesome by
being covered in debris from the flood waters.

The walk along South Bank was pretty. I think if I lived in Brisbane, I would find an excuse to go down there at least once a week for a nice walk or jog. I would have liked to see the Botanical Gardens, but that wasn’t an option, between the flooding and the time constraints. It would have been nice to get some of the plant names in English. I saw a lot of plants I recognized from Vanuatu in Australia and would have liked to get the English names of them. Oh well.

Downtown Brisbane at dusk.

The Kangaroo Cliffs were very pretty, though lacking in Kangaroos. There were a lot of rock climbers out and about. I like the idea of going for a walk in the park, climbing a rock wall and going out for a drink at one of the pubs with a view. Too bad I just went for a walk and a taxi ride to a hotel instead.
Brisbane seems like a nice city. The areas I was in were clean, slightly touristy and very welcoming. At some point, I’d like to go back for a proper visit, not a tour of the hospital.

2-23 Freedom!!

This was a good place

I did eventually get free of the hospital in Brisbane. It took a long time. Once I got my freedom, I went exploring. I left at 11:30. I got to the hotel around 8. I didn’t stop moving through those eight and a half hours.

First, I went to the Lone Pine Koala Reserve. It is a reserve for animals native to Australia. I started by petting a kangaroo. The kangaroos were super chilled out and used to humans. They sell kangaroo food and you can feed them, too, but I walked backwards through the place so I just pet a few instead.

Then I wandered through a lot of exhibits until I found the Cuddle a Koala place. So, I held a koala. The koala was a total ham for the camera. He looked right at it. Then he groped me. I think we had a moment. Then he pooped on my foot. Oh well, still a wild animal.

I’m holding a koala.
My life has these moments of AWESOME!
At the reserve, I saw a couple of cassowary. They look like dinosaurs. I think it is the giant head ridge. I also spent awhile talking to an emu. She was looking at me funny, and no one else around spoke English. I thought it was worth a try.

From there, I spent awhile wandering through the koala exhibits. They separated out the ages of koalas, as they would separate themselves in the wild. They labeled them with things like “Kindergarten” and “Retirement Home” so us unenlightened ones would know who we were looking at. The koalas are very cute, but I can’t tell a huge difference between the old and the young ones.


These guys were pretty lively,
the rest of them were all asleep.

After the koalas, I went and watch a platypus playing for a bit. His house didn’t have good lighting for pictures, but I got a short video. He kept swimming in circles. I think he was just bored and goofing off. There was also a neat skeleton of a platypus that showed the structure of the platypus and how the bits all fit together.

Happy Roo!
From there I went to bird watching. There were a lot of birdies. Most of them were caged. There were a lot of them, but I’m not a birder so I can’t tell you very much about them. The lorekeets were not caged and were very friendly. They have bird feed for them and you can hold the trays up. The Lorekeets come and sit on the edge to drink. I felt like a birdy statue of liberty. Unfortunately there was no one around to take a picture of me being silly. Then a bird peed on my arm and I decided it was time to move on.

And then they peed on me.
Pretty though, aren’t they?

I wanted to see a wombat. Their habitat enclosure was flooded, so there weren’t too many of them out and about. All I managed to see was a wombat butt. He was hiding in a log at the time. I asked him to turn around and look at me, but he wasn’t really interested. Oh well. 
In short, I held a koala and petted a kangaroo. Those were things to check off the bucket list.

2-23 Surgery Outcomes and Summary

I went into surgery on Monday afternoon. I tried very hard to convince them that I didn’t need a general anesthetic. I don’t like general anesthesia and I know it really knocks me out. Combine that with not having anyone in country to take care of me, I was a bit nervous about being put under.

They explained to me that because they were potentially working directly with the nerves, a nerve block might not work and that would be bad. Basically, if I felt something I could twitch and make them slip and that would be Bad.
I went to sleep

Three hours later, I woke up speaking Bislama. The nurse was a little confused. I’m just impressed with myself. I’ve managed to internalize Bislama to the point that I woke up in unfamiliar circumstances and immediately asked where I was in Bislama. Go me.
Once my brain worked enough to start asking questions, I did. The story as I understand it goes something like this.

They opened up the incision in my wrist to get access to the nerves. Once in there, they found the nerves fully intact. The surgeon cleaned it out really well and stitched it shut then wrapped it up in a lot of bandages.

I still don’t have feeling in my thumb. There are two explanations and no way of knowing which one is true. Explanation A) I damaged the skin nerves. They are too small to be repaired but will hopefully regrow on their own eventually. The problem with this explanation is the way the numbness maps to the nervous system and that it is such a large area. I’d have to have damaged/severed several skin nerves to take out that much of my thumb. Explanation B) I contused (bruised) the superficial radial nerve. It is now swollen and not letting the signals go through. I should get feeling back in a few months when the swelling goes down. The problem with this is that the surgeon didn’t seem to think I’d managed to hit it, at all.

Under either explanation, I will eventually get sensation back in my thumb. This is a good thing. I’d like to be able to feel my thumb.

Now, my hand hurts more than it did. I haven’t actually seen the incision. I know it is a lot bigger but I was told to keep it wrapped until the stitches come out in ten days. I’m not convinced with will happen because I know I’ll be sweating in Vila and that will make the bandages unsanitary. We’ll see what the Peace Corps Medical Officers have to say about it. I also want to know how many stitches I got. I’ve got a record to update…

All in all, this has been a pretty awful trip. I don’t like being cooped up inside. I don’t like waiting. I don’t like surgery. I spent most of it hungry and all of it lonely. It has been really hard to be on my own in a medical system I don’t know and to be without resources outside of myself to draw on. For instance, knowing that I couldn’t get checked out of the hotel unless I could get out of the ER but that getting out of the ER would mean I would have to officially refused care meant that I would then have to sit through the wait again to be seen. If I’d had someone available, I could have had them check me out and run errands while I waited. Not having an advocate at the hospital was hard, too. I had to both think about my own care and what I would tell me if I were not the patient. I had to run the line between being a pushy pain in the ass as my own advocate while being the patient that the nurses had to take care of. It was not fun.

I am now on my way back to Vila. I will write more about my one free afternoon in Brisbane after I fill out my immigration card.

2-21 Post Surgery

I finally had surgery. They came to get me around 3 today. I was down in the surgical unit until 7. I missed dinner which was really too bad since I was damn hungry.

I more or less have a functional brain again. Despite repeatedly trying to get a local anesthetic with a nerve block, I ended up under general anesthesia. I was out for about 3 hours. When I woke up, I confused the nurse. I wasn’t speaking English.

I was speaking Bislama.

I think I’ve learned the language pretty well.

This is short because my hand hurts and typing is both difficult and a little painful. As far as I know, they cut open my hand, looked at the nerve, decided it wasn’t damaged, cleaned it out and sewed it back up. I still have no sensation on my thumb. I’m a bit concerned.

I’m still on IV antibiotics. I’m really thirsty and my throat hurts. Stupid anesthesia.

2-20 Lost in Purgatory

Sorry it is sideways.
But this is my fashion statement.

Around 10:30 pm Saturday night, I woke up completely when they told my neighbor they’d be closing the ward and we were all moving. I put my things back in my bag and fell back asleep until they came to move me. That ward was a six-bed room with three men, two women and me. My cubicle didn’t have a curtain, my neighbor was using it to double block his cubicle. My neighbor was also a bouncer, used to bouncer’s hours with bouncer friends who also keep bouncer’s hours. They were talking while I was trying to sleep. (It was probably like 8:30 at night, really.)

I fell back asleep waiting to be transported to a different ward. I got to my new ward around 11:30. They did all the usual things and shot some more antibiotics in my arm. Then the nurse informed me that in half an hour, I would be fasting and was there anything I’d like to eat or drink before then?

I had a glass of water and a sesame crackers. I passed out.

At 5 am, the nurse came back to wake me up. In an hour, I needed to be scrubbed for surgery, in a surgical gown and hooked to an IV with my antibiotics already pushed. I got up. I got my hands taped up again. Showering with plastic bags taped over both hands is really interesting.

I have no good hand
To explain that, at this point, I have a bandage on my left wrist where I cut it and an IV in my right wrist. Honestly, the IV is the more painful and annoying of the two. The lock keeps catching on things and the tagaderm is tugging at my arm hairs. I can’t feel the parts that should hurt on my left hand, which makes it worrisome but less painful.
I got myself scrubbed eventually. I even washed my hair, sort of. I put on the paper underwear they provided. (I didn’t have a choice. The nurse stressed that point.) I put on the lovely purple gown they provided. I got back to my bed in time for my breakfast IV and antibiotics. I braided my hair and brushed my teeth (without swallowing). I almost felt human.

Seriously, though I am writing this in a light tone, Saturday was a really bad day. I was having random crying fits all day. I am incredible lonely and I want someone to take care of me or at least to be my advocate. I still don’t want to be here and I am still struggling with a lot of things, including some of the fundamentals like lack of sleep and food, but at least I’ve had one place to stay all day.

My Purgatory
Since 6 am, I’ve been waiting for surgery. At noon, they told me I could eat lunch because the theaters are all full. I’d been pushed back to Monday.
I immediately pulled out my chocolate stash. An hour later, a different nurse came in and told me not to hold my breath about having surgery today because a trauma had come in the ER. I told her I’d been told to eat. She looked confused. She went to go talk to some people. She came back and told me I was right and she’d be talking to the surgeon, not the ones in charge of running each operating theater. I ate lunch. It was hospital food, but I was damn hungry.

It is now 7:30 pm. I’ve been playing computer games most of the day. When I got bored with that, I would go for walks or do yoga on the terrace. I found raspberry sorbet at the hospital store. That improved the world for an hour or two. I’ve gotten a lot of funny looks for my fashion choices today. I am wearing my black and pink flowered zuba board shorts, a white tank top, black flip flops and TED stockings. I have bandages on both wrists and I’ve been wearing my gown backwards like lavender jacket. People must think I’m nuts when I go wandering around in the hospital.

The terrace. This is what they call “outdoors.”
My neighbor is a lovely woman who has an iPhone. We got to chatting, I was listening to her story and being interested and sympathetic. She’d been in the hospital for way too long and it’s looking like she’ll be here for awhile longer, poor woman. Then she heard me lamenting the lack of internet. She let me use her iPhone for a bit. Awesome!

One of the other women in my ward is actually more of a girl. I think she’s about 17 and has also been in the hospital for too long with very little chance of getting out anytime soon. I’ve offered to play cards with her, but her family is great about being there almost constantly during visiting hours. I’ll play after 8 pm tonight when they have to leave.

Our last roommate is a cranky old lady. She is not a happy camper, but she also sleeps most of the time. I think this room is a total promotion from the previous one. It is a Gynecological ward, but hey we’re all ladies here!

At midnight, I go back on my saline-by-IV diet. Hopefully tomorrow morning I will get surgery and the sooner I’m out of the hospital and into a hotel the happier I am.

I got the impression Medevacs were swank. This has been a nightmare.

2-20 From the ER to the Short Stay Ward

I got up Saturday morning and walked to the hospital. Do not pass go, do not collect $200. I didn’t eat breakfast, I just got myself there.

I checked in, was recognized by the staff from the night before and then sat down in the waiting room. Around 8:30, a nurse came to find me. Then I sat in a different chair for awhile. Around 9, the ortho doc sat down and we chatted. She poked my thumb a bit. She told me I’d be an in patient for a few days because they want to do a general anesthetic. She told the nurse to admit me.

By 10 am, I’d gotten through to the PCMOs who had in turn called our financial person who called the hotel. I had to go check back out of the hotel that I’d been in for three hours, except that I was admitted to the ER.

I chatted with my nurse about the situation. She asked me if I had family or friends in the area. I explained that I had exactly no one anywhere in this country. She decided I’d developed a sudden interest in smoking and told me to go take a smoke break and be back by noon.
I took off like the stereotypical bat out of hell. Not only did I need to go pack up my things and check out of the hotel room, I also needed to stock up on little things for my stay in the hospital like toothpaste, chocolate and Aussie cash. I caught a bus into a shopping district in Brisbane. (The bus card was courtesy of another patient in the ER who gave me her old empty card and a whole bunch of recommendations about places to go and things to see while she was between bouts of morphine.)

I stopped in at a camera store and got an SD card for my new camera. I stopped by the money changer and changed the US cash the Peace Corps had given me for travel expenses. The man in front of me there couldn’t have been slower if he’d been doing it with both eyes closed and counting with just his tongue. Then I went to a food court and got a real fruit smoothie. I miss smoothies. They are amazing and don’t really exist in Vanuatu. I also got a chocolate-nutella crepe. That was the first food I’d eaten since the airplane dinner the day before. After that I stopped in a hippy-food store and stocked up. Then I ran to catch my bus and make it back by noon.

I informed my nurse that I was once again not interested in smoking and would be in the waiting room when she was ready to start the IV. Around 1 she came and got me, only to be called away before she could actually start the IV. So, I chilled in a bed for awhile. She came back and put in another IV, this time in my forearm. I only have two good veins for needles. Both of them had been recently stuck. It took her two tries to get this one and she went for it at my request. The other option was my elbow and I didn’t want to deal with keeping my elbow straight for the next few days. It hurt, but she got it eventually and pushed another dose of anibiotics.

Then I hung out in that chair for another hour or so. They took the bed away for someone who the ambulance brought in. I wasn’t worried about it, just tired. I wanted to get admitted so I would at least have a bed to lay down in.

Dinner. Not appetizing.
Around 2:30, I was admitted. I did things like re-packed my bag to be able to find things and sorted my receipts into the “need to turn into Peace Corps” and “put in computer” piles. I charged my phone, camera and computer. I wrote part of these blog posts. I played video games. Around 7, they pushed more antibiotics. After that, I tried to eat dinner but nearly puked it back up. I decided fasting could start early and took a shower instead.

My shower never got warm. I usually take cold showers on Pentecost and it is no big deal because Pentecost is hot. The AC here was at about 65 degrees. I was freezing. The shower didn’t help anything. I went and got two more blankets and huddled under them until I fell asleep.

2-20 The Continuing Saga

That’s the arrow pointing the way…

I landed in Brisbane around 6:30, Brisbane time. Then I started going through immigration. That went pretty quickly, though honestly I read my book through most of the line. I stopped in Duty Free shopping and bought a cheap digital camera. I didn’t bring one and some things just require documentation.

When I got out to Customs, I was appalled by the number of people. Please try to understand that the island of Vanuatu has about 8,000 people on it. The line for Customs was probably 400 people long. It went out of the zigzag and wrapped back around the baggage carrousels. I haven’t seen that many people in one place since I left New Zealand’s airport 6 months ago.
I got through the line, again I read my book for most of it. (Young Warriors edited by Tamora Pierce, if anyone cares.) I stopped at a mobile phone kiosk and bought a new phone. It was an expensive night. From there, I caught a taxi to the Brisbane Royal and Women’s Hospital. This place is huge. There are more people staffing the hospital than live on Pentecost. For those of you in the Cities, this is the HCMC of Brisbane and sprawls like it, too.
I checked into the ER around 8 or 8:30. Around 9, I was seen by triage. I was put in the fast track waiting room. I stayed there until 12:30 or so when I was brought to X-ray. I waited in the X-ray waiting room for another half hour, got an X-ray and went back to the fast track waiting room. I didn’t break any bones. Around 2:30 in the morning, I was put in a consultation room. I stayed there for another hour.
There were lots of signs, that one is above the bus station
Remember how I got up at 4 after about 4 hours of sleep? With that time difference, I was pushing 24 hours without sleep. I was in a place I didn’t want to be, worried about my hand and frustrated by being caught in the system. I was lonely and miserable.
By the time the nurse came in again, I was crying. She decided something had to be done with me, sooner rather than later and left. I sat by myself for another half an hour. The doc came in. I cried at her, too. They told me that the ortho doc would be in a 7 am and I had the choice of staying in the ER until then or going and checking into the hotel. It was 3:30 in the morning, I had to be back in under 4 hours. I figured I’d stay.
Then they took away my bed.
The ER was too busy to let someone like me use a bed when there were other people still waiting to be seen. I changed my mind. I checked out, they pulled the IV and I caught a cab to the hotel at 4am.
At the hotel, I took a shower and fell into bed. I slept off and on for an hour and a half. I got up a little after 6 when it was clear that I was too keyed up to sleep and it was time to get back to the ER.