Showing posts with label medical. Show all posts
Showing posts with label medical. Show all posts
Saturday, July 07, 2012
Saturday, June 23, 2012
Toilet Training the Nation
This was the rather provocative title of a recent news
article discussing the state of sanitation in the second of my worlds. An
official from the Health Ministry is quoted as saying that as of 2010 some 42
million people in the country still defecated in the open. But this was down
from 71 million in 2007 so they have made phenomenal progress in three short
years (if the statistics are accurate).
Since people from the first of my worlds probably find that
amazing and wonder what people do, let me hasten to explain that it is a
timeless tradition in the tropics around the globe to use local streams,
rivers, rice paddies, ditches or just a spot in the nearest banana patch or
woods. It usually rains a
lot and washes it all away, plus the strong tropical sun dries (and rots) things
quickly. And where dogs and/or pigs run loose, well, they also help with, uh,
waste disposal. Friends tell me of having to take a stick with them to keep the
pigs away until they finished doing their “business”. People living by the sea just wade out a ways and go and the waves and tide will wash it away. The problem of course is that as the population grows, so does one's risk of catching a waterborn disease!
Even in the Mega City you can still sometimes see people
using ditches and canals, especially children. Of course in big cities it’s
easy to build a toilet without a septic tank, especially if you live along a
main road with drainage canals beside them. You just run the “out” pipe into
said ditch or even build a little hut over the ditch. Some people still use
chamber pots or plastic bags and go empty them into the ditch after dark.
 |
| This is the goal |
The article discusses that one of the biggest problems is
changing people’s mindsets. Even if the government or some other agency builds
them a toilet, some people will still not use it. When I first went to live
among the No people many years ago there had already been a sanitation project where
two squat-toilets with bathing area had been built for every 4 families,
complete with concrete septic tank. The project
also put in wells with hand pumps near each toilet building. People
liked having the wells but few of the toilets were actually being used. They
said the problem was water. Since you can't put in a well too near the septic tank or you may get contamination, they had to carry the water to flush the toilet. Not
only that, they didn’t like keeping it clean (they said neighbor kids would use
it and not flush and leave it a mess.) It was easier for them to do what they
had always done – use the roadside irrigation ditch or an irrigation ditch out
in the field. They felt it was “cleaner”.
Slowly over the next two decades though, most families in that No village did build a toilet in or next to their homes and nearly all now have their own well. In
fact most have installed small electric pumps so they can more easily fill
their concrete water tanks in the bathroom making it easy to bathe and flush toilets.
Gone are the days of hiking a kilometer to the river with a dozen empty coconut
shells to get drinking water! But even so, there are still a few die hard families
who can’t be bothered to build a toilet and to this day, 2012, continue defecating outside in a ditch.
Unfortunately, even with toilets, many people still allow small children to relieve
themselves anywhere. And there are always a few people who aren’t on the ball cleaning
up the kids’ messes so you still do sometimes need to watch where you step.
In the article, a junior high boy was quoted as saying he’d
rather have a satellite dish (for TV) than to have a toilet. That is not at all
an uncommon attitude. I have been in many rural homes which have a TV, a
motorcycle or two, sometimes even a satellite dish and a refrigerator, but not
a toilet. The problem isn’t money, it’s a mind set.
Thursday, December 30, 2010
Sad stories for Christmas
I think I am coming to the conclusion that it is not possible to completely solve the problem of poverty.
Lola is a 23 year old girl from the mountains. She and her two siblings were raised by their grandmother, and an aunt paid for her schooling through high school. She then came to the city and got a job in the fish market. There she met another orphan, also raised by his grandparents. He was a fish slicer. They didn't get married but just moved in together, which is quite common these days among the young folk. The excuse is that they don't have the money for a wedding. There are also plenty of older people who have been previously married who have "live-ins" because divorce isn't legal.
Six years later Lola has 3 children ages 1, 3, and 5. They rent one room in a house located over the ocean. There is no bathroom. All waste goes beneath the house where the tide carries it off each day, though of course it can be pretty smelly during low tide. They buy water from a neighbor, paying per bucket. Cooking is done over charcoal, usually outside unless it is raining. The husband lost his job a few months ago for some unknown (to me) reason and only intermittantly works now. He seems to have his heart set on being a fish slicer and doesn't want to look for other work. He spends his days at the market, hanging around with his friends and eating with them, waiting for an occasional opportunity to slice fish. Meanwhile the wife is at home with the kids. She is still nursing the baby and when she doesn't get enough to eat the baby cries a lot. While her live-in worked, they had plenty of fresh fish to eat. Now it's difficult.
She stopped by to pick up some CDs from her aunt. Her aunt gave her fare to go home but after she left, her aunt started wondering why she had bothered to come just for CDs and then realized that Lola probably didn't have any food in the house and had probably been hoping the aunt would give her money. Lola's now embarassed to ask for help because she has had to ask so many times and some of her relatives have begun advising her to leave the live-in and go back to the country where she and the kids can at least plant vegetables and eat.
Thinking about the kids, the aunt collected some stuff around the house, sugar, Milo, coffee, mung beans, a few left-over Christmas goodies and went to the market and bought charcoal, oil, eggs, vegetables, 10 kilos of rice and a kilo of chicken. When she arrived at Lola's house she found the live-in sitting there watching TV, hoping that a lottery ticket he'd bought would pan out netting them about $1.25 with which they planned to buy food. Lola had apparently bought 1/4 kilo of rice with what was left from the bus fare and they had eaten rice soup for lunch. The kids were super excited to see the Christmas treats and the big package of Milo.
Lola's grandmother has begged her on several occasions to come back to the country and so have several of her aunts. But she refuses. The man, who is quite large and through it all has managed to keep his weight up by eating with friends, refuses to look for other work. Is he cognitively challenged? Is he unable to think outside his small box? Is he lazy? Or does he just have the problem of being unrealistic? This is the kind of situation that makes relatives and other observers want to pull their hair out.
But you can't run people's lives for them.
Another painful, yet also hopeful story is that of Rita.
Today was a joyous day for a 9-year-old girl I will call Rita. Four years ago Rita had suffered a broken femur. Nothing was ever done about it and eventually the bone became infected. Earlier this year social workers brought her to the city where she was taken in by an expat doctor and his wife who helped navigate the paperwork to get the girl treated. It was a long process with many obstacles. They got her some crutches and she began to be able to get around a bit. She was hospitalized for nearly a month on IV antibiotics to clear up the bone infection. Then she had some heart arrhythmias and the cardiac consultant refused to give permission for surgery. Colds and such caused more delays. She had also been quite malnourished and was tiny for her age. One of the doctors was outraged when he saw her. He said it was child abuse to allow a child to go that long untreated. Social workers eventually brought her 12-year old brother to the city also and he is staying with his sister. He too was tiny and malnourished and had never been allowed to go to school. But finally, just after Christmas in a surgery that didn't start until 11pm and went until 2am, the leg was repaired. Today Rita is leaving the hospital to the great delight of her foster parents and all of her well-wishers. Go, Rita!
Lola is a 23 year old girl from the mountains. She and her two siblings were raised by their grandmother, and an aunt paid for her schooling through high school. She then came to the city and got a job in the fish market. There she met another orphan, also raised by his grandparents. He was a fish slicer. They didn't get married but just moved in together, which is quite common these days among the young folk. The excuse is that they don't have the money for a wedding. There are also plenty of older people who have been previously married who have "live-ins" because divorce isn't legal.
Six years later Lola has 3 children ages 1, 3, and 5. They rent one room in a house located over the ocean. There is no bathroom. All waste goes beneath the house where the tide carries it off each day, though of course it can be pretty smelly during low tide. They buy water from a neighbor, paying per bucket. Cooking is done over charcoal, usually outside unless it is raining. The husband lost his job a few months ago for some unknown (to me) reason and only intermittantly works now. He seems to have his heart set on being a fish slicer and doesn't want to look for other work. He spends his days at the market, hanging around with his friends and eating with them, waiting for an occasional opportunity to slice fish. Meanwhile the wife is at home with the kids. She is still nursing the baby and when she doesn't get enough to eat the baby cries a lot. While her live-in worked, they had plenty of fresh fish to eat. Now it's difficult.
She stopped by to pick up some CDs from her aunt. Her aunt gave her fare to go home but after she left, her aunt started wondering why she had bothered to come just for CDs and then realized that Lola probably didn't have any food in the house and had probably been hoping the aunt would give her money. Lola's now embarassed to ask for help because she has had to ask so many times and some of her relatives have begun advising her to leave the live-in and go back to the country where she and the kids can at least plant vegetables and eat.
Thinking about the kids, the aunt collected some stuff around the house, sugar, Milo, coffee, mung beans, a few left-over Christmas goodies and went to the market and bought charcoal, oil, eggs, vegetables, 10 kilos of rice and a kilo of chicken. When she arrived at Lola's house she found the live-in sitting there watching TV, hoping that a lottery ticket he'd bought would pan out netting them about $1.25 with which they planned to buy food. Lola had apparently bought 1/4 kilo of rice with what was left from the bus fare and they had eaten rice soup for lunch. The kids were super excited to see the Christmas treats and the big package of Milo.
Lola's grandmother has begged her on several occasions to come back to the country and so have several of her aunts. But she refuses. The man, who is quite large and through it all has managed to keep his weight up by eating with friends, refuses to look for other work. Is he cognitively challenged? Is he unable to think outside his small box? Is he lazy? Or does he just have the problem of being unrealistic? This is the kind of situation that makes relatives and other observers want to pull their hair out.
But you can't run people's lives for them.
Another painful, yet also hopeful story is that of Rita.
Today was a joyous day for a 9-year-old girl I will call Rita. Four years ago Rita had suffered a broken femur. Nothing was ever done about it and eventually the bone became infected. Earlier this year social workers brought her to the city where she was taken in by an expat doctor and his wife who helped navigate the paperwork to get the girl treated. It was a long process with many obstacles. They got her some crutches and she began to be able to get around a bit. She was hospitalized for nearly a month on IV antibiotics to clear up the bone infection. Then she had some heart arrhythmias and the cardiac consultant refused to give permission for surgery. Colds and such caused more delays. She had also been quite malnourished and was tiny for her age. One of the doctors was outraged when he saw her. He said it was child abuse to allow a child to go that long untreated. Social workers eventually brought her 12-year old brother to the city also and he is staying with his sister. He too was tiny and malnourished and had never been allowed to go to school. But finally, just after Christmas in a surgery that didn't start until 11pm and went until 2am, the leg was repaired. Today Rita is leaving the hospital to the great delight of her foster parents and all of her well-wishers. Go, Rita!
Tuesday, May 04, 2010
My Dengue Journey
Everybody’s writing their Journey stories so here’s mine. This is the fourth time I’ve had dengue fever. According to what’s out there, there are 4 types of dengue. So I have apparently hit them all. Am I a world record or what? So unless they discover a fifth type that should mean that I am done with it and need never fear another mosquito!
Nobody writes much about what the dengue journey is like. You read about the symptoms of high fever, severe headache and backache but not much about the real, you know, experiential part of it all. Today is Day 6 of Round 4.
Headache. Oh yeah. All four times I had a headache. They say it’s often pain at the back of your eyes. Well this time it was the bones above my eyes, the bones below my eyes, the bones of my temples, the bones in front of my ears and my teeth. They hurt so bad I didn’t even notice the back of my eyes! Move your head and unnghhhhhhhhh!!!!!!!!!!!!!!!!
Lower backache? Oh yeah. Not as bad as the time I had it in South America when I had to grit my teeth and stop breathing just turn to the other side. This time I could still breathe when turning but it kept me rolling back and forth ever searching for some comfortable position.
Fever? Of course, that’s why it’s called dengue fever. Highest recorded this time was only 39.8 and that’s cuz a friend persuaded me to take paracetamol whenever it got above 39 (almost 103F). The record was the second time when it hit 41 (105+F).
Stomach pain? It wasn’t so noticeable earlier, it was a vague cycling from extremely hungry to nauseous to slightly painful and back around again. Now that the fever has broken those sensations have intensified. I don’t usually vomit as long as I don’t drink too much at a time. And nothing sounds good so no danger of eating too much. Besides, you get a weird taste in your mouth and if you do eat anything with chemicals in it the flavor of the chemicals is super enhanced.
Rash? Today I do have a rash but frankly I couldn’t really have seen whether I had a faint rash before that or not because when my fever gets that high my vision gets dim. Yeah, literally like somebody dimmed all the lights, including the sun, moon and stars.
What I don’t see mentioned in the medical literature is the weird mental stuff. It’s kind of funny but when you’re in the midst of it, it is not boring. Most of the time you’re lucky and just sleep or lose consciousness but sometimes you see weird things. Like, the time when my fever was 41 (105+F) I would see lots of ugly stuff, like heaps of squirming guts, mounds of worms, disgusting nasty things. If I opened my eyes and looked at something real it helped. But in the dark of a moonless night in a remote village you don’t see anything at all even if you do open your eyes. The only thing that helped was praying and forcing yourself to think about beautiful things like flowers, butterflies, clouds, etc. This time there was none of that but my mind was like incessantly nattering away at nothing, like it was busy-busy working on some urgent problem until I finally had to forceably shut it off and think consciously about something else. Later I was reading a weird email so long I couldn’t scroll long enough to ever get to the bottom and I kept finding it embedded and looped upon itself. The person it was from would never in a million years have been so verbose about anything! Of course in reality there was no such email but hey, I was READING it! I could give you a synopsis of it! That’s the weird kind of mental stuff you don’t hear much about.
The next step is wait and see if you get any of the the hemorrhagic stuff with it. So far on this journey I have been blessed and have not had any bleeding that I ever noticed, no gum bleeding or nosebleed or even noticeable rash. May God grant that this (hopefully) last stage of this journey also be so
blessed.
Nobody writes much about what the dengue journey is like. You read about the symptoms of high fever, severe headache and backache but not much about the real, you know, experiential part of it all. Today is Day 6 of Round 4.
Headache. Oh yeah. All four times I had a headache. They say it’s often pain at the back of your eyes. Well this time it was the bones above my eyes, the bones below my eyes, the bones of my temples, the bones in front of my ears and my teeth. They hurt so bad I didn’t even notice the back of my eyes! Move your head and unnghhhhhhhhh!!!!!!!!!!!!!!!!
Lower backache? Oh yeah. Not as bad as the time I had it in South America when I had to grit my teeth and stop breathing just turn to the other side. This time I could still breathe when turning but it kept me rolling back and forth ever searching for some comfortable position.
Fever? Of course, that’s why it’s called dengue fever. Highest recorded this time was only 39.8 and that’s cuz a friend persuaded me to take paracetamol whenever it got above 39 (almost 103F). The record was the second time when it hit 41 (105+F).
Stomach pain? It wasn’t so noticeable earlier, it was a vague cycling from extremely hungry to nauseous to slightly painful and back around again. Now that the fever has broken those sensations have intensified. I don’t usually vomit as long as I don’t drink too much at a time. And nothing sounds good so no danger of eating too much. Besides, you get a weird taste in your mouth and if you do eat anything with chemicals in it the flavor of the chemicals is super enhanced.
Rash? Today I do have a rash but frankly I couldn’t really have seen whether I had a faint rash before that or not because when my fever gets that high my vision gets dim. Yeah, literally like somebody dimmed all the lights, including the sun, moon and stars.
What I don’t see mentioned in the medical literature is the weird mental stuff. It’s kind of funny but when you’re in the midst of it, it is not boring. Most of the time you’re lucky and just sleep or lose consciousness but sometimes you see weird things. Like, the time when my fever was 41 (105+F) I would see lots of ugly stuff, like heaps of squirming guts, mounds of worms, disgusting nasty things. If I opened my eyes and looked at something real it helped. But in the dark of a moonless night in a remote village you don’t see anything at all even if you do open your eyes. The only thing that helped was praying and forcing yourself to think about beautiful things like flowers, butterflies, clouds, etc. This time there was none of that but my mind was like incessantly nattering away at nothing, like it was busy-busy working on some urgent problem until I finally had to forceably shut it off and think consciously about something else. Later I was reading a weird email so long I couldn’t scroll long enough to ever get to the bottom and I kept finding it embedded and looped upon itself. The person it was from would never in a million years have been so verbose about anything! Of course in reality there was no such email but hey, I was READING it! I could give you a synopsis of it! That’s the weird kind of mental stuff you don’t hear much about.
The next step is wait and see if you get any of the the hemorrhagic stuff with it. So far on this journey I have been blessed and have not had any bleeding that I ever noticed, no gum bleeding or nosebleed or even noticeable rash. May God grant that this (hopefully) last stage of this journey also be so
blessed.
Wednesday, April 07, 2010
Do not let your cat sleep on your back
It all started one night when I was peacefully minding my business, snoozing on my stomach. For some reason the cat decided to take a nap on my back. Maybe he was lonely or maybe he felt cold, I don’t know. But since he’s hot and heavy I didn’t really want him there so I wiggled a little to get him off. Instead of getting off he dug his claws in. I know at least one claw went all the way thru my t-shirt!
Now a few weeks later, I have a huge, nasty, painful boil on my back – just below the shoulder blade where it is difficult to reach and impossible to see. They say heat is good for bringing a boil to a head. So for five long days I put hot water in a plastic bag, and tied it shut. Then I tied the bag into a sarong and hung it over one shoulder and tied it like a sash so that the bag would be on top of the boil. But after 5 long days it still hadn’t come to a head and I couldn’t lay on my back at all cuz of pain and swelling. So a couple days ago I finally went to a doc. She took one look and ordered a huge dose of antibiotic. Said she since there wasn’t yet(!) a head she didn’t want to cut until I’d been on an antibiotic for three days.
So here I am 2 days and several doses later. The thing has started to drain a little but is still very painful and still huge and I still can’t lay on my back. I don’t think it is an ordinary staph infection cuz the drainage is gaggingly foul smelling! I guess I'll have to go back tomorrow and see if the doc can drain it all at once.
And so my friends, that is why you should never ever let your cat sleep on your back!
PS It was cultured and turned out to be something the doc had never seen - Morganella morganii. But very consistant with something a cat might drag in - ughhh!!!
Now a few weeks later, I have a huge, nasty, painful boil on my back – just below the shoulder blade where it is difficult to reach and impossible to see. They say heat is good for bringing a boil to a head. So for five long days I put hot water in a plastic bag, and tied it shut. Then I tied the bag into a sarong and hung it over one shoulder and tied it like a sash so that the bag would be on top of the boil. But after 5 long days it still hadn’t come to a head and I couldn’t lay on my back at all cuz of pain and swelling. So a couple days ago I finally went to a doc. She took one look and ordered a huge dose of antibiotic. Said she since there wasn’t yet(!) a head she didn’t want to cut until I’d been on an antibiotic for three days.
So here I am 2 days and several doses later. The thing has started to drain a little but is still very painful and still huge and I still can’t lay on my back. I don’t think it is an ordinary staph infection cuz the drainage is gaggingly foul smelling! I guess I'll have to go back tomorrow and see if the doc can drain it all at once.
And so my friends, that is why you should never ever let your cat sleep on your back!
PS It was cultured and turned out to be something the doc had never seen - Morganella morganii. But very consistant with something a cat might drag in - ughhh!!!
Tuesday, February 23, 2010
Avastin
No, it's not a nautical term. It's a medicine used for retina problems. Monday (Feb 8) I had Avastin injected into my eye – and I have survived to tell about it! What follows is the gory details of the injection. If you do not like gory details just skip this post! But I am writing it for others who may someday need such an injection.
In early January I noticed an area of distortion in the upper left quadrant of one eye. At that point it was not in the macula and did not affect reading. But since I am very myopic I am at risk for retinal issues so went to see a local retina specialist.
I kept hoping the distortion in my right eye would get better with conservative treatment (anti inflammatory drops) but after a few weeks the area only got bigger. Once I decided to go for the anti-VEGF injection I went to the one and only doc in town who does it – and found out I’d have to wait another week because the Avastin would have to be ordered from the capital city. Although I wavered again and again over the next week, the area slowly got even bigger until I was totally unable to read a clock or calander or recognize faces with that eye . Reading a computer screen was slow and difficult even with enlargement, it was like looking through dirty water at italic and other weird shapes with piecs of the letters missing. And of course it is my dominent eye so it keeps trying to take over. By the time Monday came I was ready, if not exactly looking forward to it. The doc had ordered eye drops to start 4 days before the injection and an extremely (excessively?) high power antibiotic (Levofloxacin). Seemed a bit of over kill and after googling Levofloxacin I’m sure my fingers and feet started feeling numb!
Day 1 On Monday after lunch I went and got in line. They took me first so no chance to ask anybody else how it went. I was gratified that they used good aseptic technique, anesthesia drops, betadine drops and a presumably sterile face cloth with only a hole for the eye. The doctor put on some kind of head gear as well (I couldn’t see well with no glasses.) I was told to look off to the upper left. I am very nearsighted and couldn’t see much in the dim lighting but found a piece of shadow I tried to focus on. They put a gizmo to hold the eyelids open and did some more touching of the eye, none of which was painful. The injection itself wasn’t very painful but I saw the swirling of the medicine go in and lost the shadow I was trying to fix my eye on. I’m afraid my eye moved a little as I ended up with a good sized blood clot on the white of my eye. They patched the eye and gave me a list of instructions – eye drops every 2 hours for a week while awake, an anti-glaucoma drug the rest of today and tomorrow. Continue with the antibiotic for 5 more days. no bending, strenuous exercise or activity, no lifting heavy things, avoid sunlight and dust, close eyes while bathing for next week, and come back tomorrow. (The needle was nowhere as big as the drawing shows and was inserted on the outer side not the top.)
I felt okay but it was weird having an eye patched, you kind of lose distance perspective like stepping off curbs, reaching for things, etc. The eye was starting to ache by the time I got home but the anti-glaucoma pill really seemed to help. I ended up taking the patch off because what with wearing glasses over it my eyelids kept brushing it and it was annoying. I did find a piece of clean gauze in my cupboard to cover it that first night. I could see as well as before the procedure but the blood did look kind of gross and I had to wipe some clots away that ran down after I put eye drops in.
Day 2 went okay, still taking the anti glaucoma drug and high power antibotic and eye drops every 2 hours. When I went back the doc said to not get my face wet in the shower (now he tells me!) but just clean with a cloth and to wash my hair like in a beauty parlor, not bent forwards. Sigh! Do you know how many times in a day a person bends over? Especially a tall person in a short man’s country?? I mean, books off of shelves, getting clothes out of cupboards, pans out of lower cabinets, lower desk drawers. I even have to get on my hands and knees to plug my computer in! That’s not to mention feeding the cats, or picking up things I drop, making bed, etc. Good things my knees are still good as I get lots of deep knee bends in these days! My eyes seemed tired and so I rested in the afternoon and went to bed a little earlier than usual.
Day 3 no more anti glaucoma med and so far so good, no aching. I got my hair washed today with assistance. We did at the outside sink. It was a bit messy and I had to change clothes afterwards but it’s great to have clean hair. It could be my imagination but the distorted area seems slightly clearer, I can read enlarged fonts through it, in a way it’s like having my own private magnifying glass LOL! Though still distorted. Faces are still not recognizable but I can see that it is a face, it’s not just all grayed out. And I can now see the center dot on the Amsler grid. I’m to go back in 2 weeks.
Day 4. Woke up feeling better. The bloody eye feels less sore. The possibly imagined slight improvement is still there. Wondering about this antibiotic tho. Something is giving me a head ache and making me feel kind of buzz-headed and spacey. It’s hopeless to do serious work. The bloody eye is getting slightly yellow around the edges (I can’t see cuz that eye still has the gray spot in the middle of whatever I look at but Maret helped me take a picture of it.)
Day 5 Still have a slight head ache. Wondering if it’s ok to stop the Levofloxacin a couple days early? Vision in right eye is dimmer than left. Used to be the other way around. Letters are also bigger in the right than the left. It’s been that way a long time, long before this bleed started. I CAN read with the right eye – it’s still dim and distorted but I CAN read. Interesting that in passages colored with colored pencil I can’t see the color. Hmmm. But I CAN read it. My eyes don’t work together yet, though so I still feel like things are kind of out of focus. I am going out to a meeting today so we shall see how I do!
Day 14 Went back to the doc today. I feel like the vision has improved significantly, tho not as to what it was before all this started. The line of print I read in a book or the screen is straight and clear tho the line above bows upward and the line below bows downward. I guess the distance acuity isn’t quite as sharp as it was as tho since I am not able to read all the letters on the chart. This doc is Dr Brevity. He kind of grunts and says “It’s flat”. Wondering if that’s good or bad I asked what was flat. He said the macula is flat that it had been swollen last time he saw it. I guess that’s good! But then he greases up the eye with lidocaine gel and sticks his scope in it and grunts again. Then goes off and writes a note to the referring doc and says it’ll happen again. (!?) He sees a scar, a black spot. There’s lattice degeneration and atrophy at 6 o’clock. I can go back to the referring doc in 2 weeks and she can laser it. So I am befuddled. Is this something new again? Why are we suddenly talking about laser??? His brevity doesn't help.
I have spent a lot of time on the internet and don’t find much. It seems no one has definitive answers to my questions such as why did this happen? How can I prevent a recurrence? Is exercise okay or not okay and what kind is bad? Anything but contact sports? Or as one doc said, only slow gentle stuff like walking and Tai Chi? And what about heavy lifting - like heavy bags when travelling and hauling water and washing clothes by hand in the village and hauling stuff on a motorbike? Certainly the three docs I have seem so far all had different opinions as to what was even wrong, let alone how to treat it or what if anything I could do to avoid future problems. Sigh!
In early January I noticed an area of distortion in the upper left quadrant of one eye. At that point it was not in the macula and did not affect reading. But since I am very myopic I am at risk for retinal issues so went to see a local retina specialist.
I kept hoping the distortion in my right eye would get better with conservative treatment (anti inflammatory drops) but after a few weeks the area only got bigger. Once I decided to go for the anti-VEGF injection I went to the one and only doc in town who does it – and found out I’d have to wait another week because the Avastin would have to be ordered from the capital city. Although I wavered again and again over the next week, the area slowly got even bigger until I was totally unable to read a clock or calander or recognize faces with that eye . Reading a computer screen was slow and difficult even with enlargement, it was like looking through dirty water at italic and other weird shapes with piecs of the letters missing. And of course it is my dominent eye so it keeps trying to take over. By the time Monday came I was ready, if not exactly looking forward to it. The doc had ordered eye drops to start 4 days before the injection and an extremely (excessively?) high power antibiotic (Levofloxacin). Seemed a bit of over kill and after googling Levofloxacin I’m sure my fingers and feet started feeling numb!
Day 1 On Monday after lunch I went and got in line. They took me first so no chance to ask anybody else how it went. I was gratified that they used good aseptic technique, anesthesia drops, betadine drops and a presumably sterile face cloth with only a hole for the eye. The doctor put on some kind of head gear as well (I couldn’t see well with no glasses.) I was told to look off to the upper left. I am very nearsighted and couldn’t see much in the dim lighting but found a piece of shadow I tried to focus on. They put a gizmo to hold the eyelids open and did some more touching of the eye, none of which was painful. The injection itself wasn’t very painful but I saw the swirling of the medicine go in and lost the shadow I was trying to fix my eye on. I’m afraid my eye moved a little as I ended up with a good sized blood clot on the white of my eye. They patched the eye and gave me a list of instructions – eye drops every 2 hours for a week while awake, an anti-glaucoma drug the rest of today and tomorrow. Continue with the antibiotic for 5 more days. no bending, strenuous exercise or activity, no lifting heavy things, avoid sunlight and dust, close eyes while bathing for next week, and come back tomorrow. (The needle was nowhere as big as the drawing shows and was inserted on the outer side not the top.)
Total cost was $760 which I paid in cash after it was done. (And that was the cheaper procedeure. Lucentis would have been over $2100!)
I felt okay but it was weird having an eye patched, you kind of lose distance perspective like stepping off curbs, reaching for things, etc. The eye was starting to ache by the time I got home but the anti-glaucoma pill really seemed to help. I ended up taking the patch off because what with wearing glasses over it my eyelids kept brushing it and it was annoying. I did find a piece of clean gauze in my cupboard to cover it that first night. I could see as well as before the procedure but the blood did look kind of gross and I had to wipe some clots away that ran down after I put eye drops in.
Day 2 went okay, still taking the anti glaucoma drug and high power antibotic and eye drops every 2 hours. When I went back the doc said to not get my face wet in the shower (now he tells me!) but just clean with a cloth and to wash my hair like in a beauty parlor, not bent forwards. Sigh! Do you know how many times in a day a person bends over? Especially a tall person in a short man’s country?? I mean, books off of shelves, getting clothes out of cupboards, pans out of lower cabinets, lower desk drawers. I even have to get on my hands and knees to plug my computer in! That’s not to mention feeding the cats, or picking up things I drop, making bed, etc. Good things my knees are still good as I get lots of deep knee bends in these days! My eyes seemed tired and so I rested in the afternoon and went to bed a little earlier than usual.
Day 3 no more anti glaucoma med and so far so good, no aching. I got my hair washed today with assistance. We did at the outside sink. It was a bit messy and I had to change clothes afterwards but it’s great to have clean hair. It could be my imagination but the distorted area seems slightly clearer, I can read enlarged fonts through it, in a way it’s like having my own private magnifying glass LOL! Though still distorted. Faces are still not recognizable but I can see that it is a face, it’s not just all grayed out. And I can now see the center dot on the Amsler grid. I’m to go back in 2 weeks.
Day 4. Woke up feeling better. The bloody eye feels less sore. The possibly imagined slight improvement is still there. Wondering about this antibiotic tho. Something is giving me a head ache and making me feel kind of buzz-headed and spacey. It’s hopeless to do serious work. The bloody eye is getting slightly yellow around the edges (I can’t see cuz that eye still has the gray spot in the middle of whatever I look at but Maret helped me take a picture of it.)
Day 5 Still have a slight head ache. Wondering if it’s ok to stop the Levofloxacin a couple days early? Vision in right eye is dimmer than left. Used to be the other way around. Letters are also bigger in the right than the left. It’s been that way a long time, long before this bleed started. I CAN read with the right eye – it’s still dim and distorted but I CAN read. Interesting that in passages colored with colored pencil I can’t see the color. Hmmm. But I CAN read it. My eyes don’t work together yet, though so I still feel like things are kind of out of focus. I am going out to a meeting today so we shall see how I do!
Day 14 Went back to the doc today. I feel like the vision has improved significantly, tho not as to what it was before all this started. The line of print I read in a book or the screen is straight and clear tho the line above bows upward and the line below bows downward. I guess the distance acuity isn’t quite as sharp as it was as tho since I am not able to read all the letters on the chart. This doc is Dr Brevity. He kind of grunts and says “It’s flat”. Wondering if that’s good or bad I asked what was flat. He said the macula is flat that it had been swollen last time he saw it. I guess that’s good! But then he greases up the eye with lidocaine gel and sticks his scope in it and grunts again. Then goes off and writes a note to the referring doc and says it’ll happen again. (!?) He sees a scar, a black spot. There’s lattice degeneration and atrophy at 6 o’clock. I can go back to the referring doc in 2 weeks and she can laser it. So I am befuddled. Is this something new again? Why are we suddenly talking about laser??? His brevity doesn't help.
I have spent a lot of time on the internet and don’t find much. It seems no one has definitive answers to my questions such as why did this happen? How can I prevent a recurrence? Is exercise okay or not okay and what kind is bad? Anything but contact sports? Or as one doc said, only slow gentle stuff like walking and Tai Chi? And what about heavy lifting - like heavy bags when travelling and hauling water and washing clothes by hand in the village and hauling stuff on a motorbike? Certainly the three docs I have seem so far all had different opinions as to what was even wrong, let alone how to treat it or what if anything I could do to avoid future problems. Sigh!
Tuesday, January 26, 2010
Distortion of reality
It’s been a wild week or two around here in the third of my worlds. Two weeeks ago I noticed an eye problem. At first I thought it was due to fancy graphics on a website I was reading but then noticed ALL the windows on t
he computer were like that. Even the clock across the room looked dented in on one side. Being still a bit jet-lagged it took me awhile to figure out what to do. To make a long story short, I finally got in to see an eye doctor the following week and the next day had some tests. To see a doctor you find out his or her clinic hours and then show up early to get your name on the list. First come first serve. Even coming early doesn’t guarantee you won’t be waiting 3-4 hours on a hard, crowded bench in a tiny hot waiting room.
he computer were like that. Even the clock across the room looked dented in on one side. Being still a bit jet-lagged it took me awhile to figure out what to do. To make a long story short, I finally got in to see an eye doctor the following week and the next day had some tests. To see a doctor you find out his or her clinic hours and then show up early to get your name on the list. First come first serve. Even coming early doesn’t guarantee you won’t be waiting 3-4 hours on a hard, crowded bench in a tiny hot waiting room. Having diagnostic tests is always an interesting experience. But even finding this place was an experience. I just kept asking security guards all along the way. You had to wend your way through the hospital and find the back door, go down a dirt alley out to a paved alley and kitty-corner across to what looked like a parking ramp. People I asked insisted the eye place was in there and after wending my way thru rows of cars in the semi-dark saw that there were indeed signs of a building back there. I guess they didn’t want to waste space and so built a parking ramp right at the front entrance. The eye place was cheerfully painted and lighted inside and was well air conditioned. The waiting room was much bigger than clinics around here usually are so I didn’t even need to worry about my knees blocking anyone’s way.
One test involved using a dye. Before the test they wanted to make sure I wasn’t allergic to the dye so they injected a small amount of the dye into the skin of my arm – like a TB test. The guy said it would sting a bit – yikes! He wasn’t kidding! I was NOT prepared for the excruciating pain~ all I could do was try to breathe like they teach women in labor to do. It left a fluorescent green welt on my arm the rest of the day.
Anyway the tests went fairly well once I figured out that when the technician told me t
o look right or left she usually meant HER right or left not mine. They had been saying I needed a companion to go home (maybe because people come out of there disoriented not knowing which direction was really right and which was left?? Ha, ha!). But since I felt fine I just got a taxi and went home. They gave me the results on two CDs so naturally I copied them and had fun looking at them on my computer.
o look right or left she usually meant HER right or left not mine. They had been saying I needed a companion to go home (maybe because people come out of there disoriented not knowing which direction was really right and which was left?? Ha, ha!). But since I felt fine I just got a taxi and went home. They gave me the results on two CDs so naturally I copied them and had fun looking at them on my computer.So far treatment is anti-inflammatory eyedrops that give me a headache. It isn't doing any noticeable good but at least it's not invasive! I still haven’t heard what the doctor thinks is causing the bleeding. Sigh! I sure hope it improves in another week or so and no further treatment is needed. Meanwhile I’m chowing down the green leafies and antioxidents.
Wednesday, December 30, 2009
"Suicide" drugs
What is with all these suicidal drugs???!!
I am amazed at the countless TV commercials for various prescription drugs. The commercials spend maybe 5 seconds telling what the drug is for and then 25 seconds hurriedly reading a long list of horrendous side effects such as liver failure, edema, coma, death, mood swings, elevated blood pressure, weight gain, and suicide. And suicide is what they all have in common! There are various drugs- antidepressants, drugs for arthritis, bipolar disorder, anti-smoking and more. And suicide is a possible side effect of all. One's distinct impression is that the side effects far outweigh the benefits. Are they really hoping to boost their sales??? Or is there some other purpose for these “ads”??? Creepy!!
I am amazed at the countless TV commercials for various prescription drugs. The commercials spend maybe 5 seconds telling what the drug is for and then 25 seconds hurriedly reading a long list of horrendous side effects such as liver failure, edema, coma, death, mood swings, elevated blood pressure, weight gain, and suicide. And suicide is what they all have in common! There are various drugs- antidepressants, drugs for arthritis, bipolar disorder, anti-smoking and more. And suicide is a possible side effect of all. One's distinct impression is that the side effects far outweigh the benefits. Are they really hoping to boost their sales??? Or is there some other purpose for these “ads”??? Creepy!!
Wednesday, July 22, 2009
More on giants
Now the son of the man who was said to be killed by a giant is complaining of chest pain. He is worried that the giant may be taking further revenge on him. So he left his carpentry job in the city to go see the quack doctor in the village. This is the same young man who survived 13 stab wounds a couple years ago plus a couple bouts of pneumonia afterwards. I suspect it is more due to the fact that he suddenly took up smoking during his father's illness, but what do I know?
He was somewhat relieved when the quack doctor assured him it wasn't the giant but rather a dead grandmother who is demanding some chickens.
I can't help wondering why grandparents who loved us in life would now turn against us in death and become malevolent.
He was somewhat relieved when the quack doctor assured him it wasn't the giant but rather a dead grandmother who is demanding some chickens.
I can't help wondering why grandparents who loved us in life would now turn against us in death and become malevolent.
Sunday, July 05, 2009
Slain by a Giant????
Giants are apparently large spirit beings who like to live in certain trees, especially large trees with heavy shade. They are said to be able to cause mischief if you inadvertantly disturb them.
A friend’s brother recently became sick. He was 50 years old. Last week there were rumors that a “friend” of his whose father was a renowned practitioner of black magic had put “poison” in his food. But, this week they said it was a giant.
There was an old mango tree on his property which had been there since he was a boy. It’s a tree that bears the smelly mangoes, they are very sweet but have an unusually pungent odor and not everyone likes them. Some neighbors recently asked if they could cut the tree down and use it to make charcoal, a common way for rural folk to make a bit of cash. Since not many people are interested in buying the fruit, he agreed and it was done. But, soon afterward he became ill. According to the quack doctor, there had been a giant living in that tree and he was angry because it was cut down. The quack doctor recommended that they do a certain ceremony with a white chicken and 8 eggs. They did do the ceremony but it didn't do any good.
From what I could tell, the man had lived a hard life. His wife died soon after their third child was born, nearly 20 years ago. He left the kids with his parents to raise and he went to the city and spent many years as a pedicab driver. His meager earnings were spent mostly on drinking. He often just slept in his pedicab rather than rent a room. He smoked and drank for years and didn’t eat well. After his father died 5 years ago, he moved back home with his mother and worked some on the family farm but continued smoking and drinking heavily with his friends. When I heard that he was complaining of lack of appetite, weight loss, difficulty breathing, swelling, I assumed that he was probably starting to have problems with liver failure.
But, what do I know? Whatever it was, he died this morning. His entire family was present as he had requested. But I do wonder what they will put on the death certificate.....
A friend’s brother recently became sick. He was 50 years old. Last week there were rumors that a “friend” of his whose father was a renowned practitioner of black magic had put “poison” in his food. But, this week they said it was a giant.
There was an old mango tree on his property which had been there since he was a boy. It’s a tree that bears the smelly mangoes, they are very sweet but have an unusually pungent odor and not everyone likes them. Some neighbors recently asked if they could cut the tree down and use it to make charcoal, a common way for rural folk to make a bit of cash. Since not many people are interested in buying the fruit, he agreed and it was done. But, soon afterward he became ill. According to the quack doctor, there had been a giant living in that tree and he was angry because it was cut down. The quack doctor recommended that they do a certain ceremony with a white chicken and 8 eggs. They did do the ceremony but it didn't do any good.
From what I could tell, the man had lived a hard life. His wife died soon after their third child was born, nearly 20 years ago. He left the kids with his parents to raise and he went to the city and spent many years as a pedicab driver. His meager earnings were spent mostly on drinking. He often just slept in his pedicab rather than rent a room. He smoked and drank for years and didn’t eat well. After his father died 5 years ago, he moved back home with his mother and worked some on the family farm but continued smoking and drinking heavily with his friends. When I heard that he was complaining of lack of appetite, weight loss, difficulty breathing, swelling, I assumed that he was probably starting to have problems with liver failure.
But, what do I know? Whatever it was, he died this morning. His entire family was present as he had requested. But I do wonder what they will put on the death certificate.....
Thursday, May 07, 2009
Spraying pigs to prevent swine flu??
It is unfortunate when people take action without knowledge. 
(http://flutracker.rhizalabs.com/)
It seems that the "swine" part of the name of the current flu pandemic is having repercussions around the world. It was announced that fear of swine flu recently led the Egyptian parliment to demand that all pigs be slaughtered. The reaction in the second of my worlds hasn't been quite that drastic but I got a text message this morning that people supposedly from the health department had been going around the area "spraying pigs against pig flu".
Remembering the "spraying against dengue" that was done a few weeks ago, I wondered what on earth they could be doing. This flu isn't being spread by pigs, pigs are not getting sick, and as far as I know there is no vaccine out yet and even if there was it would likely be injected not sprayed.
The villagers were in a bit of an upheaval because they are concerned that their pigs are being sprayed with some kind of poison or even a virus to make them get sick and die. They are very aware of the paranoia towards pigs by some of the folk of a different religion and they well remember the attacks on pig farms by some fanatics a few years ago.
A quick check on the internet showed a few stories on how the department of health in various parts of the country has begun spraying pigs with disinfectant. More texting back and forth revealed that the pigs had been sprayed as well as the area around them and that it was odorless. And at least one family had just flatly refused to let their pigs be sprayed. I told them about the spraying with disinfectant and suggested that it was probably okay and wouldn't hurt the pigs.
I do wish the folk from the health department would put a bit more effort into explaining things to people.
I am not sure how much good spraying bleach water on all the pigs will do towards stopping this human flu pandemic but perhaps it makes nervous people feel like the government is doing something?
(http://flutracker.rhizalabs.com/)
It seems that the "swine" part of the name of the current flu pandemic is having repercussions around the world. It was announced that fear of swine flu recently led the Egyptian parliment to demand that all pigs be slaughtered. The reaction in the second of my worlds hasn't been quite that drastic but I got a text message this morning that people supposedly from the health department had been going around the area "spraying pigs against pig flu".
Remembering the "spraying against dengue" that was done a few weeks ago, I wondered what on earth they could be doing. This flu isn't being spread by pigs, pigs are not getting sick, and as far as I know there is no vaccine out yet and even if there was it would likely be injected not sprayed.
The villagers were in a bit of an upheaval because they are concerned that their pigs are being sprayed with some kind of poison or even a virus to make them get sick and die. They are very aware of the paranoia towards pigs by some of the folk of a different religion and they well remember the attacks on pig farms by some fanatics a few years ago.
A quick check on the internet showed a few stories on how the department of health in various parts of the country has begun spraying pigs with disinfectant. More texting back and forth revealed that the pigs had been sprayed as well as the area around them and that it was odorless. And at least one family had just flatly refused to let their pigs be sprayed. I told them about the spraying with disinfectant and suggested that it was probably okay and wouldn't hurt the pigs.
I do wish the folk from the health department would put a bit more effort into explaining things to people.
I am not sure how much good spraying bleach water on all the pigs will do towards stopping this human flu pandemic but perhaps it makes nervous people feel like the government is doing something?
Saturday, May 02, 2009
The rabies got a bit more personal all of a sudden
About a week and a half after the dog was killed, I went outside one evening to break up a fight between two of the puppies who had really latched on to each other and were making quite a racket. I shouted, I smacked their back sides, I even flipped them over a couple of times. No effect. I didn’t want to dump water on them because they were still small and it was night and I didn’t want them to get chilled and end up sick. So, stupidly I whacked them a bit closer to the head with my hand. It broke up the fight but one of them bit my finger. The holes weren’t big because the puppies are still small but their teeth are sharp – it felt like it went all the way to the bone!It bled a lot, dripping all over the floor on my way to the bathroon to wash it. That is good they say, for cleaning out a wound. I washed it well with soap and plenty of water. Somebody had some betadine so I applied that. Coincidentally, a teenager in the house had been bit by the neighbor’s dog earlier in the day. That dog probably isn’t rabid, he just likes to bite. When the neighbor got home she came over and brought some grated up pulp from a particular tree that they say draws out poisons. So they packed the teenager’s wound and my finger with it. It was cool and soothing but after an hour I took it off and reapplied betadine. My wound wasn’t particularly painful but of course we are all aware that the mother was recently killed for presumed rabies.
From what I have gathered, the incubation for rabies in dogs is usually 3-6 weeks but can be as long as 6 months. The virus works its way up the nerves into the brain and when it gets to the brain it infects the saliva glands and the saliva is what carries the infection to other animals or people. That is also when the symptoms start. So apparently the animal is not contagious until about the time the symptoms start or a couple days earlier. That is why they say to observe the animal 10 days. If it was coming down with the disease, it will be showing definite symptoms in that time. If the dog is not sick within 10 days, then it was not infectious at the time of the bite – even though presumably the animal might still come down with the disease at a later date.
To comfort (?!) me they told me all about a 10-year old boy in the next village who had died of rabies a couple years ago. He got it from a puppy that they didn’t know had rabies. (Puppies die from all sorts of things.) They told me about a 20 year old girl from another village who had also died of rabies of unclear origen. So rabies is definitely endemic in the area. In fact, one of these puppies was killed in the night presumably by a rabid dog. Fortunately for me, that puppy was not the one that bit me.
The government has intermittent campaigns to vaccinate dogs and there are antirabies shots for those bitten, although with the chronic electricity problems in the area one wonders how viable the vaccine is. After arriving back in the third of my worlds a few days ago I heard that rabies is also an ongoing problem here though they seem to have made more progress in getting animals vaccinated routinely. They also vaccinate water buffalo, cattle and horses. I told the vet about my adventure with the puppies and he confirmed what I had found out about incubation, etc. He also suggested that I considered getting vaccinated against rabies since I am often in a high-risk area. He himself gets an annual booster. He also advised me that the next time I want to break up a dog fight to just use water!
Anyway, I am now past the 10-days and the puppies are still healthy.
Wednesday, April 29, 2009
On rabid dogs
April 10, 2009
I always hate it when they kill a dog. Today they clubbed a dog whose pups are about 6 weeks old. She looked and acted like she had rabies. She was normally good natured but a couple nights ago I noticed her attacking dogs that usually would attack her. Yesterday I noticed she was running around a lot and snarling at her pups when they wanted to nurse, even nipping them. I tried to feed her last night but she seemed to have trouble eating, she'd eat a little and then have to stop and cough. She was obviously hungry but seemed unable to eat. This morning she was chasing everything - cats, chickens, other dogs and running a lot. She kept coming back though and smelling her pups front and back. By midday her mouth seemed frozen partly open, though she did come and let her pups nurse once.
They clubbed her just now. There is no cure for rabies and if she were to bite anybody it would be a disaster. Even so we don't know how if any of the other dogs she attacked may have become infected. Her puppies may also already be infected. Sigh.
The teenage boys plan to eat the dog.
Rabies in humans is a big problem in the second and third of my worlds and there are usually a few dozen deaths each year from rabies. One 10 year old boy in thos village died a couple years ago from a puppy bite - a puppy they did not know had rabies. The post-bite vaccines are available but apparently are expensive and can only be gotten in a big city where there is electricity. Poor rural folk find the cost of the vaccines and the cost of getting to the city and staying there for the duration prohibitive. And sometimes you don’t know the dog is rabid.
The teenage boys plan to eat the dog.
Rabies in humans is a big problem in the second and third of my worlds and there are usually a few dozen deaths each year from rabies. One 10 year old boy in thos village died a couple years ago from a puppy bite - a puppy they did not know had rabies. The post-bite vaccines are available but apparently are expensive and can only be gotten in a big city where there is electricity. Poor rural folk find the cost of the vaccines and the cost of getting to the city and staying there for the duration prohibitive. And sometimes you don’t know the dog is rabid.
Thursday, April 02, 2009
Avoiding dengue fever--
It is 8:15pm and the temperature in my room has finally dropped to 90 degrees. Earth Day or Hour or whatever it was has passed and we DID have power so I spent it sitting in front of the fan! (I'm off to the village tomorrow seeking some slightly cooler place.)
I am teaching a class on cross cultural communication and one thing we talked about is how people can see the same event and have very different perceptions of it. Or people have the same experience and interpret it very differently. Today when I arrived to teach I was almost overcome by the strong chemical/pesticide smell. The place I teach is a large school complex with several hundred students from kindergarten through high school and college. Apparently government workers had been by earlier in the day and sprayed for mosquitos for the prevention of dengue fever. They sprayed while all the kids were present. Some of the children had vomited.
Not only was I practically gagging at the odor myself, I was horrified that they had sprayed with the kids all there running around. All sorts of questions flood my mind - do they not know that the spray is poisonous? Why don't they spray in the afternoon or on a weekend? I wondered if the sprayers even take any protective measures themselves? Etc.
But I was apparently the only one who was upset. Everyone else just laughed or said that that was just the way they do it here.
I suppose so. Just like the article I read recently which said gold miners on a neighboring island sometimes rub mercury all over their skin to make them strong....
I am teaching a class on cross cultural communication and one thing we talked about is how people can see the same event and have very different perceptions of it. Or people have the same experience and interpret it very differently. Today when I arrived to teach I was almost overcome by the strong chemical/pesticide smell. The place I teach is a large school complex with several hundred students from kindergarten through high school and college. Apparently government workers had been by earlier in the day and sprayed for mosquitos for the prevention of dengue fever. They sprayed while all the kids were present. Some of the children had vomited.
Not only was I practically gagging at the odor myself, I was horrified that they had sprayed with the kids all there running around. All sorts of questions flood my mind - do they not know that the spray is poisonous? Why don't they spray in the afternoon or on a weekend? I wondered if the sprayers even take any protective measures themselves? Etc.
But I was apparently the only one who was upset. Everyone else just laughed or said that that was just the way they do it here.
I suppose so. Just like the article I read recently which said gold miners on a neighboring island sometimes rub mercury all over their skin to make them strong....
Saturday, January 10, 2009
Dr. Quack-Quack
Maybe when I retire I should open myself up a little clinic. I can be Dra. Quack-Quack, which in the local language would mean ‘sort of like a quack but not exactly”. It shouldn’t cost much to set up. After all, quack doctors do not need any training. They have no boards, no licensing, and no annoying bureaucratic oversight. Why, I could set up my living room to be the waiting room. I could hire a friend to make snacks for people to buy while they are waiting. Another friend who is a master of detailing every bodily symptom and the minutest sensation – including ones you never thought even HAD any sensation - could sit there and write down a list of peoples’ complaints. Another friend does massage so she could work there too. And, we have a floor tile in our living room that sort of looks like some saint's face. I could hire another friend to sell candles so visitors could burn candles to it while they are waiting.
Yesterday a friend got a frantic text from her mother in the village saying that she needed $40 immediately because the quack doctor had told her she had a huge kidney stone and needed treatment urgently. At first I was breathless – who ever heard of a quack doctor charging that much for anything? In a country where the daily wage in rural areas can be as low as $2/day, that is phenomenally steep for a quack doctor. Usually they are paid only a small donation. As I finally began breathing again and oxygen returned to my brain, I began asking how she knew she had a kidney problem? After all, my friend had just been out there last week for New Years and she was fine then.
Turns out she had numbness down her backside and the back of her thigh. Now, it may have been a long time since I was in nursing school but the human body hasn’t changed and I’m sure that is NOT the symptom of kidney stones. In fact, sounds suspiciously like sciatica –pinched nerve in the back. I told the daughter to bring her mother to town. There is a real doctor, a neurologist even, who does charity work every morning and charges only $1. The mother argued a bit because she was apparently quite convinced by the quack doctor that she needed treatment. She said the quack doctor was going to operate on her and it was urgent! Operate???? Yikes!!!
Really, I could do better than that. For only 5-10 cents (I’d have to pay my workers) I could look at all their complaints, listed by my able friend, and any I couldn't help I could at least send them on their way in the right direction for help, whether to the massage lady, the pharmacy, the charity doctor, the appropriate specialist or the government hospital.
My friend put her mom’s name on the list to be seen by the charity doctor this morning and then met her at the bus terminal. As I suspected, he told her it is not kidney disease as she has no trouble urinating, no blood, no pain. It is a pinched nerve. All my friend had to pay was $4 for her mom’s bus fare, $1 for the doctor and $5 for medicine. Saved her a whopping $30 and everybody’s stress has decreased enormously!
Sunday, August 26, 2007
Sina's Feet
In case you were wondering, Sina's feet are better now after having kept them wrapped in banana leaves all week. Hmmm, maybe we could patent it???
Monday, August 13, 2007
Things I do not understand
There are some things I still do not understand.
Today I got a series of frantic text messages from the second of my worlds about Sina. Sina is semi paralyzed. 30 years ago she was playing Tarzan and fell off of a jungle swing and damaged her spine. She recovered to the point of being able to get around with two long sticks. But in recent years her legs have gotten weaker and she has more difficulty walking at all. She’s really into warm water compresses, pehaps it makes her legs feel better or maybe she feels it will have some healing powers. But since her legs have gotten weaker, she also has less sensation in her feet. She has burned herself several times with water that was too hot. Last year she burned her feet and decided to treat the foot with local herbs to make it heal faster. So she applied the herbs and wrapped the foot in plastic for several days. I ended up treating her for the beginnings of gangrene in the tips of two toes. Thankfully after two courses of Cipro, ands lots of exposure to the air they did eventually heal. (I don’t think you want to hear about the smell!!)
Well, it seems she has once again burned her feet. Although by now she has a lot of experience with how long it takes for burns to heal, she wanted it to happen faster. So she allowed somebody to come and try a “new treatment” on her: one liter of salt mixed with 1 liter of kerosene plus the equivalent of a liter-sized chunk of ice. They soaked her feet in it. They said at first her feet got hard like ice and then after the ice melted they swelled and blistered. So now her state is MUCH worse than at first and she is in a lot of pain. So they are texting me asking what to do.
Why, oh why would they do such a thing??!!! Did they think “magic” would somehow offset the innate characteristics of the ingredients??? Normal skin would blister with such treatment, how much more burned skin!!! My friend here says maybe it’s because they didn’t go to school. But I don’t recall ever having any teacher telling us not to soak our feet in ice, kerosene and salt, do you?
Maybe there’s a lesson in there somewhere about trying to force things along faster than they’re meant to go?
Today I got a series of frantic text messages from the second of my worlds about Sina. Sina is semi paralyzed. 30 years ago she was playing Tarzan and fell off of a jungle swing and damaged her spine. She recovered to the point of being able to get around with two long sticks. But in recent years her legs have gotten weaker and she has more difficulty walking at all. She’s really into warm water compresses, pehaps it makes her legs feel better or maybe she feels it will have some healing powers. But since her legs have gotten weaker, she also has less sensation in her feet. She has burned herself several times with water that was too hot. Last year she burned her feet and decided to treat the foot with local herbs to make it heal faster. So she applied the herbs and wrapped the foot in plastic for several days. I ended up treating her for the beginnings of gangrene in the tips of two toes. Thankfully after two courses of Cipro, ands lots of exposure to the air they did eventually heal. (I don’t think you want to hear about the smell!!)
Well, it seems she has once again burned her feet. Although by now she has a lot of experience with how long it takes for burns to heal, she wanted it to happen faster. So she allowed somebody to come and try a “new treatment” on her: one liter of salt mixed with 1 liter of kerosene plus the equivalent of a liter-sized chunk of ice. They soaked her feet in it. They said at first her feet got hard like ice and then after the ice melted they swelled and blistered. So now her state is MUCH worse than at first and she is in a lot of pain. So they are texting me asking what to do.
Why, oh why would they do such a thing??!!! Did they think “magic” would somehow offset the innate characteristics of the ingredients??? Normal skin would blister with such treatment, how much more burned skin!!! My friend here says maybe it’s because they didn’t go to school. But I don’t recall ever having any teacher telling us not to soak our feet in ice, kerosene and salt, do you?
Maybe there’s a lesson in there somewhere about trying to force things along faster than they’re meant to go?
Tuesday, April 10, 2007
The sad story of Alma
Alma was an only child. Her parents indulged her terribly. Everything she wanted, she got, though her family was not particularly well off. After Alma’s father died several years ago Alma continued to live with her mother and grandparents. Three years ago she got married and insisted that they live with her family. They now have a 2 year old daughter.
While Alma was pregnant she showed signs of kidney problems and the doctors told her to quite eating junk food, avoid salt, and quit drinking Coke, of which she was quite fond. But Alma was always accustomed to do what she wanted to do so she ignored the advice. In January this year she was hospitalized. with a blood creatinine of over 900 Umol/L (normal is 53-97). The doctors found both kidneys shrunken and non-functional and said that there is nothing they can do unless she wants to go on permanent dialysis.
The family of course cannot afford dialysis and there is no insurance or government subsidy here for catastrophic illness. Her previous employer, like many, had not paid her social security so she didn’t have any help from that either. The doctor said dialysis would have to be 2-3 times weekly for the rest of her life plus medications. In addition she would have dietary restrictions - not that she had ever shown much interest in restricting her diet.
Alma was by then quite sick. She had stopped urinating and was instead losing water through other orifices. They took her home. Then three weeks ago she had a dream in which her dead father appeared and told her she needs to live for the sake of her child. So she insisted that she be taken back to the hospital and put on dialysis. Her mother was willing to sell her rickety house and the small plot of land it stands on, though it is unlikely that it would bring enough to cover very many weeks of dialysis and so would only postpone the inevitable. (And then they would have nowhere to live.)
Alma was readmitted to the hospital but her condition deteriorated there, so in the end they took her back home. Alma’s husband had taken unpaid leave from work because of the hospitalizations but feeling the pressure of all the accumulating debt went back to work despite his mother-in-law’s protests that he should stay at his wife’s side.
Poor Alma. In death as in life, her first thoughts were for herself. She asked her husband to never marry again. Her dying wish was to be buried next to her father in an expensive cemetery some distance away that requires expensive vault and coffin. She never seemed to be concerned about where money would come from, and continued to eat and drink what she wanted. These last two weeks she has been mostly semi-comatose. Today Alma died, at age 32.
Alma’s in-laws are upset and some are having nightmares. Alma’s mother has never been shy about demanding money from them for the wedding, the baby, the hospitalizations, medicine. And no doubt she will now demand they take out more loans to pay for the expensive burial. The in-laws feel very stressed at the debt they have already incurred and upset at what seems to them to be extravagance. In fact, the local community fund has offered to pay for burial but Alma’s mother refused because the fund will not pay for the expensive burial in teh expensive cemetery.
I never met Alma. I know her story through her in-laws, who are obviously quite biased. But surely there was something loveable about Alma. Her parents certainly loved her. Even now her mother continues to try to indulge her last whim. Her husband also loved her enough to stay until the end, and it can’t have been easy to watch. And surely her daughter loves her. As for me, I feel very, very sad. I also feel a bit of relief that it is over, yet also some exasperation at the inability of Alma’s mother to see the real burden her need to indulge has caused to others. I also feel angry that employers can skirt the law by only pretending to pay the social security and then when a worker needs it finds out they can't get help because it’s not been paid. Although Alma didn’t seem to be a great candidate for dialysis because of her lack of compliance, yet it distresses me that she really didn’t have a choice because there is no way they could pay for it.
If only we lived in a perfect world....
While Alma was pregnant she showed signs of kidney problems and the doctors told her to quite eating junk food, avoid salt, and quit drinking Coke, of which she was quite fond. But Alma was always accustomed to do what she wanted to do so she ignored the advice. In January this year she was hospitalized. with a blood creatinine of over 900 Umol/L (normal is 53-97). The doctors found both kidneys shrunken and non-functional and said that there is nothing they can do unless she wants to go on permanent dialysis.
The family of course cannot afford dialysis and there is no insurance or government subsidy here for catastrophic illness. Her previous employer, like many, had not paid her social security so she didn’t have any help from that either. The doctor said dialysis would have to be 2-3 times weekly for the rest of her life plus medications. In addition she would have dietary restrictions - not that she had ever shown much interest in restricting her diet.
Alma was by then quite sick. She had stopped urinating and was instead losing water through other orifices. They took her home. Then three weeks ago she had a dream in which her dead father appeared and told her she needs to live for the sake of her child. So she insisted that she be taken back to the hospital and put on dialysis. Her mother was willing to sell her rickety house and the small plot of land it stands on, though it is unlikely that it would bring enough to cover very many weeks of dialysis and so would only postpone the inevitable. (And then they would have nowhere to live.)
Alma was readmitted to the hospital but her condition deteriorated there, so in the end they took her back home. Alma’s husband had taken unpaid leave from work because of the hospitalizations but feeling the pressure of all the accumulating debt went back to work despite his mother-in-law’s protests that he should stay at his wife’s side.
Poor Alma. In death as in life, her first thoughts were for herself. She asked her husband to never marry again. Her dying wish was to be buried next to her father in an expensive cemetery some distance away that requires expensive vault and coffin. She never seemed to be concerned about where money would come from, and continued to eat and drink what she wanted. These last two weeks she has been mostly semi-comatose. Today Alma died, at age 32.
Alma’s in-laws are upset and some are having nightmares. Alma’s mother has never been shy about demanding money from them for the wedding, the baby, the hospitalizations, medicine. And no doubt she will now demand they take out more loans to pay for the expensive burial. The in-laws feel very stressed at the debt they have already incurred and upset at what seems to them to be extravagance. In fact, the local community fund has offered to pay for burial but Alma’s mother refused because the fund will not pay for the expensive burial in teh expensive cemetery.
I never met Alma. I know her story through her in-laws, who are obviously quite biased. But surely there was something loveable about Alma. Her parents certainly loved her. Even now her mother continues to try to indulge her last whim. Her husband also loved her enough to stay until the end, and it can’t have been easy to watch. And surely her daughter loves her. As for me, I feel very, very sad. I also feel a bit of relief that it is over, yet also some exasperation at the inability of Alma’s mother to see the real burden her need to indulge has caused to others. I also feel angry that employers can skirt the law by only pretending to pay the social security and then when a worker needs it finds out they can't get help because it’s not been paid. Although Alma didn’t seem to be a great candidate for dialysis because of her lack of compliance, yet it distresses me that she really didn’t have a choice because there is no way they could pay for it.
If only we lived in a perfect world....
Friday, March 16, 2007
Toothache
It’s been two weeks since I last heard from a friend in the second of my worlds. Two weeks ago she texted asking advice for a toothache. She had taken antibiotics for two days and it still hurt so she gargled with raw whiskey. Didn’t help. She then tried putting kerosene on the tooth. That made it even worse. The last text message was that it hurt so bad she was ready to die. I advised her to get some oil of cloves (they grow them there) and see a dentist. And I haven’t heard anything for two weeks now despite having sent several text messages.
Did she really die???? I would probably have heard if she had. Did she run out of load on her cellphone? Surely she would have had time by now to go to town and buy a new card. Did the phone get broken? Possibly. Today I texted another friend who will be going out to that village on Sunday and promised to let me know if she had really died, ha, ha, ha.
Everybody here laughs at the story, because they have all had that kind of toothache. The pain is all consuming, preventing sleep, preventing thinking, preventing anything but PAIN! People in that kind of pain DO feel that death is preferable. I have seen adults cry and groan, and children scream all night long.
There are dentists in town. But at the local market in my friend’s village there’s a guy with a pair of pliers and a big glass jar full of teeth he has pulled. He doesn’t use anesthesia but people say they don’t care because by the time they come to him the pain is so bad they are desperate. Something so few ever have to experience in the first of my worlds.
Did she really die???? I would probably have heard if she had. Did she run out of load on her cellphone? Surely she would have had time by now to go to town and buy a new card. Did the phone get broken? Possibly. Today I texted another friend who will be going out to that village on Sunday and promised to let me know if she had really died, ha, ha, ha.
Everybody here laughs at the story, because they have all had that kind of toothache. The pain is all consuming, preventing sleep, preventing thinking, preventing anything but PAIN! People in that kind of pain DO feel that death is preferable. I have seen adults cry and groan, and children scream all night long.
There are dentists in town. But at the local market in my friend’s village there’s a guy with a pair of pliers and a big glass jar full of teeth he has pulled. He doesn’t use anesthesia but people say they don’t care because by the time they come to him the pain is so bad they are desperate. Something so few ever have to experience in the first of my worlds.
Thursday, December 28, 2006
On wobbly legs
As I get my still wobbly self to the computer to update this blog, let me assure you that I am still alive, and, a brief scan of the internet shows that the world has managed to carry on just fine without me the last few days.
I am recovering from a bout of some weird gastroenteritis that's going around. It hit me Christmas Eve and I spent the next two days flat on the floor with grog-inducing fever, abdominal pain and diarrhea hoping I wouldn't vomit too. Wednesday the fever broke so I sweat all day long but at least felt well enough to sit up part of the day and alert enough to read - in between trips to the bathroom. By evening I managed to get somebody to buy me a liter of Sprite and that went down well. Lost 10 pounds in two days - let me know if you'd like me to send you some bugs....
Now I am up and about, no more nausea, though after a trip upstairs my legs are really tired and crampy and I felt the need to sit and rest before coming down again. Combing my hair makes my arm tired, and holding a book makes my hand cramp. Amazing that as recently as last Saturday I was doing stair step aerobics and today I am so weak I would probably fall off the step!
On Christmas day my house helper stopped by to get some ice. I apparently looked so bad that she was afraid to go home so she and her roommate moved in for a couple of days. Very kind of them. Though of course since I certainly wasn’t in any condition to make any demands on anybody, they had plenty of time to watch VCD movies on my old laptop.
I’ve had my share of GI upsets in my life but this was the all time champion, definitely a new strain of whatever it was. And now freed of the fever, I would like to know more about the epidemiology of this bug. Was it contamination from raw eggs used freely in holiday cooking? Did anybody else get sick who was at any of the same events I was at? If so, what could have been the common factor? Not that I will ever know for sure, but I’m curious....
I am recovering from a bout of some weird gastroenteritis that's going around. It hit me Christmas Eve and I spent the next two days flat on the floor with grog-inducing fever, abdominal pain and diarrhea hoping I wouldn't vomit too. Wednesday the fever broke so I sweat all day long but at least felt well enough to sit up part of the day and alert enough to read - in between trips to the bathroom. By evening I managed to get somebody to buy me a liter of Sprite and that went down well. Lost 10 pounds in two days - let me know if you'd like me to send you some bugs....
Now I am up and about, no more nausea, though after a trip upstairs my legs are really tired and crampy and I felt the need to sit and rest before coming down again. Combing my hair makes my arm tired, and holding a book makes my hand cramp. Amazing that as recently as last Saturday I was doing stair step aerobics and today I am so weak I would probably fall off the step!
On Christmas day my house helper stopped by to get some ice. I apparently looked so bad that she was afraid to go home so she and her roommate moved in for a couple of days. Very kind of them. Though of course since I certainly wasn’t in any condition to make any demands on anybody, they had plenty of time to watch VCD movies on my old laptop.
I’ve had my share of GI upsets in my life but this was the all time champion, definitely a new strain of whatever it was. And now freed of the fever, I would like to know more about the epidemiology of this bug. Was it contamination from raw eggs used freely in holiday cooking? Did anybody else get sick who was at any of the same events I was at? If so, what could have been the common factor? Not that I will ever know for sure, but I’m curious....
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