Something else I’ve been spending time on … writing reviews for TripAdvisor about the various places I’ve visited in the region (Laos and Thailand) over the last few months.
(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…)
I went for a trip down south to Pakse and somehow have ended up under medical supervision for an infected leg wound (acquired some weeks ago but never quite healed). So yes, I’m resting up, exploring Vientiane and writing! Only thing is my mobile phone (and incidentally, computer as well) buggered up and I’m stuck here with a cheap replacement mobile phone and no camera. Damn!
So trust me, there is more to come…
Here’s some random shots from around town…
This is the Vietnamese imposter ‘masseur and nail person’. I was innocently sitting under a tree reading my book…
I was invited to a function at the Australian Embassy that included people working for the Disabled Women’s association – fun games and activities- wheelchair races, table tennis and boche, and a showing of selected Tropfest films – interesting that most of the locals disappeared during the film showing, made one think about the language and culture that came through the films – quirky, English language only – I loved them, but what were the locals supposed to think?
So, the injury and the dangers lurking on Lao footpaths (see future posts) =and my brunch of tuna and plastic cheese and biscuit sandwich with water and antibiotic chaser … but do check out that spectacular green Thai pedicure!
Damn it … another mosquito bite … dengue? Malaria? Living life on the edge…
I love it, but I hate it. Can’t get the new wifi device to work when I need it, can’t get my photos off my phone, can’t do what I want to do, spend hours keeping up with friends/family/social media, and then it’s time for bed. And then work. I have so much I want to share but can’t for the life of me get things to work! Grrrrr. Stay tuned, I’ll work it out eventually. And I do have lots to share! xox
GOOD, BETTER, BEST … NEVER LET IT REST!
I’ve moved from a crazy culture that seems always to be in an urgent hurry, to one that isn’t. And I’m loving it. I tried the good, better … but was never the ‘best’ – of course! So like a dog chasing its tail, I never got to where I (thought I) wanted to be. I didn’t get that prized tenure, I was judged ‘not good enough’ for every job I applied for. I saw the people that got that prize, and it didn’t look like much fun. Because there is always another hurdle before you get to the next prize. And another after that.
I don’t know a lot about Buddhist culture but it seems to me that in comparison to the one I’ve left, where you must achieve NOW! or at least in this life time – after all, it’s the only one we’ve got, there is a different way. If I don’t get it right in this lifetime, I’ve got another chance. Another lifetime. I will try, but I won’t have lost anything by not reaching that prize. Because I can try again in the next life time. And the next. And the next…
I interpret this to be equivalent to making the most out of what we have – now. To see merit from good actions, leading a good life, rather than simply to judge and be judged on ‘success’ or ‘failure’.
Slow down. Live a good life. Be kind. Be generous. Do the best you can. And forgive yourself.
Today I was sitting in my Lao language class and I realised that I’d forgotten to reload my pump (insulin supply) and it had run out. I was running on empty. I mentioned this to my colleague Susan, who has been fully briefed on potential issues for a diabetic and she said – you must go now and fix it up. Thank you Susan.
Wow. I thought about how many times I’ve sat in classes, meetings, doing busy work or whatever situation – even socially with friends, colleagues etc., and put my own (diabetic) needs last. No I can’t let my diabetes be an inconvenience to others, I must keep going and then when I do get the chance to fix things up, I deal with the consequences on my own. The soaring out-of-control blood sugar levels, the ‘hypo hangover’, the difficulties in getting the body into catch up mode. The panic and distraction of trying to work out where I might get a syringe from, how I might get my levels back under control, how I might get home myself to access my supplies. And I’ve done all this on the quiet because I never wanted to bother anyone! I didn’t want my ‘problems’ to become other people’s problem.
So after 40 years of having diabetes, for virtually the first time I have been given the permission to prioritise my health and wellbeing over everything else. I have a whole action contingency plan (under medical insurance) so that if I need to get specialised help, I will. Other people who might be able to get me over the boarder to Thailand or to better health care have been briefed. I have a whole team that is actually at the ready to take care of my health needs if it became necessary.
After a life of ‘looking after myself’, and not wanting to bother anyone with my condition(s), and never wanting to appear to be any more helpless than anyone else (when in actual fact I have virtually never taken time off work due to my chronic condition(s) – no work/no pay being partly the reason!), I have finally found my self in a position where I feel entitled to put my health and well-being needs first. And this is as a volunteer in a developing country. What is wrong with our ‘first world/Western’ mentality that it has taken me this long to feel that I can?
Diabetes is damned hard work and a persistent pain. It can be hard enough moving to a new country, new language, new ways of understanding the world, and new food options, without the blood sugar levels (BSLs) going completely and utterly crazy!
I managed to travel with no problems carrying a whole case of medications as hand luggage (+helmet, +laptop, +essentials). The case was only checked once in Bangkok, by a very efficient airport official who checked through and opened some packets with her rubber gloved hands. I had my explanatory letter ready and it really was no problem.
When I got to the hotel I filled the bar fridge with my insulin and other items needing refrigeration, and let the staff know not to turn the fridge power off. Still living in (another) hotel I haven’t yet been able to properly unpack and consolidate my supplies so I still don’t really know what I’ll run out of – but as per my earlier post #T1D diabetic supplies for a year I know I will.
So my blood sugar levels and insulin requirements have plummeted since arrival. I try to surmise why this might be, and whether it is transient, or more longer term. Some possible reasons:
- Constant state of excitement and joy!
- Low level but constant underlying stress
- The heat and humidity
- Food – eating less, and changes in diet
- Beer Lao – insulin replacement therapy?
- (Slightly) more exercise, exertion
Really though, it could be anything! Hormones? Body trying to cure itself? …
So being on an insulin pump, where I have a constant set basal level of short acting insulin, onto which I would bolus a dose if I eat carbohydrates, or to correct a higher bsl, I have already lowered my basal (24hr dose) from 20 to 17 units of humalog, and hardly bolused at all, even when I do eat, because my bsl is already too low.
To cut a long story short, I need to constantly monitor my bsl using my meter and my precious supply of blood testing strips – of which I was only permitted to order 11 boxes from NDSS when I left Australia. So the saga continues and I’m still pissed off about it – that my short and long term control over my health is hampered by my own country’s medical system that would not allow or assist me to get the supplies I needed before I left. Again, still a work in progress … T1D and its persistent struggles …