TRIAGE IN TANNA

WOW - Thanks for all the responses to the "Need Your Help" blog post on my young friends medical problems. Many people recommended international aide organizations which will take me many weeks, or months, to research - which I will do. I hope to find something that will work for with our limited needs.

As it happens, a few days after I made that post an angel sent me a couple doctors.

I had just walked back to the bungalows, tired from a long day at the factory, which included a heated "discussion" with the electric company that keeps trying to over-bill the coffee factory (oh, and the electric company people only speak french and bislama - just imagine the fun i had), and the property manager asked if I wouldn't mind taking a couple tourists to a nakamal so they could get some kava. The night before I had only a little bit of kava and got a stomachache so I was really hesitant to drink again this night, plus I was feeling loathe to play tour guide (even though I love doing it). When I reluctantly asked which tourists, barely concealing the lethargy in my voice, he pointed to two tall, good-looking, college guys.

Uhmm... yeah... Kava sounds great.

So a few minutes later I'm leading the guys, both Londoners, to my local pub. Now here is where the secret of the Peace Corps comes into action - as opposed to Ni-Van culture and even many other aide organizations - I shared information. Quite simply I talked with the tourists, and then later had a chance to share (use) what I learned with my people (my community). This is an element that is the single greatest barrier to Vanuatu culture - not sharing information. But more on that later. In this case, I quickly learned that Simon and Kumar where both soon-to-be doctors. They had traveled to Vanuatu to volunteer for a few weeks at a hospital in Luganville. Luganville is Vanuatu's second largest urban area after Port Vila, and is on the northern island of Santo. They had come to Tanna for a brief vacation (visiting the volcano, of course) before starting their work.

Well, what do you know? I meet two doctors and I just happen to have two patients. Would I let these two fine young men enjoy their vacation?

Hell no.

As soon as we finished kava I told them about Charlie and Danny and they were very excited and engaged about the prospects of helping out. On our way back to the bungalows we made a small visit to Charlie so the guys could get a look at the situation. They examined him for about 20 minutes and then we headed home. The next morning we ate breakfest together and discussed his prospects. It was clear to all of us that he would definitely need surgery and maybe several, not to mention some serious long-term therapy. After acknowledging that neither of those things was going to happen any time soon we decided that it certainly couldn't hurt to try and construct a brace that might actually improve the situation at least a little bit.

We immediately started brainstorming about how best to build a brace. We drew pictures and discussed the various elements of the problem. Number one - the multiple ways in which the foot was turned. Number two - we can only use available resources. Number three - the parents would likely only participate in the most minimal way, so everything needed to be simple simple simple. Then I started collecting supplies and laying them all out on the large diningroom table. We had bamboo, fabric, duct tape, scraps of wood, metal wire, velcro, hammer, and a few other random things including a coconut shell and a plastic PlayStation game box (like a DVD box, but 2/3rds the size). We wanted to consider every possibility. Then we decided it was time to bring back Charlie and see how we would need to fit our different possibilities.

The docs were able to re-examine his feet, test his flexibility, and test his pain threshold. Unfortunately it quickly became apparent that even our best efforts would be nothing more than a waste of time. His feet were so far twisted that there was simply no sensible way (apparant to us), with what we had on hand, to build a brace. Not that we didn't try. Kumar started cutting into his PlayStation box with the idea of strapping down his feet with velcro. Simon and I looked for ideas to create an angled contraption that would better meet the twist of his feet. His mother, father, aunts and uncles wandered around the periphery and tried to keep Charlie happy and comfortable. The doctors were so determined and so committed - and all of us were so hopeful that surely we could come up with something - that it was kind of hard to let go of the idea. But ultimately that's what we needed to do. Until I can get some further information on the brace idea, I think I'll just have to focus on trying to find some path to surgery.

Then Danny showed up. This kid was on his death bed a couple years ago. Some crazy infection that caused his legs to swell up starting at the knees. They soon broke out in pussy, oozing sores and they took him to the hospital where his condition got much worse. They gave him some meds but the details are sketchy. At one point his entire body swelled up and it scared the family so much that they took him home and started with "custom" medicine, which mostly consists of wrapping the wounds in leaves and drinking herbal concotions. He lost a ton of weight, had trouble with appetite, and most people thought he might not make it, but didn't know what to do about it.

Many months went by and his condition started to improve, but not his legs. Over the past year and a half his health greatly improved and when I met him I found him is great spirits. Unfortunatly he was always just sitting on the ground - often in the same place for hours at a time. Mobility was incredibly difficult and painful for him. He had a makeshift wheelchair but that's tough to use in a land with no sidewalks or any paved areas. His right let seemed healthy, but his left leg was completely swathed in hand-torn fabric wraps at all times.

Eventually I decided on my own that he needed to start physical therapy. I made him walk around a bit with out his crutches, and then eventually took away one crutch forcing him to start using more muscles in his legs. I was hoping to give him the encouragement (tough love) to kick-start long overdue physical therapy.

So I was extremely happy to have Simon and Kumar on hand the first time I asked Danny to remove his bandages. My jaw practically hit the floor. His leg was still very swollen (like he had no ankle) and he still had sores up and down his calf - each one very large, and actively oozing clear and white puss. They were bright red and pink, and some had a white ring of skin around them - I later learned this was scare tissue. Some appeared sunken into the skin as the leg had continued to swell up around them.

Looking at his leg I felt so bad for him and couldn't believe I had taken away this crippled kids crutches. What a bastard I am. The doctors told me that it was actually a very good thing to do, even considering how bad his leg was. The constant sedentariness was very bad for blood circulation, which was very bad for healing. They also said that if Danny was in the US or the UK he would be on intravenous IV's for a couple weeks, doctors might even cut out his sores, and he would be monitored closely. If his infection worsened it could ultimately mean an amputation. As with Charlie they brainstormed the best-case scenario with what we collectively had on hand.

Kumar immediately went back to his bungalow and brought out one of the pre-packed needle kits that he was supposed to take with him to Santo. I busted out my own extensive Peace Corps med kit in case anything could be utilized. They decided that they would give up a coarse of some powerful anti-biotic, Kumar woud clean and drain the sores, and then Danny would need to follow some new health guidelines - keep it un-covered, but with loose mosquito netting, and keep it clean (both more difficult than you can imagine). With these steps the doctors were still not at all optimistic of chances for complete recovery, but they hoped it would give him a chance for great improvement that might bring him more comfort, and allow him to more easily live and play and continue with treatment. Hopefully the huge encouragement boost to Danny will also play a key role in his health - nothing like positive energy and a sense of hope to get you through the tough times.

[the photo shows only some of the sores; Kumar in the forefront, Simon in the top right, Joseph behind Danny prepared to hold back his arms with force]

So we sat Danny on the end of one chair with his leg stretched out on another chair so anything dripping off would go into the coral and sandbeach floor. With Joseph (father of baby Charlie) holding Danny's arms from behind and Annie holding his legs down from the front, and with Lucy holding a notebook over his eyes so he couldn't see the needle that he already knew was there, Kumar started poking around and pushing the puss out of the sores. Poor Danny was squirming and screaming for the next 20 minutes, but I think it was necessary and the least that could be done. I think Kumar and Simon did an excellent job. I'm sure they also felt some satisfaction with having likely made a serious impact in Danny's health after the let down of Charlie. I know I did.

Shortly after Danny hobbled back to his village the tour truck arrived to take the London boys out to the volcano. We had a long, rough day so Lucy, Annie and I decided to join them - my third trip to the volcano.

I had no idea at the time that our doctor heros would then do something so moronic that it will provide forever an indelible image in my mind. Two doctors running for their lives from flying firebombs. Running so fast, in fact, that they ran right out their sandals.

To be fair the volcano was very un-active when we arrived. Not ominously quite, like when a big one is brewing, but just un-active. Lots of smoke, but only soft rumbles and only minor eruptions. Very minor. So minor, in fact, that Kumar and Simon got bored and decided to walk around the outer rim. They walked over to a section that dips down low and is very much in the line of fire, but still an equal distance from the opening as where I still stood. Then they sat down on a large rock, facing the volcano. The girls kept imploring me to call them back, that they were in serious danger, that they shouldn't - in the very least - be sitting down. I waved them off, told them to let them be, they were adults and the volcano was doing nothing.

It continued to do nothing.

And without a lick of warning a massive eruption exploded out of the volcano, the ground shook and we all instantly soiled our pants. All of us on top screamed out and stepped back, looking up and out and left and right making sure no bombs were coming our way. The explosions first go straight up and you have to wait a bit to fix on the trajectories before knowing which was to run.

I desperately looked down to Kumar and Simon who I saw frantically scramble from sitting to running. They ran away from the volcano then remembered to stop and look up - always better to dodge than get hit in the back. But bombs were falling all around them so they continued to run and look, run and look. I couldn't believe what I was seeing and then couldn't believe myself when I bursted out laughing. I mean, i was laughing really fucking hard - it was sheer lunacy! bombs were landing in front of them while they were running and I was laughing. I guess it was a nervous thing. They ended up surviving, but just barely. We all had strong pulses for quite a while after that. Very exciting. I reminded them of my favorite Churchill quotes:

"Nothing is more exhilerating than to be shot at without effect". I told them this applied to them - "Nothing more exhilerating than to have a volcano erupt in your face without effect".

When we got home I got a reward for my good deeds of hooking up the doctors with my little friends - Simon offered me his video iPod which included the entire second season of Lost. Rare that a TV show would ever grabbed my attention in the same way as Lost especially since I don't ever watch TV. In fact, I first watched Lost from downloading it on iTunes (love you Apple!). Anyway... I left for Vanuatu with just three episodes left in the season and I got to cozy up in my bungalow later that night and watch all three of them in a row. After 6 months in Vanuatu that truly is a special treat. Sounds silly, but it's true. As Matt would say 'it's like cigarettes in prison'.

Thank you Kumar and Simon - and good luck in Santo!