A Medical Perspective

There are so many things that have happened over the last couple of days it’s impossible to record them all.  Little things, sometimes funny things, sometimes very poignant things.

For example, our first morning, it must have been around 7:00am there were four figures on the rock ledge below the white tree steps.

I called out to Chris, “looks like our fruit has arrived”.  This was on account of doing a “trade” the day before with three of the local lads who’d climbed onboard with the masses upon our arrival.  Now, when I say “trade”, it was a transaction in blind faith and trust, given that we had no idea of the exchange rate.

I mean, how many bananas, pamplemousse, coconuts, pineapples and green-stuff do you get for a parcel of hooks, fishing line and shirts?

So we just handed the stuff across and made our “terms of trade” clear:

1/. What ever you think is fair

2/. We don’t want to leave you, or the village, short of any food.

But it was not the fruit, it was a woman, Dana and three children, two of whom were her own, who wanted to present us with two woven baskets with long woven
string handles.  So Chris and I jumped in the dinghy and zipped over to the rock ledge. I was in the bow and as I leaned over the front to push off the rocks, Dana reached out and put the basket around my neck.   “Oh, thank you so much”, I said, “Is this for me?”   “Yes, for you, and this for our sister, Joy” said Dana. (They never did get the name “Jo” right.  Jo was happy with the name Joy anyway)   “Would you like me to give it to her?”  I exclaimed.  “Better still, why don’t you come with us and give it to her yourself?”   Their faces lit up and in a flash they clambered down the rocks and jumped aboard.

Once onboard, Joy (Jo) was overwhelmed as they gave her a hibiscus flower and the basket.  It was a wonderful moment. The four women were so happy and genuine in their greeting and welcome.

Now, let me introduce Graeme – that’s DrGD – he’s a doctor, so we can’t show you his face …

The following words are his, totally, or almost totally, and I disclaim any responsibility from this point on …

Graeme Duke speaking …
Monday 13th July
Our second day at Merelava commenced with an attempt at an early morning rise at 6AM for our fist clinic of this section, at the village of Laekwel. Our chores for the day were largely split into three tasks – those helping out at the clinical (Richard, Jessie, Graeme, and Jo), the “ferry team” taking passenger and medical/optometry equipment in the dinghy for the 30min trip around the coast to and from shore), and the Engineering team (Simon ,Chris, Terrence and Rob) attempting to solve the riddle of the broken motor required to pull up the anchor chain.

Merelave Medical /Optmetry Clinics
Monday 13th July
[Ed- this section contains medical jargon and may be skipped by those who don’t like visiting the doctor; however it is compulsory reading for healthcare professionals; this section is worth 50 CME points ].

Our clinic was quickly setup in the Anglican church building in the village of Laekwel. Jessie and Patricia (the island’s sole Healthcare Aid Worker.) took the medical histories and summarized them on a pre-printed Patient Record Card). One by one they presented these to Graeme (me) who checked their blood pressure, blood sugar, temperature and pulse rate and signs of anaemia and carried out a cursory examination of other simple complaints – arthritis, earache, etc. Richard then checked vision and refraction and where necessary ordered spectacles which Jessie handed out to the delighted customers. Some villagers had walked 1.5 hrs from other villages to attend the clinic. This puts a new meaning to the term Ambulatory Care!  (Previously known as “Outpatients”)

Sadly there were several patients for whom we could do little. The island had exhausted its supply of important medication (antihypertensives, and hypoglycemics) so some patients were found to have dangerously high blood pressure or sugar levels. After lunch of local fruits and bread Richard gave a lecture on hygiene and basic healthcare, whilst Graeme (me again) went off to the clinic house to examine several patients requiring more attention. Graeme and Practricia reviewed the pharmacy stores (one bookshelf of assorted medications) and left a supply of extra antibiotics and analgesics. The cargo ships rarely visits Merelave- twice a year would be a good year. Tomorrow we head to the other side of the island for the second clinic at the village of Tasmit.

Tuesday 14th July
After rising at 6AM we set sail (actually motored!) around the island to the village of Tasmit. Richard, Jesse and Simon walked from Laekwel where they had slept the night. Chris took Graeme ashore with 14 boxes of clinic equipment. Getting ashore from the rocking dinghy onto the rocks was the first difficulty and the next was getting the boxes up the 500m ascent (20 deg incline) to the village. Five children and a mother assisted us onshore and 20 minutes later a dozen young men scampered up hill with our gear.
Once again our clinic was setup in the church building, with a similar division of labour. 44 patients were seen in the morning, followed by a hygiene talk in the afternoon and screening of 64 school children. There were no FTAs!  In the afternoon an antenatal clinic was arranged at the back of the church using two pews as a makeshift examination couch. Graeme’s memory of his obstetrics can be summarized in the statement “most babies come on their own and doctors only get in the way”.

One notable young mum (Linda) 34 weeks pregnant needed to have a Caesarean delivery. Remaining on the island was not possible as there are no medical facilities, and so the only solution was to take her with us to the next island and arrange a flight out to the nearest hospital. (refer Roberts earlier Post) Whilst we were discussing this the mother had decided to return to her village, 2-hours walk away. We did not find this out until afterwards, so an uncle was sent from our village to notify her and request her return. She left her village at midnight and we were able to pick her up at 7:30AM the next morning. A 6hour cruise through squalls and rough seas brought us to the island of Gaua. In summary she had walked a total of 6hours in one day (to the clinic, back home, then back to meet the yacht). Which of us would be prepared to endure a 6hour walk and a 6-hour rough boat trip within weeks of giving birth? A referral letter was typed and printed on-board as we sailed. We hope and pray they get to the hospital in Luganville safely and we await with interest the arrival of another Merelavian. We suggested she name the baby “Chimere” but this may not be the memory she wishes to retain of this pregnancy!

In addition to the above, there were a number of other medical diagnose, such as, perforated ear drum, young girl with an umbilical hernia, several cases of arthritis in the knees (any wonder given the carrying, climbing and walking they do), pterygiums, and cateracts.

(Note from Robert:  Graeme’s payment for the day was a giant pamplemousse – grape fruit – which was enormous.  Unfortunately he dropped it on the way down the hill and it was so big it kept rolling down through the undergrowth and he couldn’t find it.  Like I say, the climb up the hill to the village is seriously steep.  I think Graeme might go back to Bulk Billing from now on, or take payment in bananas and papayas)

Smooth seas, fair breeze and please pray for Linda and baby “Chimere”

Robert