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Introducing Derek Allen
Special Note: We are currently sourcing a programme to allow us to offer an option for Indonesian translation of the website. Meanwhile we have had some of the website translated into Indonesian Bahasa, and this will follow the English version in the interim.
Welcome to TroppoDoc.com
Dr Derek Allen is a doctor based in Indonesia who has chosen to work in the third world to help poor people in Vanuatu, Pakistan, Eastern Europe, Africa, and Indonesia.
He finds his work challenging, interesting, and self-fulfilling and wonders why more people aren’t doing it.
Dr Derek is very enthusiastic about introducing other people to the third world and getting them involved in various projects.
To see what Dr Derek is doing please check the website regularly and feel free to contact us with any questions you might have.
We are always looking for people to come and help from any walk of life, with any skills, medical or non-medical. Volunteers are important and very useful in life-saving work. They are warmly welcomed for any length of time they wish to come and help in the poor areas of the world where Derek works. Usually people find that the time they spend helping the poor is always too short – Derek finds that, and he has been doing
this type of work for 20yrs plus now. So if you volunteer for a day, a week, a month, a year or more, you will probably find that you will wish to stay even longer. If you are interested in helping us help those less fortunate than ourselves in any way, please go to the “ Volunteer Database” page and register. This is non-binding, and ensures you will receive newsletters, as well as providing numbers for help with funding, etc. If you can come and volunteer, and have a choice of dates to come, please co-ordinate with Bronwyn Boele van Hensbroek ( boele@xtra.co.nz) so she can suggest the most ideal dates - especially if you would like to time your travel to/into Indonesia with another volunteer, or Derek, or go at a time when there are no other/fewer volunteers. We need to know numbers of who is going and when, so Derek can be preparing for larger or smaller groups - thereby ensuring each volunteer has a quality time.
Dr Derek is also in desperate need for sponsorship in urgent projects.
Communication: Derek really enjoys communicating and responding to people directly, but email access is usually only about once a month when he is in Indonesia. However, he can be contacted directly by phone or txt most of the time - contact us . For urgent email enquiries, or are unable to contact Derek, please contact Margaret.
Memperkenalkan Derek Allen
Selamat Datang Kepada TroppoDoc.com
Dokter Derek Allen adalah seorang dokter yang berlokasi di Indonesia. Dia telah memilih untuk bekerja membantu memerangi kemiskinan di Vanuatu, Pakistan, Eastern Europe, Africa dan Indonesia.
Dia menemukan bahwa pekerjaannya menatang, menarik dan disanalah dia menemukan jati diringa dan bertanya kenepa banyak orang tidak melakukannya.
Dokter Derek sangat anthusias memperkenalkan orang-orang kepada negara-negara miskin dan melibatkan mereka pada proyek – proyek yang bervariasi.
Untuk melihat apa yang Dokter Derek sedang lakukan, anda dapat melihat pada regular website dan merasa bebas untuk menghubung kami dengan pertanyaan yang mau kamu ajukan.
Kami selalu mencari orang untuk dating dan membantu dengan keahlian apa saja, medical atau non-medical.
Jika kamu tertarik untuk membantu kami, anda bias ketik ke “Volunteer Database”.
Dokter Derek juga didalam keadaan putus asa untuk mencari sumbangan pada project – project penting. Kunjungi project page untuk keterangan lebih lanjut.
Komunikasi: Derek senang sekali berkomunikasi dengan orang – orang dan memberi secara langsung, teapi akses email biasanya hanya sekali sebulan ketika dia berada di Indonesia Namun, dia dapat dihubungi melaului telefon setiap saat. Hubungi kami untuk email penting atau jika Derek tidak terhubungi silakan menghubungi Margaret.
Latest Updates/News
Journal Update May 15-28 2009 Djibo northern Burkina Faso
From the capital we travelled north west for 4-5 hours to get to Djibo, on the edge of the Sahara not very far from the Mali border.and Tembouctou !! It is the end of the dry season and there is no grass to be seen but there are scrubby trees some with but many without leaves in thousands of hectares of sand. The road started with bitumen seal but the last 40 km are corrugated and potholed making the bus ride memorable for the wrong reasons. Several stops along the way to pick up or drop off people in places sometimes where no habitation is to be seen… and they start walking off between the trees across the burning sandy land…. temperatures at 3 pm in the shade 45-47 deg Celcius !!!
Dr Ken and Jocelyn Elliot meet me at the bus stop in Djibo and that after noon I sit in on his 3 times weekly surgical clinics. Amazing problems are seen …-longstanding fungal infections of ankle tissues,osteomyelitis with bone coming through the skin surface, prostatism, large inguinal hernias, some with rugby ball size hydrocoeles, maxillary facial tumours, genital tract tumours in a woman
With limited laboratory and X-ray facilities, diagnosis is by years of experience with an awareness that cure is an unlikely outcome in many cases. Ken has an exercise book with operating days 6 times a week booked up pretty much for a month in advance. Ken carries out more than 100 operations a month, gives all his own anaesthetics and provides an amazing service in acute and non acute operations
Operating starts around 7;30 am and the next day was no exception. 2 hernia repairs, removal of osteomyelitis sequestra from a thigh, open prostatectomy, removal of ganglion, removal of bladder stone (calculus the size of hen’s egg)
Ken is teaching me the skill and art of operating on people who need repair from many things, from partial leg amputations to removal of large ovarian tumours, and in the 3 afternoons a week of clinic he passes on his wide experience assessing those to be operated on and those not (usually because of possible hidden malignancy)
As well as operating technique he teaches me the skill of, safe spinal anaesthesia, to ready the patients before we start operating.
I see at his clinic things I have never seen before like osteomyelitis extruding bones, eyes that are coming out from the sclera due to Vitamin A deficiency and infection with the only possible choice being to remove the blind eye under anaesthesia to stop the dull pain, traumatic cataracts, cystic hygromas growing from a childs neck and 2 weeks old babies with saucer size appendages present at birth protruding from their skulls.
A young woman presents with a large vesico vaginal fistula . Ken removes 2 large bladder stones irregular and rough in nature from her bladder through her vagina
So many large bladder stones causing recurrent urinary infection and so many hernias, one has to wonder if the limited water intake of the men here leads to constipation- straining at stool and hernias Maybe.
Meanwhile Tessa and Melioni busy themselves at the house in the compound living under the constant gentle hum of a fan moving the 45degree air about in an effort to keep coolish. and walking around Djibo which every Wednesday boasts the largest cattle market in the Sahel. Roads here are of sand and there are many small motorbikes as transport with some donkeys and camels for the back to nature types. Everything is covered with red dust
Soon enough the 28th arrives and time for Tessa and Melioni to fly back to New Zealand leaving me for for 8 weeks that will be filled with very constructive learning . I am hoping for both anaesthesia and rural surgery with handfuls of bush experience thrown in for good measure !!
May 15th
Tessa and Melioni are doing very well with car transport for them to
Djibo tomoro (I am on bus ) temperatures in Djibo presently 42-46
degrees C (in shade )
May 11th – 14th
Soon enough it was time to get Gavin back for his plane trip to the
UK and to carry on to Djibo to work beside Dr Ken Elliot. However on
our way to Ouaga we stopped for the night in Fada to break the long
hot dusty journey and as we walked into the SIM guesthouse compound
there was a man sleeping under a tree in the driveway. Later that
afternoon, upon enquiry, we found out he was not the gardener, I had
supposed, but a waif who had drifted in a week or two before begging
for money for food and cigarettes. He had a crude material cover
around his lower right leg, and was fairly uncommunicative. After some
time with the house helper for Mark and Karina, we found out he was
from Niger and some 6 months previously had fallen at his village and
injured his Right leg. When we uncovered his leg ,part of the distal
third of his Tibia bone was poking through the skin with the attendant
infection, and it appeared he was able to walk with difficulty and the
assistance of a strong supporting pole. Tessa and Gavin swung into
action with dressing of the surrounding infection and starting him on
pain relief and antibiotics for the next two weeks as well as
antidepressants for his clear clinical depression. Yes he needs
further treatment, this requires his agreement, and whether this is
operative bony fixation and antibiotics or amputation and prostheses,
will be discussed with him and possible doctor involved as he
hopefully rises out of his depression with medicines, and food and
ongoing care.
There are three people with complex disease in Mahadaga who clearly
need investigations and treatments that are not available in Mahadaga
but which are important for the continuation of their life although it
will cost a little more of course.
Bernadette is a 17 year old woman with a 6 year history of an
increasing pounding in her chest with a limit to how much walking she
can do (2 km) before she becomes breathless and develops chest pain.
On examination she has a palpable thrill in her chest and a loud
murmur coming from her heart. She needs an ECG, Chest X-ray and Echo
cardiogram to clearly define her cardiac problem and then the work
will start to find a way of getting this repaired if it is a
repairable defect. Otherwise she will die young with a heart that
feels like it is beating itself to death !!
Boundi is a 14 year old girl who was deemed smart enough by her
family for her to be sent to Ouagadougou at the age of 11 to gain a
better education than is possible in Mahadaga. She was in Ouaga for 2
years staying with her brother there and going to school. However at
the age of 13 yrs her brother sent her home to the village as she had
become both deaf and mute and had great difficulty walking and her
brother did not know what to do and she could no longer continue her
education.
She has been back in her village for a year now and her walking has
improved but her deafness and muteness remain. On examination her
walking, was almost normal but she is profoundly deaf and mute.
Otherwise she appears bright and alert. She needs assessment by a
paediatrician, and maybe a child psychiatrist in Ouagadougou to try
and unravel the cause of this severe problem and then to maybe look at
treatment options !!
Toumbonl is a 30 year old woman with 8 children who came to see us in
clinic with a 3 year history of epigastric pain, dizziness and
headache. We took her blood pressure at the time, 135/80 and felt her
pulse. On examination she was short of breath at rest with a resting
tachypnoea of 26/minute. For her epigastric pain and possible symptoms
of hypovolaemia we gave her water drinking advice and famotidine. For
her regular pulse with irregular volume we gave her aspirin and now we
need to get her an ECG to rule out atrial fibrillation and start her
on appropriate treatment. Mahadaga does not have an ECG machine so to
Diapaga, Fada or Ouagadougou she must go as this is a symptomatic
heart defect that may well shorten her life as a mother of 8.
April 30th – May 10th Mahadaga
Clinic work with medical manager Mambogiri (Nurse)
as local language translator. Apparently about 7 % HIV positive on
voluntary testing last year, malnutrition, endemic malaria/
tuberculosis/typhoid disease as well as scorpions/snakes/centipedes.!!
8 am to 1 pm with no breaks, Gavin and I see malaria, typhoid
disease, malnutrition, HIV related problems, probable Tuberculosis,
intestinal worms, Giardiasis, Sickle Cell Disease, Beta thallassemia,
anaemia, hypertension, osteoarthritis, schizophrenia, depression, Post
Traumatic Stress Disorder, Rheumatic Heart disease, Asthma, Heart
Failure, cataracts, Iron deficiency, ear infections, fungal and
bacterial skin infections, to name but a few.
In the afternoons we visit hospital patients that we are called to
see ; a 30 yr woman with jaundice and a Ross River fever like syndrome
of painful joints in the hands and feet, a 35 year old woman who has
been living on the edge of the hospital grounds for 7 years with a
tumour of her spine and paraplegic. An operation on her spine in Benin
5 years ago hasn’t changed anything and on examination she has a
septic arthritis of her knee,( infection of her knee joint), a 5 month
old baby with fever…
We carry out small operations, excision of lipoma, draining a
hydrocoele (fluid collection around a testicle), suture up trauma
lacerations, reduce incarcerated inguinal hernia in 4 year old boy,
assess another 5 yr old boy with grapefruit swelling around testicles
since 1 yr of age for hernia repair in Diapaga, 55 km bumpy road ride
away.
One night we are asked to see another volunteer, helping the nearby
handicapped rehabilitation centre who has received a scorpion sting.
In Mahadaga, we can buy millet and sauce (very unappetizing) and on
occasions mangoes and onions. Fortunately we had bought pasta, rice,
couscous and tomato concentrate in Ouagadougou and milk powder for
Melioni, so our diet is sufficient.
Out on the main dirt road of Mahadaga it is incredibly busy. There
seem to be numerous free roaming goats pigs, sheep, donkeys and dogs,
along with bicycles and motorbikes, donkey drawn carts and truck and
trailer units from the nearby cotton factory, occasionally using the
track as well as plenty of pedestrians. It is the official siesta time
between 12 midday and 3pm because of the heat, so things tend to be
much quieter on the street and in the clinic. Over the course of 8
clinic days we see almost 400 people and Gavin carries out some
teaching regarding abdominal pain that is well received by the 15
nurses who attended the talk and practical examination of the abdomen
to rightly ascertain the diagnosis. Mahadaga is a dispensary under
Government definitions and only after it has one doctor for a 12 month
period can it hope to attain Centre Medical (hospital) status and can
then advertise and attract doctors for more short term servicing.
There are between 130-150 baby births here each month, no operating
theatre and because of no doctor they are not allowed to carry out
life-saving blood transfusions.
Next day 29th bus to Kantchari and ½ size bus to Diapaga, with
tired but grateful eyes to see the SIM (Mission) 4WD driven by Dale Johnson
there soon after our arrival in torrential rain, to take us on the last part of journey to Mahadaga.
Leaving Christchurch on evening of 23rd made it a 6 day direct
journey and we are quite remote, pot holed sand/mud road, to a place
where there may be 1 public bus a week… maybe
April 28th
OnTuesday we take the bus to
Fada, 4 hours and stay the night at SIM guesthouse , meet Karina,
participating in a youth ministry 17-24 yr olds.
April 26th,27th
Sunday recover from flight and Monday given back passport at airport
with visa on arrival for 1 month given.
April 25th
Next plane to Ouagadougou arrive 7 pm on 25th. Meet Gavin Bond,
final year med student from Nottingham UK, at airport and sleep night
at SIM hostel (opposite Ouaga International School).
April 24
Depart Wellington to Auckland meet Tony Denny and
Margaret Reid with further supplies to take, then Emirates to Sydney,
Dubai, Abidjan. No long delays, no overnight stops just direct to
Burkina Faso Unfortunately baby stroller taken consigned at Auckland
never arrives at Abidjan ..we are sure Emirates will find it???!!!
March 24 – April 24
Time spent in New Zealand with Melioni recuperating from her successful cleft palate surgery which was carried out in Auckland
She now has the opportunity to thrive and lead a healthy happy and useful life
Also opportunity to catch up with supporters and family, recharge batteries, sort out and relocate some of my remaining New Zealand assets and resort and repack ready for shipment a large amount of donated medical supplies.
This stay also provided the opportunity to discuss revamping the website and this work is well under way. In between all of this is planning for a second three month commitment to go to Burkina Faso (north of Ghana in sub Saharan west Africa) to work with Dr Ken Elliott at Djibo 200 kilometres north of the capital Ouagadougou and also to visit Mahadaga to the west of the capital by the Benin border
Feb23-March 23; Nurses Helen and Abbey (Wellington NZ ) depart and Dr
Ben ( Belgium) takes a 2 week break for a visa renewal run. Nurse
Tessa (Wellington NZ ) arrives after night crossover at Sorake
Beach. This is the 4th time that Tessa steps into Melioni's life and
we return to Pulau Tello by the usual 6 hour ferry boat.
Melioni continues eating and drinking, maintaining but not increasing
her 6.7 kg weight.
More island clinic work is possible this month as the Camat, (local
political head of sub district ) is electioneering (elections April 9)
with his wife and is happy to take a medical team along to the
various islands in his private runabout.
Morning and evening clinics in the Benghong house, house calls late
morning for the economically and physically disabled and village
clinics in Pulau tello, or more remote islands in the afternoon.
Notable patients; Daimar (close friend of Given's is a 17 yr old boy who
recently developed visual and auditory hallucinations and was sent to
his home island village when he became catatonic. After 2 months of
tribal medicine and no improvement in his catatonic state, he returned
to Pulau tello to see me. He was stiff, no facial expression or
communication, incontinent of faeces and urine, drinking 1-2 cups of
water per day on command and was severely dehydrated.
Treatment was infusion for dehydration and medicine for schizophrenia
and over a couple of weeks, his urine and faecal continence returns,
mobility slowly recovers and he is able to read and recite.
5 month old girl Jeni, comes to the evening clinic with a 2 week
history of fever and swelling of her leg and she was covered head to
toe in tribal medicine. After transfer to the Catholic Mission
hospital, she was washed and found to have an ascending cellulitis of
the leg, secondary to a scratch or insect bite. We started her on
antibiotic injections for her infetion that night, prior to my
departure to Singapore formy visa renewal. Unfortunately after my
departure her medicines were changed to oral meds, she was not
admitted to hospital and 2 days later she died from overwhelming yet
treatable infection.
A 44 yr old fisherman from Memong Island, married with 5 children
presented with ' resistant' tuberculosis. he had been given a course
of TB treatment but his Tb had returned. He needed Streptomycin
injections daily for 2 months. The Government medical clinic didn't
stock this medicine and he was too poor to be able to purchase
medicines from Rumah Sakit Pulau Tello. he was unable to afford the
cheapest lodgings in Pulau tello and it was impractical to canoe to
Tello every day for his injections and unable to pay for food for his
family while he was in Tello and too sick to fish. Troppodoc paid for
his Streptomycin medicine ( the other Tb medicine is free through the
government), paid for his lodgings and daily food and sent a sack of
rice each month that he is receiving his injections.
A 38 yr old man Miko , with an abdomen distended by ascites and
looking like a malnourished, wasted, dehydrated terminal cancer
patient. We drained 5 litres of yellow/ red fluid from his abdomen to
make his breathing more comfortable. Ten days later he was dead.
Terminal care for Sinuti,- a 61 year old diabetic lady, on whom I did
a partial amputation of the forefoot for gangrene, 3 years earlier now
in severe cardiac failure, with pain in all of her body, especially
her legs.. Over several days with 4 hourly visits, night and day, we
controlled her pain and made her passing as comfortable as possible.
Mr Benghong completed the new clinic and bedroom for doctor with
splendid views across the harbour,- which takes the clinic patients
outside of his house.
Constant rat visits to my bedroom and rat poisoning is rewarded by
the smell of a dead rat in my room, which is full of boxes of medicine
and medical equipment. It took me 2 days, in between my clinic
responsibilities to find where the dead rat was ! I threw the remains into the sea, Mr Benghong said please next
time could I throw the remains into the crab and crayfish storage
tanks.
Given our interpreter received a new bicycle donated by Tessa and Troppodoc to
enable him to get to school each day at 6.30-100 pm. Given is also
told he has to repeat school entrance exams, despite being told last
year that he had passed them. This will mean he has to take a year off
school to sit these exams again in Teluk dalam and thus re enter
secondary school again to complete his final 2 years.
Late at night Tessa and I are called to see 18 month old twins who
are suffering from diarrhoea and vomitting. They are wrapped up
tightly in clothes and blankets to avoid ' the wind' despite there
high fever. With treatment and lots of family health education
regarding treatment of fever and diarrhoea, keeping children at normal
temperature and fluid replacement, over the next 2 days both toddlers
were guided to physical safety in a situation that would have clearly
taken one or both of their lives.
…the helicopter is still detained at Padang Military airport !
Aaaarrgh !!! Derek
Feb 4-22; a one day crossover with departing volunteers Margaret
T., Margaret R., and Cheryl as incoming volunteers Helen, Tony, Abbey
and Dr. Ben arrive.
Helen and Abbey are nurses at Wellington hospital, Tony is a master
brewer from Auckland (veteran volunteer) and Dr. Ben Knippenberg is from
Belgium, one year out from his graduation.
As they arrive , Jan and I attempt to take Melioni, still onle eating
soft foods and milk, to Malaysia while we both get visa renewals for
Indonesia. Unfortunately Melioni is refused departure from Medan
unless I bring one of her parents to Medan to sign a consent form in
front of Immigration officials.... expensive and time consuming.
So we return (Jan with visa extension from Penang),-Jan flew there
and back in one day. We fly back to Gunang Sitoli, ambulance to Teluk Dalam
and join others for 6 hour ferry crossing to Pulau Tello.
Dr Ben, who had agreed to work at catholic Mission hospital in Teluk
Dalam, found he was surplus to requirements on arrival as a German
gynaecologist and his wife had appeared to help out ! I am very glad
that he agrees to volunteer at Pulau tello.
Dr Ben, Abbey and Helen launch themselves into clearing away some
of the lumps and bumps surgery that was building up. They repaired
hand and chest injuries sustained by a badly injured fisherman while
he was in the water. they excised a facial cancer, removed a cancerous
growth on the sole of the foot, and amputated a dead Great toe.
These operations were carried out at the Catholic
Mission hospital in Pulau tello with the kind permission of sisters
Antonio and Ingeborg.
Tony launched himself into maintenance of the 7 school rainwater
collection systems, that Troppodoc has started, faulty taps and displaced
gutters and downpipes, - Tony also fills in spectacle dispensing, medicine dispensing to name
just a few of his hats.
Notable patients are; 21 yr lady who had difficulty in child birth
of her first child in the village; the baby was forcibly pushed out by
the traditional birth attendant, ( usually a village grandmother ) 2
weeks before I was called by the Catholic Sisters to see her. She had
a high fever, low blood pressure and a volleyball sized tender mass
eccentrically in abdomen,- probably a partially ruptured uterus with
an infected haematoma needing i.v. rehydration and antibiotics.
Dr Ben meets a 19 year boy, coughing for a year, 35 kg in weight !!,
thin as a rake, who was started on TB treatment ASAP and who only just
survived the first few days of treatment..
Dr Ben does several dental extractions of rotten teeth, much to the
patients delight.
We visit the widow of a former paraplegic patient who died in his
40's leaving her with 2 children aged 3yrs and 1 yr. She is barely
managing to keep her children fed as she lives in a house on borrowed
land, with no land of her own to cultivate and has married into this
island village so has no direct family here. We try to think of ways
to support her and family nutritionally in the short and long term.
Derek
Jan 23-Feb 4; Margaret (Gisborne),Margaret (Tauranga), Jan
(Tauranga),and Cheryl (Singapore) come to help as volunteers in
Tello. Margaret T. ( veteran volunteer) Jan and Cheryl (previous
Troppodoc volunteers) and Margaret R. first time volunteer.
Accomodation for Margaret R. and Cheryl in nearby guesthouse 100
metres from Benghong house where Margaret T., Jan and I are staying.
We continue morning clinics in the Benghong home, with the owners
warm approval, every morning starting at 7.30-8.oo and running for 2
hours approx., before doing house calls around Pulau Tello on motor
scooter and walking, attending those who have mobility problems either
from their sickness or from limited money..
In the afternoon we go to one of the more distant villages on Pulau
Tello, and in the evening at 7 pm, start another clinic at my place of
residence.
Apart from many patients with joint problems, stomach problems and
cardiac and lung problems,- some patients stand out…
35 year old fisherman with the bone of his great toe exposed and
black after a rope accident around his toe, while out fishing some
months before. It is looking to become imminently gangrenous.
24 year man with active infection, likely to be leprosy of his great
toe for some months. Two other toes are already truncated. I have
informed the government health service 1 year ago of the person and
his problem and have been waiting patiently for the government to
supply dapsone and rifampicin, medicines I don't have which he
requires for 9 months to cure his leprosy.
51 year old man with spreading blackness in skin on sole of foot
with a black growth protruding from the surface that is uncomfortable
to walk on, probable malignant melanoma but for comfort sake growth
will need excising.
We travel out to see a 45 yr lady with a diabetic ulcer in sole of
forefoot, quite deep and needs ongoing dressings for protection from
infection.
48 yr lady with severe ulceration of her cornea of one eye for some
weeks,- probable Herpes but needs antibiotic control of bacterial
super infection and appropriate analgesia for the severe pain..
Unfortunately the cornea appears to become cloudy as it heals despite
ocular steroids.
(A big thank you to the organizers and for all the support from the Fundraiser at Whale Beach
Sydney, that raised good funding for Troppodoc work.
Thanks especially to Ian, Michael, Trina, Julie and many other
supporters. Derek +)
We are currently setting up a "Volunteers Page" where volunteers can comment on their experience and time working with Dr. Derek Allen and TroppoDoc. It is hoped it will provide comradeship and encourage others interested in helping those less fortunate than themselves. If any previous volunteers would like to share their comments, handy tips, etc, could they please forward them to Bronwyn: boele@xtra.co.nz . Thank you very much.
January 10: Clinic at Benghok house in the morning before visiting patients in nearby villages. People with blood pressures of 210/94, 190/100, malaria, tonsillitis, hypovolaemia, anaemia (presumed pernicious with no source of blood loss, no splenomegaly in woman of 45 years with normal PV loss) A village visit in afternoon before 7 pm start to evening walk in clinic at house. There are 24 village compounds on Pulau Tello with an estimated population of 5-6,000 people.
January 11; Patients seen today include, 45 year old woman with iridocyclitis, 60 yr old man with pneumonia, asthma and abdominal colic, 19 yr old man with schizophrenia, 60 yr old man with pneumonia and probable Tuberculosis, 55 yr old woman with severe fungal infection of the feet, 42 yr old man with a dressing of the partial amputation of his great toe by a rope in his small fishing boat, 11 yr old boy with ear pain from bad dental caries, 55 yr old woman with poorly controlled Diabetes Mellitus, 9 yr boy with malaria, 40 yr old man with a discharging ear, In all 42 patients seen today plus travel to west Tello. Margaret Thorpe is my reliable and knowledgeable nurse assistant since her arrival back here from NZ last December 1.
January 12: I was woken by loud knocking on the front door by a man in his mid 30's. I had seen him the previous week for left sided loin pain, probable kidney stone, and here he was back at 5 am with what turned out to be a 1.5cm x 1.5cm x1cm stone that he was unable to pass from the tip of his penis. He had been excruciatingly sore for some hours before coming fo see me. After a little anaesthetic and gentle manipulation, I was able to get the stone out which he proudly took home. Kidney/ bladder stones are a commom outcome of not drinking enough water here. I went back to bed but by then it was 7 am, the start of the morning walk in clinic and the usual round of clinic, house calls, village clinic and a 7 pm evening clinic.
January 13th: After morning clinic, I went to wharf to catch 10 am boat to Teluk Dalam, which eventually leaves at 12 midday. Six hours later in Teluk Dalam I visit Stella Maris hospital to pick up stored ambulance and drive to Gunung Sitoli wharf early the next morning.
January 14th: With Margaret Thorpe to pick up Jan and Margaret-two volunteers arriving from Tauranga. These two had met in Medan and because internal flights were disrupted for a week, they had taken a minibus/kijang from Medan to Sibolga {9 hours) and then the overnight ferry from Sibolga to Nias in a cabin cooled by a fan!.I went to see relatives of a woman who had been blind for the past 12 years (? temporal arteritis ) and also visited a man who had suffered fron rectal bleeding for some months.This took time that meant we did not have enough time to drive back to Teluk Dalam to catch the ferry for the six hour trip back to Tello. We drove back to Teluk Dalam, a crowded ambulance,and I went to visit Melionis birth parent's village to find Melioni's 4 month old sisterAyuin with severe respiratory distress from a chest infection and malaria. Her mother had taken her to Stella Maris hospital that afternoon and they had advised hospital admission, but mother couldn't afford the hospital cost so had taken her 4 month old daughter home to die !!!! Ayu had been sick for two weeks and the cost of oxygen support overnight alone would have cost 500,000 rupiah (NZD82)!!!
January 15th: At midnight Ayu dies in Stella Maris hospital, where early intervention would have saved her ! Her parents are too poor to visit either of the two medical facilities only 3 km distance ( walking distance) from their house. I visit Bupati to seek help from official for impounded helicopter release from Padang and am puts onto Air Communication representative and top Nias Selatan lawyer for assistance with meetings. Meetings!!!!!!!!!!!! I'd rather be a Dr.
January 16th: Early morning (4am) start to drive to Gunung Sitoli to check in at 7am for 8am flight to Medan to connect with flight to Batam and ferry to Singapore to renew monthly tourist visa. A 2 month tourist visa is possible in Singapore but I would need to stay for a couple of days and I am acutely aware of volunteers Jan and Margaret who I had left early that morning on Teluk Dalam wharf to catch the boat to Tello Island. They are both very keen to work/help the poor people of Tello. I stay a night in Singapore, having safely exited Melioi from Indonesia for the second time and the first time without a parent attached ,..
17/1; return by early morning ferry to Batam(Sing $34 for return) and taxi to airport (70,000 rup) and catch next plane to Medan, unfortunately didn't get there before last plane leaves for Nias !! Pardede intl Hotel, near airport and about 300,000 rup/night (US$30 )
18/1; Fly to Gunung Sitoli (650,000 rup)and drive direct from airport in ambulance to Teluk Dalam wharf about 2 1/2 hours depending on various market days along the way and weather and the condition of the deteriorating road.. Arrived at wharf to find 10 am ferry to Tello Island not yet departed, so a quick ambulance unload, a qyuick drive to Rumah Sakit Stella Maris where the Sisters kindly let me store the ambulance in T.Dalamand walk hurriedly back across town to wharf to catch the 6 hour small boat ride in open sea (safe and reliable) to Pulau Tello. departure eventually 12 midday and arriving Tello about 6 pm
19/1 The team has now swelled to margaret T from Gisborne and margaret R from Tauranga, Jan B from tauranga, Cheryl T from Singaporeand myself. margaret R and Cheryl decide to stay at nearby guesthouse (wisma) (85,000 rup/night with own room and en suite ) Margaret T, Jan, myself and Melioni stay at Mr Benghok house. We visit patients in towna 45 yr man with bilateral corneal scarring making him blind, 45 yr old woman with severe atopic dermatitis and iridocyclitis, 22 yr man with severe tuberculosis, 50 yr woman with deep plantar ulcer in her foot, 65 yr woman with poorly controlled Diabetes through poor compliance and heart failure.
20/1; the usual day begins with a 6 am tello beach clean up by myself and melioi watching, Jan joins me.Clinics at the house begin at 6 am, then travel around the outpatients with poor mobility around tello town from 10 am to 12 midday and beyond, a village clinic visit on West Tello and back for evening house clinics starting at 7 pm.Cheryl is on the case of taking her pictures- photojournalism-,Margaret Reid interacts very usefully with the many children who join into the periphery of the village clinics. Jan Beamish and margaret Thorpe, nursing fantasticas well as minding Melioni as the clinic progresses.
22/1; While visiting Rumah Sakit Susteran, i was asked to see a 21 yr woman who had experienced msjor difficulty delivering her first child st term.The baby was forcibly pushed out of the abdomen and pelvis by a Traditional birth attendant, this ended the babiy's lifeand now, 2 weeks later the woman hada hot tender swollen abdomen and was in septic shock. On examination she appeared to have a football size abdominal haematoma, possibly from a ruptured uteruswhich was now infected.Treatmnt was started for her, but her battle would be certainly uphill.She was from one of the outer islands and was one of the lucky few to have made it to Pulau tello and Rumah sakit Susteran !!!
; another man asked to see on top of our usual workload with a diabetic ulcer that was extending from his knee to his ankle and about to extend across the doesal surface of his foot. i admited the 45 yr woman with iridocyclitis for iv antibiotics to exclude retro orbital abscess, for 48 hour treatment.
23/1; took boat from Pulau tello to Teluk dalamto see Director of Aviation for sub province of south Nias to further the helicopter use in Nias selatan after getting freedom for it in Padang. hat night went to visit melioni's parents and village for a clinic and found 30 people gathered in the family rudimentary house waiting for her mother to die. She had suffered for 4 days from severe abdominal pain and was drinking only 1-2 cups of water a day. On examination she was suffering from severe abdominal colic and was at high risk of suffering from acute appendicitis, cerebrovascular accident or myocardial infarct. After some hours of sitting with her and encouraging to drink regular small sips of Oral Rehydration solution, the pain slowly abated and I was able to return to the small beautiful Sorake Losmen I was booked into. the local language for this complaint is 'Mag' which is a very common cause of what they consider as inevitable death from 'wind' in the abdomen.such an avoidable cause of death.!!!
22/11/08
Meeting with Ngaire Todd, volunteers, plus friends, talking TroppoDoc, enticing support maybe - future volunteers.
More gorse control while Pam cares patiently for Melioni.
23/11/08
Return to Dunedin North - East Valley Baptist Church, sharing in their service and the support that helped and strengthened me through hard years at University and beyond, - reaffirming my essential values that we as individuals and communities are expressions of God's love for the poor and needy in a world burdened with disease and hunger vis-a-vis The Good Samaritan (let's go out of our way to help those in needy circumstances).
In the afternoon, drive to Gore to visit Bronwyn (multiple volunteer) and Gary McBain, family and friends. Discuss future horizons for TroppoDoc and enjoy their warm family support.
24/11/08
Return to Hampden for a day in the trees.
25/11/08
Drive to Christchurch, fly to Rotorua, meet Jan Beamish (previous volunteer), drive to Auckland, visit sister-in-law Gwen, family Rebecca, Joshua and stay with Dr. Mark Izzard (volunteer) and Wendy and family.
Meeting with Tony Denney (volunteer) and CEO of TroppoDoc.
26/11/08
Margaret Thorpe (friend, multiple volunteer and Director of TroppoDoc), Melioni and I fly to Singapore via Sydney.
Thanks to Qantas for their generosity (through Margaret and Tony's request) toward the carriage of excess luggage of donated medicines for free clinics to poor people in remote areas.
At Sydney Airport, while Margaret minded Melioni in transit, I was able to meet Ian Cope (Australian TroppoDoc representative), Isabel and Trina Minter, to discuss the plans for a TroppoDoc fundraiser on December 14th at Whale Beach Restaurant, Sydney - to help in projects such as Ermawati with her life threatening fistula (vesico-vaginal) and helicopter freedom for remote villages and severely injured surfers alike.
27/11/08
In Singapore Margaret and I meet with Cheryl-Ann Tan (volunteer) with more donations - books, writing pads, clothes and more for Victor and other poor children and families in Nias and Nias Selatan.
Margaret and I meet with Crisis Relief Singapore, Chris and Joy Seng regarding our joining a group to assist in the cyclone damaged areas of Myanmar for almost a week.
28/11/08 - 4/12/08
Melioni, Margaret and I catch the ferry from Singapore to Batam, fly to Padang and meet with supporter Rick Cameron and guests Julie Jensen and Michael Fay.
A big thank you to Rick for his warm hospitality.
Julie and Michael have a guest speaker spot at the Whale Beach fundraiser.
I visited and started the helicopter at the Airforce Compound, watched patiently by Margaret and Melioni.
Delivered 100kg of donated medicines to the freight boat to Pulau tello - now the laws have become stricter regarding carriage of passengers, so no passenger connection to Tello is possible. (Apparently too many recent sinkings!!!)
4/12/08
Unfortunately SMA Airlines also temporarily grounded.
5/12/08
Margaret, Melioni and I fly to Medan.
Brief meeting with Sr. Stefani (Deltua Convent).
We have a 5hr wait in airport before plane is cancelled due to poor weather/rain.
Meet supporters Mick and Lian Stevens, Michael Fay and Julie Jansen.
A complimentary night at Pardede International Hotel on Merpati Airlines.
Melioni is happy and feeding well. She weighed 5.8kgs on airport scales.
6/12/08
Margaret, Melioni and I fly to Gunung Sitoli, pick up the ambulance at Laverna Convent and drive to Teluk Dalam.
We visit Stella Maris Hospital - Melioni's home for 8mths. All the staff are surprised and happy to see Melioni's weight gain.
We stay at Sorake Beach Losmen.
7/12/08
Stormy conditions, the boat is unable to make 6hr crossing to Pulau Tello, so we wait for the morrow.
8/12/08
For some reason unknown, the boat leaves for Pulau Tello half an hour early at 9.30am - we were lucky to have checked first thing, and parked ambulance at Stella Maris Hospital.
Melioni handled the 6hr boat trip well, although some large swells, and we were met by Given at Tello.
Back to Mother Theresa Benghok's house, where Margaret, Melioni and I are staying. Her leg is looking very good, with still some healing required on 2 open sores.
House calls start immediately to people recently unable to walk - probably Dengue Fever, another with a moderate stroke (Cerebral Vascular Accident), and Margaret also caring for Melioni in a house with numerous rats.
9/12/08
Margaret and I buy tickets back to Padang for our Myanmar Crisis Relief Singapore trip, and continue house calls to another person unable to walk and fever and vomiting - probably Dengue Fever, another 20yr old with Schizophrenia and fungal infections, breathing difficulty secondary to anaemia.
We visit the Catholic Sisters at the Catholic Mission and Dr. Samuel in Puskesmas.
Melioni is very shy toward Mother Theresa and daughter Meyliana.
Given's mother is happy to look after Melioni for a week while Margaret and I help in Myanmar cyclone damaged areas.
10/12/08
We were very sad to say "see you soon" to Melioni, in Given's mother's arms early morning.
Deliver medicine to Bernard (Schizophrenia).
Margaret and I catch boat to airport and plane to Padang.
Refill helicopter with fuel and fly (hover) helicopter, which is going much better, and talking to Rick Cameron and relevant policeman, that helicopter freedom is getting slowly close.
11/12/08
Margaret and I fly Padang - Batam, Mandala Air (www.mandalaair.com) and ferry to Singapore.
Unfortunately 5hr flight delay, so we caught 9.10pm ferry to Singapore, 1hr trip and Singapore 1hr ahead. We arrive 11.10pm and to hotel by midnight for 5am pick-up for flight to Myanmar.
12/12/08
We have a 5am pick-up by Johnny from CRS and fly Singapore - Yangon (Myanmar).
Margaret and I meet the 7 other volunteers at airport from Crisis Relief Singapore, - Chris, Simon, Wendy, Mark, Christine, Sue En, Mark 2, with many bags/boxes of donations of clothes, games and water filters.
We were met at Yangon airport by guide (compulsory) escort and assisted through customs.
Margaret and I had brought some medicines from Pulau Tello.
The volunteers from Singapore all attended the same church, although for most of them this was their first mission trip.
We were able to buy needed medicines from a pharmacy at the local market in Yangon.
13/12/08
4am meeting/devotion with team and 6am start on 8hr bus trip to Bogaly in the Irrawaddy Delta. A ride in bus on slow rough road to settle into guest house (intermittent electricity) and by boat to village across large river - 121 people seen and treated before 9pm and back to guest house.
14/12/08
4.30am devotion and 6am start on boat for 5hr trip to remote village, working in partnership with local NGO (non governmental organisation) AR YONE OO.
Propellor was knocked from the drive shaft by an underwater fallen tree in a small channel – amazingly it was refound after 1hr of assistants walking chest deep in muddy water, and then re-attached.
Margaret and I are the only medically qualified members of the team which included Event Manager, teachers, engineer, banker, journalist and accountant.
Time now short, so chose a closer and more accessible village. We saw and treated about 60 people, and boat back to Bogaly - arrive 10pm for dinner.
15/12/08
5am devotion, breakfast and 7am boat start to village missed yesterday.
Mortality in these villages is high. Cyclone/tsunami struck with 2-3mtrs of water between 10pm and 8am - so many children dead, enormous sadness and emotional trauma.
155 people seen and treated, clinic finished 7.30pm and return to guest house and dinner by 1am!!!
Other team members supporting Margaret and I by orderly crowd control, symptom documenting, blood pressure checks, and measuring 0-5yr olds height and weight, as well a children recovery play clinics, testing water sources and giving 2500Ltr water filters for water cleansing.
16/12/08
6am devotion, 8am boat to village 1hr away - 200 families. There is much tragedy from the cyclone.
Margaret and I picked up an 11yr old boy with cataract, 40yr old lady with cystic goitre the size of 1/2 bread loaf, 17yr old boy with scrotal cystocoele, 40yr old man with terrible 2mth infection of his penis, that had de-nuded 30% of the skin.
In total working at different consultation desks, Margaret and I saw 197 people.
Boat back to Bogaly, arrive 7pm, dinner and bus back to Yangon - and arrive at hotel at 3am.
17/12/08
An hour spent in Yangon markets, and fly Yangon - Singapore, arriving at 9pm Singapore time.
Simon and Wendy offering us to stay overnight at their home. Margaret and I completely tired after lots of good hard work in villages affected tragically by cyclone/tsunami.
Government death toll 73,000, but locals put figure at around 500,000 dead from cyclone/tsunami - many of these children.
18/12/08
Margaret and I check in 7am at Changi Airport for 8.50am flight Singapore - Padang and back to a working telephone system.
Looking forward to finding out how fundraiser in Sydney Whale Beach Restaurant went under mangement by Ian, Trina and Isobel, Michael and Julie - and many others, I am sure.
I am looking forward to seeing Melioni in Tello tomorrow and I am sure Margaret is too.
19/12/08
Margaret and I fly Padang to Tello, carrying out a clinic on way to wharf and Tello Island. We saw 19 people with problems ranging from malaria, osteoarthritis, to respiratory infections.
Boat to Pulau Tello at 1 pm and back to check in at the Benghok house, retrieve Melioni from Given's house, where she had been well looked after by Given's mum and visit to the Catholic Mission Clinic to say I was back in town and ever ready to help if needed.
Melioni took a couple of hours to warmly recognize us and forgive me for going away.
20/12/08
Many patients seen after being introduced by our host Mr. Benghok.
A 50 year old lady who we had seen a week previously with probable Dengue Fever and forced bed rest, now had septicaemia and severe urinary tract infection. Margaret catheterized her and she had 2 litres of frank pus in her bladder. She was going to be a difficult but survivable case, but before I could initiate chemical treatment, she said she wanted no injections and would take oral medicine only.
Some people here believe that injections allow the devil into their body and if you thus diethen you will be going to Hell. Unfortunately her infection was so severe, oral treatment was begun but she died later that night, never changing her point of view. This belief is supported by some of the Dukans, (traditional healers) as they have no access to effective intravenous or intramuscular therapy.
While we were away in Myanmar, a 30 year old and a 40 year old woman had died as a result of cerebrovascular accident or stroke.
Mr Benghok took us to see several people from his church at their homes who were quite sick, bilateral corneal scarring, Heart Failure and fungal infections.
21/12/08
Morning clinic at Mr Benghok’s house as patients arrive to be treated before and after breakfast.
Margaret and I, along with Melioni, do house calls to various individuals unable to travel easily.
Meet Member of Parliament who promised he would try to help facilitate the return of the helicopter to active service for the people of Nias Selatan, especially Pulau Pulau Batu.
We revisit Captain Solly who requested my medicine especially; he suffers from hypertension, Ischaemic Heart disease and Heart Failure and the Troppodoc team revived him three times after he had been given the Last Rites in preparation for his presumed imminent death.
22/12/08
Taking pictures of Ermawati's fistula to show by e mail to surgeons in Sydney who are interested in repairing her perineal region and function back to normal. Unfortunately it appears that her bladder is severely damaged in size, I was only able to measure a 51 mm cavity and this will make the repair work a real challenge.
Unfortunately the Rumah Sakit Pulau Tello is no longer offering discounts for X-rays to poor members of the community, and they will have to pay the same as the wealthier sector - 40,000 rupiah per X-ray. I hope this does not limit my Tb survey and treatment programme which has already netted and started more than 100 people on life-saving Tb treatment.
23/12/08
Sinuti an old friend/patient, whose half foot I amputated 2 years ago due to gangrene from her Diabetes, was seen as a house call. She is 65 years and poor and when I am not in Tello she is unable to get more than a few days treatment for her diabetes from the other medical services - at a cost she cannot afford. Her blood sugar measurement is high, she has an old infection in her hand and is now increasingly immobile due to pains in her legs.
Maria, another diabetic has good control of her blood sugar levels but has had a chronic ulcer in the sole of her foot for 4 years. Margaret starts a long regime of dressing it, hoping for some slow resolution. She is out of her Smartscan Lifescan measuring sticks for blood glucose estimations and pleads with me to buy some in Padang over Christmas and gives me 250,000 rupiah for a tube of 25 sticks.
24/12/08
Margaret, Melioni and I fly to Padang and meet three daughters of our Tello hosts Mr and Mrs Benghok with various conditions that are amenable to treatment. I will arrange to send treatment back from Tello. Of course I also needed to see a handful of their friends, but by late afternoon we were free to make our way to Rick and Jane's house to celebrate Christmas with other antipodeans.
25/12/08
Happy Christmas with friends Rick and Jane, Margaret and Melioni.
Unfortunately Melioni still has a viral upper respiratory infection, which makes me fear for the infection going to her chest again. She is still on her Tuberculosis treatment. She is now standing with support, crawling, calls Margaret mama and still calls me mama, mischievously, I think! She is reluctant to go to strangers, shakes her head for “NO”, claps her hands and shrugs her shoulders. Just delightful!
26/12/08
Christmas continues at Rick and Jane's house, but tropical downpours and storms for Christmas.
While Margaret cares for Melioni, I get to Bandara Tabing to start helicopter and run/ hover for an hour. It is running quite well apart from a small clutch problem which has recurred, but the source of the problem is becoming a little clearer. I am unable to find Base Commander to talk to - he had requested this, so conversation postponed
27/12/08 – 28/12/08
Travel in the Emergency service ship that Rick has bought and is preparing for the imminent disaster predicted for Mentawai Islands and Padang by earthquake specialists. This is my first time on this 100 foot ship, Margaret and Melioni accompany me and I can see the usefulness around both Mentawai Islands, Pulau Pulau Batu and also the areas of poor transport and little medical services. We travel to an island out from Padang which I envisage as a great helicopter base for servicing the Mentawai Islands if my direction turns that way. Sixty thousand people and no doctor in communities not joined by roads. Not unlike the Tello chain. A Gibbon sanctuary, Hornbills seen in flight, fish eagles trying for food, natural spa formations in sea shaped rocks – beautiful! And then back to Padang on a very stormy afternoon.
29/12/08
Melioni, Margaret and I fly Padang to Tello. We were up at 5am to get to airport by 7am for 8am flight, and then a 4hr wait at Pulau Tello end for the ferry that takes arrived passengers to Pulau Tello township.
There are many people to be seen, including a 40 year old probable cancer uterus patient, with a busy night to follow helping at the Catholic Mission.
Nearby, a road accident where a young man knocked unconscious for several hours, a catatonic Schizophrenic young man and a middle aged man with severely high blood pressure and facial angio-oedema keep Margaret and I busy.
30/12/08
We are back to our routine of house calls and clinics from our boarding house.
Today is not unusual in quality of patients Margaret and I seeing - 50yr man bleeding per rectum after constipation, 71yr woman with support for son above, her own problem insomnia, 59yr woman diabetes post partial foot amputation, 55yr woman diabetes and foot ulceration, 20yr man schizophrenia, 13yr boy osteomyelitis femur, 38yr woman constipation/ abdominal pain, 32yr man car trauma review, 41yrman with minor surgery for removal sebaceous cyst ear, 63yr woman assessment of R. sided cataract, 40yr woman with obesity and hypertension, 80yr woman with fungal infections on feet, 69yr woman diabetes, infection and heart failure, 74yr man recovery and rehab post CVA, 60yr woman with viral URTI, 39yr man low sperm count, 61yr woman with osteo arthritis knees and ringing in her ears, 60yr woman with hypertension 190/100 and previous stroke, CVA, 30yr woman with intermittent LUQ pain, 39yr woman with osteo arthritis knees and vision problems.
31/12/08
Even on the last day of 2008 we are in the full swing of it - Melioni, Margaret and myself, living at the Benghok house means up at 5am to clean the enormous rubbish off the local beach, then back to the house for breakfast of white rice and vegetables, and the patients start to roll in to the house door.
It is good I am living in the poorer half of Pulau Tello now, as medical help is far more accessible to the people who live here.
A small operation at the Catholic Mission Hospital (Rumah Sakit Catholic) removing a large sebaceous cyst from infront of ear in 23yr old woman, two schizophrenic patients, right lower lobe pneumonia, 70yr old man with dense stroke, (cerebrovascular accident) and a 23yr old man with clinical severe Tb that needs urgent concrete diagnosis if I am to get him onto the government Tb treatment programme. He really needs urgent X-ray at Rumah Sakit Pulau Tello, just up the road, on holiday, I am told just now... !!!
1/1/09
New years Day, the routine continues, after the breakfast clinic winds down there are the house calls for Margaret and I to do - to Capt Solly, (CHF, IHD, HT), Sinuti, ( DM, Infections and CHF), Emmanuel, 23yr old severe TB man, Bernard, 20yr old schizophrenic man.
No village clinic today as a public holiday. But an evening clinic, with only a couple of patients seen and a requested house call to 58 yr old man with severe headache and hypertension.
Margaret and I enjoy joining in on a time tradition on New Years Day night. Everyone meets down near the wharf on their motorbikes and go on a procession/motorcade round the island. This was a lot of fun and frivolity.
2/1/09
House calls as usual. Sinuti not doing well - losing her mobility and I'm thinking leg pain maybe caused by Ross River fever compounding her CHF DM and hypotension.
Sleeping tablets needed by Bernard to keep his schizophrenia under control and avoid the stress of insomnia, dental caries, schizophrenia, infected trauma to hand.
In the village clinic today - possible Tuberculosis, cataracts, malnutrition, malaria, two more probable tuberculosis patients, malaria again, more dental caries, prostatism, pterygium osteoarthritis of knees in one and hips on another are some of the diagnoses today we dealt with.
3/1/09
Another morning at home clinic with Margaret and I seeing schizophrenia, diabetes, temporal arteritis blindness, cardiac ischaemia pain in a 44 year old woman and a forehead cystic swelling booked in for excision.
In the village clinic, bilateral corneal scarring severe, depression, myopia, hypertension, 200/130, constipation, ?malaria, bilateral pterygium, dental caries, depression, and in the evening clinic at Benghok house, hypertension, facial abrasions in a 2 year old, postural hypotension and osteoarthritis knees, epigastric pain and a well check by an inquisitive 22 year old.
4/1/09
Mr Benghok asks me to see a woman in village on other side of island, 40 yrs old with severe postural hypotension and breathlessness for 2 months. On examination, no obvious site of blood loss, no obvious malaria presence but severe anaemia, narrowing diagnosisdown to things I can treat, I decide to treat for pernicious anaemia. She is definitely in danger of losing her life through breathlessness and tachycardia, but then she refuses Vit B12 injections which I have 3 of. Darn! I txt back to New Zealand, asking can I instill parenteral solution into the eye or nasal cavity to be quickly absorbed. Not sure is the reply, but try oral and hope for a speedy recovery. I have some donated Vit B12 tablets of unknown strength and efficacy, so we start this the next day and I will watch for the outcome! We hope it is successful.
16yr old man with dengue and possible cerebral malaria, painful necks and backs, COPD and ischaemic chest pain, malaena following constipation, viral respiratory tract infections are some of the diagnoses/ problemsMargaret and I saw today.
5/1/09
Medical assistance and life continues on with house clinic, house calls, and village clinics of course.
Today Margaret and I saw a range of depression, carpal tunnel inflammation, laryngitis, bilateral severe cataracts in 45 year old woman which essentially makes her blind, malaria, gastro-oesophageal reflux, hypotension, osteoarthritis, acne, post prandial baby spilling, dental caries, visit to lady with pernicious anaemia, deliverin the meds, asthyma, atopic eczema, bilateral conjunctivitis.
I will start a register of severe operative eye problems such as cataracts and pterygium and then see if I can attract a humanitarian ophthalmologist to these parts and use the Catholic Mission operating theatre. I must get some photos of this excellent resource on this page somewhere.
We were on the west side of the island facing the setting sun, as the sun goes down on a tropical ocean and the temperature is a little cooler after 6 pm, magnificent!
6/1/09
Margaret and I did home visits to Bernard (schizophrenia), Emmanuel with severe Pulmonary Tuberculosis, Maria, diabetic lady with plantar ulcer, 76 yr old Haleto with hemiplegia after stroke, from a far away island but staying in Pulau Tello at a distant relatives house. Steadily showing slight improvement, cataracts, dental caries, chronic appendix pain, renal stones, Hypertension and post Cerebrovascular accident.
Then came the relatives of woman who is said to be 11 months pregnant in her first pregnancy. We went to her thatched wooden house to find a normal size baby in utero to a normal size lady and husband and wife were adamant that she was pregnant for 11 months. I admitted her to Catholic Rumah Sakit for cervical sweep induction starting that afternoon. This was continued 6 hrly through the night by Margaret and me.
7/1/09
The morning after induction, the lady was in labour and after some shoulder dystocia, I delivered a microcephalic baby that was able to breathe and suckle to a distressed set of parents and family. I am aware of the reverberations in the village and guilt about why their baby is deformed and will die. So I refer them to their pastor in the Catholic Church for counselling.
The same day a 30yr old man comes to the clinic and I am asked to see re his severe abdominal pain and jaundice, on assessment he has peritonitis and hyperspenomegaly - possiblity of treatment and survival, but his father steps in and says he will take him home for traditional medicine!!! I try to talk the patient, family and father around to trying western medicine. Unfortunately their minds were set and he went home. Some days later we heard of his, unsurprising to me, death.
Patients withacne, low back pain, hypertension, facial cyst with request for removal, chronic appendicitis and hypergranuloma of a skin wound filled in the rest of the day for Margaret and I.
Meanwhile one of the villagers comes to us wanting to sell us a white monkey for 25 million rupiah - US$2500!!
8/1/09
Today regular house calls, ongoing dressings to limbs and digits, small operation for removal of sebaceous cyst in front of ear. 15 yr old boy with osteomyelitis, painful necks, low back pain, and an albino lady with otitis externa and Meniere's disease.
More daily counselling to family of still alive microcephalic child, with valuable lessons from Margaret on feeding and nurturing and baby appreciation.
In the afternoon we attempt to get photos of Ermawati's vesico-vaginal fistula as requested by the surgeons in Sydney, as I continue to improve her long term existence with total urinary incontinence from her vagina at the age of 27 years!!!
30 people seen at the village clinic - from antenatal checks to intestinal worms, apthous ulcers, chest infections, influenza, osteoarthritis, infected mosquito bites, gastro-oesophageal reflux to mention just a few.
9/1/09
5 am wake up call by someone hammering on the front door of Benghok house. I am called to a house on the far side of town where a long term smoker and fisherman is in what appears to be severe respiratory distress. On examination he had pneumonia plus asthma and on oxygen that was got from Rumah Sakit Tello, but no medical staff in attendance.
Asthma is one condition that with the right medicine, miracle like cures can happen. So making a rudimentary spacer, injectable steroids and antibiotics and soon he was out of his terminal distress, calm enough to hear my anti smoking advice. Fortunately Indonesia also has labelling on all advertisements and cigarette packets on the harm that smoking might do, so my advice is just another step.
Another cyst removed near someone's eye with Margaret assisting me, and patients seen with abdominal colic, paronychia, ear infection, dental caries, painful necks, more counselling to parents of microcephalic child.
We did house calls to 2 diabetics, 1 schizophrenic and lady with bilateral conjunctivitis admitted for IV antibiotics, as I try to rule out retro orbital abscess in her left eye.
10/1/09
Margaret and I do house calls to diabetics, lady with iridocyclitis, prob secondary to herpes infection.
Postural Hypotension, bilateral elbow pain, breathlessness with epigastric pain at house clinic and then Melioni, Margaret and I off to the village, where we saw possible tuberculosis, hyperetension, dizziness, osteoarthritis knees, viral airways disease, recurrent epistaxis in hypertensive patient, 3 cases of enlarged tonsils in children living in homes where father smokes much inside, dysuria, osteoarthritis knees, malaria, recurrent tonsillitis and all done with a gentle motorbike ride to the village and back just after dusk.
For previous updates visit Derek's Journal Page.
"Surgeon's Gift"
The TVNZ Close Up programme featuring Dr Mark Izzard’s life changing work with me in Tello, featured on Friday 4th April. (TVNZ Close Up. Friday 4 April – “Surgeon’s Gift”). For those of you who missed it, you can visit: http://tvnz.co.nz/view/page/465467/1686452
Mark is a very talented surgeon and did some amazing work in Tello, with incredible life changing results for some patients.
TroppoDoc Helicopter
Derek aboard his TroppoDoc Helicopter
At the moment the helicopter is being held by the authoritories in Padang. It is going to take approx USD$8-9,000 to expediate the helicopter release. If anyone would like to contribute towards helping get the helicopter released, could they please contact Margaret: margaret@troppodoc.com With the helicopter released and flight approval, I will be able to provide a more frequent and regular healthcare service to the people in the widespread archipelago of Pulau Pulau Batu. (Tello Islands), where boat travel between some islands is infrequent and can take more than 6hrs for a single journey.
Volunteer Information....
We are always looking for people to come and help from any walk of life with any skills, medical or non-medical. Volunteers are important and very useful in life-saving work. They are warmly welcomed for any length of time they wish to come and help in the poor areas of the world where Derek works. Usually people find that the time they spend helping the poor is always too short – Derek finds that, and he has been doing this type of work for 20yrs plus now. So if you volunteer for a day, a week, a month, a year or more, you will probably find that you will wish to stay even longer. If you are interested in helping us in any way please go to the “Volunteer Database” page and register. This is non-binding, and ensures you will receive newsletters, as well as providing numbers for help with funding, etc. If you can come and volunteer, and have a choice of dates to come, please co-ordinate with Margaret (margaret@troppodoc.com) so she can suggest the most ideal dates - especially if you would like to time your travel to/into Indonesia with another volunteer, or Derek, or go at a time when there are no other/fewer volunteers. We need to know numbers of who is going and when, so Derek can be preparing for larger or smaller groups, thereby ensuring each volunteer has a quality time.
If you would like to go and work with Dr. Derek Allen and TroppoDoc, here is some information.
TroppoDoc needs people with enthusiasm to help Dr. Derek in clinics, Public Health teaching in water harvesting projects….
The most economical way to Dr. Derek is to fly to Singapore with either Air New Zealand/ Qantas/ Emirates/ Singapore Airlines/ Brunei... shop around. From Singapore, either fly to Medan or Padang. Or, a cheaper option is to catch a ferry to Batam and then fly on less expensive domestic Indonesian flights to Medan or Padang. From there travel can be organized to Nias or Tello.
Derek is happy to come and meet people in Medan or Padang if needed. Although if possible, people finding their own way to Derek’s workplace will save Derek money and time, both of which relate to saving lives opportunities. Contact Margaret ( margaret@troppodoc.com) for contact details to book your flights to Tello from Medan or Padang. That way you can fly to Medan and straight to Tello, or fly to Padang and straight to Tello, where Derek can meet you.
Indonesia, where Dr. Derek works, is full of Malaria, Dengue Fever and Tuberculosis. Bring a Pyrethrin impregnated mosquito net and plenty of insect repellant, and of course light summer clothes, as Tello is on the equator and temperatures night and day are 25 degrees C to 35 degrees C. You will be protected from TB by your basic good nutrition and good health.
For your health bring malaria prophylaxis meds, such as Doxycycline 100mg tablets daily, to be started 2 days prior to arrival, and to take for 4wks after departure, and of course every day in between. Hepatitis A and B vaccine might be useful, as also is being up to date on Tetanus and Polio.
Travel insurance is an option and of course Dr. Derek will look after your wellness needs in the same highly professional way he looks after the poor people he works amongst.
Dr. Derek works in many ways… different hats like, so he might be on island clinics at Pulau Pulau Batu, or in the Tello town, government health clinic (Puskesmas), or at Sorake Beach health clinic, or travelling to Amandraya to help Extremely Vulnerable Individuals from a population of 32,000 who are sick. Or he might be transporting sick children to P. Siantar for donated surgery. So if you want to see and help him, there might be some travel from worksite to worksite, inexpensive, but time-consuming none-the-less.
Food is excellent in Indonesia, as long as you enjoy rice or noodles, and Dr. Derek will take you to reputable eating-houses, or at least one's that are open.
If you can bring supplies with you, all is appreciated…. medicines, of course, medical equipment, school resources, clothes for the poor children etc, etc.… These people are very needy and very grateful for any gift.
Indonesia uses the Indonesia rupiah, around 10,000 to 1 US dollar. Meals are often 6,000 rupiah, accomodation is USD$2.50 a night for a twin bed room at the guesthouse in Tello.
Tourist visa is purchased on arrival in Indonesia, at a cost of USD$25.00 for a month, and bringing recent or good condition (unmarked or without blemish) USD$100 are the currency of choice for the money changers in Medan/ Padang/ Gunung Sitoli. Costs in the country are very low…. travel, food, accommodation and drinks.
Important: this is a warm country and once here one should expect and plan to drink 4 litres of water per day, clean water is easily available at many stores.
Last Updated: 4/06/2009 9:16:00 a.m.
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