(Probably not so appealing to the squeamish – but good lessons to be learned…)
Some Pointers from a non-medical perspective:
- Keep any open wound clean and covered when outdoors. Use your bottled water, and keep a supply of dressings.
- Draw a circle (with pen) around any red areas. This is a sign of infection – if it is getting bigger, you have a problem.
- Get any escalating problem seen to! Check the cleanliness of any medical help you get!
- Don’t leave it, it is not like something back at home that fixes itself.
After too many tales of wheelchair bound travellers returning to Australia for treatment of infected wounds in the tropics (hey Kyra, hey Nik) I never wanted to get to that stage. So when I fell over a drain (no I wasn’t drunk… see future post for the state of the footpaths in this region…) and grazed my leg, I made sure to clean it thoroughly and report it to my ICM (in country manager – for ‘just in case’ insurance purposes).
The graze seemed ok and I covered and kept it clean, although was a raised lump underneath that wouldn’t go away. After a few weeks I thought I’d better get it seen to. I happened to walk past a clean looking medical clinic whilst away in Pakse (we’ve been warned not to get treatment for anything serious locally – I’ve visited the local hospital and can vouch for this!) I went inside and surprisingly the guy at the desk had some English and took me in to see the doctor. Again, minimal English but he ordered a blood test to check for infection, and sent me off with the nurse (who had no English at all).
She was good, laid me down on the bed and began work. She cleaned it. Then she dug a hole in it. (youch). She put what looked like a metal scone tray under my leg. Then she squeezed it. (oooouuuucccchhhh). Hard. And harder. I could feel something running down my leg and sat up to see … (bluuurrrrrgggghhhhh). Well it was mostly blood. Coagulated blood. And clear fluid. She made me lay back down AND KEPT ON SQUEEZING as hard as she could. By that time I was biting into my finger and making little yelping sounds.
The big lump under my skin was not quite so big by the time she stopped squeezing, but she hadn’t finished yet… She kept on saying, encouragingly, what I thought was ‘saep lai’ – which in my limited Lao means ‘It’s very delicious’! Couldn’t be, surely? (Later I checked my dictionary, the word for ‘infected/inflamed’ is ak-sayp – I’m guessing this might have been what she was referring to…) By that time I was saying no, no, that’s enough! I then watched her as she took off her sterile glove and began cutting a strip off it. I think I must have been distracted by more pain as she worked away and was utterly relieved when she covered it up and let me go. The doctor wanted to know how to spell ‘divorced’ and was very happy at learning a new word in the form filling exercise, and sent me off with a warning that it needed to be checked again the next day for more cleaning and signs of spreading of infection.
Back at the hotel the next day, after letting my ICM know, and him putting all resources into immediate action, I was waiting to be picked up by a car that would take me back to Savannakhet to pick up my things before getting to a place with more medical help. My friend and colleague (working in Pakse TTC) was with me and I thought I’d better check the wound and wash it down, and re-cover it (the nurse’s handiwork with a bandage had actually fallen off as I was walking and it was looking like a right old mess). So I poured some bottled water over it and wiped around it to make sure it was clean. I noticed a little bit of white stuff on the sore part, maybe a bit of stray bandage, so I pulled on it. Poor Debbie was my witness as I pulled out about 10cm strip of plastic sterile glove OUT OF MY WOUND. (gulp, eeerrrrgggghhhhh)
OK, get over it, driver was getting impatient so cleaned and covered it again and got into the car. The driver also had no English – he was not the regular driver, and I realised later when we were driving around lost in Savannakhet that he had no idea where to go. The trip that took the bus 5 hours was done in about 2 ½ hours. We passed every vehicle (and animal) on the road. He drove like a mad man. He refused to stop for anything, even though I was hanging out for a smoko. When it started getting dark (about 5.30pm) I could see why he was in such a hurry to get on the way. All those obstacles on and beside the road – bikes with no rear lights (often they ride with no front light on either, and on either side of the road), slow vehicles, cows, goats, dogs … bad enough in the daytime – far worse at night and in a hurry!
Well, made it home ok – forgot to mention the other complication, my phone had broken, being Sunday the shops were closed, my (work) computer is a dud and won’t let me get online, so I was also relying on other people with phones… Thanks to Debbie in Pakse, and Susan in Savannakhet, and David (ICM) for his initiative, all things were put into motion. Finally home I packed my bag (medications, passport, clothes for a few days) and managed to make contact with the medical insurance company and send them the latest photo of my wound. I seemed to remember in the case of an infected abscess a few years ago (another joy of diabetes) that it was useful to draw with pen around any swelling or redness so hence the artwork around the wound in the photos. Luckily it didn’t seem to be spreading or swelling up further.
The next day the medical insurance people were still umming and ahhing about whether or not they’d cover me for a trip to a decent medical facility. They decided yes at about 3pm and I headed straight off to airport for the ‘4pm flight’. By that time the last plane was fully booked and I was put on standby – first they just said no, then after talking with David on my new phone (I’d been busy that morning – new phone but almost completely broke) said they would know by 6pm if there were any ‘no-shows’, and hence a seat available.
At 6pm, after hovering around the sales office for 20mins, they asked me in, took my passport, looked at the computer and I got the ‘computer says noooooooo’. Sorry? No! Look, I need to get to the hospital (big sad face). Some more tap tap tapping on the computer and it seemed that one seat had appeared out of nowhere, and it had my name on it! Phew. Flew out on the 4pm plane at 6.30pm, surrounded by empty seats. Huh? But then we flew south to Pakse and got off the plane to pick up the rest of the passengers and sure enough, it was full to brimming! Onwards bound, north to Vientiane, and taxi to good old familiar Alie and Hotel Lao. And my Korean friends at the nearby restaurant who still remembered me from 6 weeks ago and invited me to join them.
Set off to Australian Embassy Clinic the next day. Dr Michelle is a breath of Australian speaking fresh air. I love her! And she speaks the Aussie Lingo! Even if she does make babies cry (the previous patient was there for her jabs). She congratulated me for coming in and having it seen to, and commented that the Pakse Clinic had actually done all the right things – blood test, cleaning out the wound and keeping the wound open – hence the rubber glove trick. Put me on antibiotics (Augmentin Duo), took a swab to check what the infection was – ie what antibiotics would work – cleaned and covered it, and asked me to come back so she could check it the next day, and then for reassessment on Friday.
It is now Wednesday, and she is pleased with progress. Still oozing, still red and inflamed, but getting better! So fingers crossed that the wheelchair will not be needed in my case!
After a number of checkups and some good times in Vientiane (luckily I only had a sore leg, no other symptoms) I was declared fit and ready to travel on Tuesday. Unfortunately no flights to Savannakhet until Saturday so this little trip for good medical intervention turned into quite a long stay away from my home and workplace. I have learnt some more lessons along the way and had rather an eventful two weeks. Left work on Wednesday October …. Headed for Pakse (see Pakse and Beyond post) and returned to work itching to get going on November ……. Wouldn’t want to be in a hurry! (Luckily I’m not…) Bor Pen Nyung (it’s ok…)