A memory stirred.

I’m pretty deaf, with combined middle and inner ear problems. I’d been taken in an ambulance to the Emergency Department of the local University Hospital. Years before I had been a consultant there for some time. After I had met the young Intern, a more senior guy came in. As you would expect he was masked and in a discernible slightly foreign accent said something, which was to me undecipherable. So with his mask down and me asking him to come nearer I understand that his name was Graeme and the accent marked him as a Scot. ‘I know you he said.’ I did not remember him at all until he said that he had worked, as an intern, in a country hospital about 130 Km away from my hometown and I had been flown in to deal with a young man whose motorbike handle had, when he hit a tree, gone into his upper abdomen and caused massive bleeding. I still didn’t remember the doctor but I did remember the incident – some stories you don’t forget!

There were no specialists at the hospital but the medical superintendent was a very experienced and highly capable GP. Early in the evening he called me and said that he had just ordered a plane to bring a team up to deal with the above described young man. ‘Could I come, urgently?’ ‘The plane will be ready to take off in half an hour’, he said. I owned a Mitsubishi Starion and (maybe illegally) had it up to 230 km per hour. Knowing how long it took to set up people and equipment for the journey by plane I told him that I would be there long before the plane was. And I was.

He was a very capable GP anaesthetist so I told him to get everything set up and knowing him to be a good diagnostician told him to be ready to start the moment I got there. The patient was shocked and being resuscitated as well as they were able, but the family were JW’s and refused a blood transfusion. The parents had, however, agreed to allow me to transfuse him with his own blood, which I knew was collecting in big volumes in his abdomen.

He had a massive stellate tear of his liver. I rescued as much of his blood as I could and by filtering it through gauze, we put it into an emptied saline bottle and transfused it back into him. But I was losing him and bluntly sent out the message to the parents that if I couldn’t give him more blood he was going to die. They agreed for a transfusion to be given, but there wasn’t a store of transfusable blood.

As I said earlier the GP Superintendent was a champion guy. He had previously, knowing that such emergencies arose from time to time, formed a blood bank of living people who all had agreed that, if called upon in an emergency, they would come ASAP to the hospital and be bled. Three of the right grouping came and donated their blood.

The bleeding was so massive that after my attempts to stop it failed, all that I could do was put a large number of packs into the traumatised area thus controlled (stopped) the bleeding. He was sewn up and kept under the anaesthetic.

About a half an hour into the surgery the plane had arrived and the medical crew were very helpful when they joined us in the operating room. After a bit more stabilising of his condition he was flown back to our local city hospital. The next day he was flown about 1,500 Km to the capital city of the state for further definitive treatment under much better conditions. What follows I have only heard secondhand and some of my assumptions may be wrong. I think that the big boys in the big city assumed that the probably rather limited ability-wise country surgeon was making a mountain out of a molehill. For them it would be a ‘cake walk’.

At any rate they took him back into the operating room, removed the stitches and the packs, but could not control the bleeding and had to end up repacking him and sewing him up again. Eventually he was transferred to the liver unit where he had about half his liver removed. He eventually recovered and went back to his local area. I hope that he and his parents were able to curb his desire to race his bike through the forest tracks!

Dominic Cartier.

Are we being led by the nose?

The picture shows a severe case of bilateral TB. There are people who affirm that it is best treated by going to a holy place and drinking holy water. I don’t agree.

We all know that languages change with time. When we first went to Ethiopia the common greeting in Amharic was ‘tenastelign’. That was a brief, shortened way of saying “Igzehabier tena ystelign’ which translated means ‘May God give you health on my behalf.’ If you wanted to say, ‘How are you?’, you had to choose one of three ways. You used one for females, one for males and another for important people. After some years away I went back after the Communist takeover had been overthrown. I went to a university teaching post. After a short time I found the students addressing me in what used to be the common feminine greeting but had now become the friendly greeting between people with whom you felt comfortable. They were really honouring me as someone they trusted. I had not lost respect. Older people still stood up when I walked into a room and said ‘nuur’ or something like ‘May you live forever!’

The language had changed.

In English when the Bible was first translated into English the word ‘conversation’ referred to the way one lived. Today it means a talk together. A change occurring over time with usage. ‘Gay’ used to mean ‘jolly’ or ‘happy’ the meaning has been changed to mean what used to be thought of as a sexual perversion. ‘Marriage’ used to mean a state between a man and a woman wherein there was a commitment to sexual and emotional faithfulness, in a lifelong commitment. It was a basic functional unit of society. Today it seems to be either, for some, what it has always been, but for others an excuse for a party and a declaration that they are proud to be different and want to declare their situation as normal.

The first example (about conversation) which I gave, seems to me to be like dropping the ‘ye’ and ‘thee’ of older English for just ‘you’. The next two seem to be purposeful alterations to fool the masses into seeing things differently and with the purpose of making, what was previously seen as immoral, acceptable.

The above is a prelude to the use of the word ‘vaccine’.….

The meaning of ‘vaccine’ has been purposefully redefined by the government to include altered rna (ribonucleic acid) material being injected into people to alter the body’s ability to immunologically respond to some outside attack. Previously a vaccine was always produced specifically to attack a specific infecting agent by using an attenuated bacterium or part of the troublesome ‘germ’. I am not an expert and have no desire to be such, I am retired. But what concerns me is that the ‘vaccines’ being used against COVID 19, under the new definition, have not been, by usually accepted medical and legal standards, adequately tested. They are causing at least occasional, and some claim more frequent, deaths and serious complications. I have several personal contacts who have become seriously ill. And without a doubt there are a number of cases of significant heart problems (myocarditis and/or pericarditis) in young people.

Many experts, even though a minority, in the field have warned of late serious effects, maybe even in future generations. There is a sizeable body of reported deaths and significant immediate complications, enough I believe to stop the use of a new medication. Honest discussion is, I feel strongly, being suppressed by authorities and the mainline media. The statistics which we are fed seem slanted to a desired result. Can you remember – lies, damn lies and statistics?

I am not an anti-vaccine person by the old definition but am dubious about substances produced under this new definition until they have been adequately and thoroughly tested.

Do you ever feel sorry for yourself?

To answer the question above, sometimes I do. My knees are giving me ‘hell’ today. I had my knee surgery a good few years ago and they were good for a while.

This was the first day the dressings were taken down. They healed well and I was able to be on a plane back to Ethiopia within a couple of months to help with the first group of year 4 medical students as they came into our hospital there.

They were good for a couple of years then something went wrong and although I am constantly reassured that it has nothing to do with the prostheses going bad, now every step hurts. So today I was feeling a bit sorry for myself. and decided to look at a few photos of those who really did have something to complain about.

I have chosen a handful from more than a hundred leg shots, and cut out the really nasty ones but you choose if you want to read on.

Continue reading →

Children….

I’m writing this because I read yesterday of the 150 children kidnapped from a school in Nigeria. This is one of many such attacks with about 1,000 children in all being taken since December last year. Some, a minority, have been released. That is mind-boggling and I’m surprised that that it doesn’t provoke international ire and offered help to the Nigerian Government for help. Such help may of course have been offered and rejected. Some of the pictures I have seen from before indicate that some taken were Muslims. The latest school attacked was the Bethel Baptist School.

In Australia as doctors we have to be very careful. It is difficult for medical students to get into watch a child being examined without parental or guardian permission. As a doctor I am not allowed into an operating room without special registration with each individual hospital, even with adults being operated on. This is a long way away from the old system where operating rooms had mezzanine floors built so that many students and other doctors could watch and learn.

It reminded me of a medical student from Australia visiting us in Ethiopia for an elective term, who told me that I dare not treat children with the affection that I did there, if I was in Australia.

This boy had been run over by a cotton picking machine and had massive injuries from his pelvis down. It took my hat on his head to get a smile out of him. It was a weak smile but took weeks to achieve!

Months later when we got him standing with help, I got a real smile! He had about 20 operations.

Sometimes it took my glasses to get any attention

You can see that this poor kid has lost an arm. We had at least one case a week of cases like this. This occurred rarely because of an accident but ususlly because with a fracture (I guess we could call that an accident!) but that had been badly managed by a local healer who bound the limb, leg or arm so tightly that it caused gangrene.

This young guy had been kept at home until his leg dropped off. You can see how flexed his hip is. He was so weak that we had train him to stand up again, initially by holding him. We did make wooden legs initially and later there were prosthetic limbs available.

This is one such limb made in Arba Minch for a teenager who was so ill when he came in with a gangrenous leg and septic shock that even after initial resuscitation he had 2 cardiac arrests on the operating table. He did well and the last I saw him was attending school supported by an Australia who visited us and met him. There is a lot more to the story than I have told here, as you can guess!

You can see the scar on this boy’s head. He was in ICU and with a very low GCS (a count of severity of head injury) and the nursing staff wanted to put him in the ward as they were sure that he would die. I resisted and although he had a few problems (he was nearly blind), he survived and he loved me and would come running to me whenever he heard my steps. Should I have held him and tickled him? His dad was so happy that he lived!

I may show a copy of some gross pictures of suffering in my medical memoirs blog but here sufficient to say that I treated a thousand or more kids and they all needed medical, emotional and often physical loving. My heart bleeds for those taken in Nigeria and their families, but this is a worldwide problem. Let’s give all the help we can!

Dominic Cartier.

Maybe Malnutrition plus ?….

Don’t you wish that you had a better memory. I have a terrible memory for names and it gets me into trouble. My wife accuses me sometimes of not being interested in people. But that’s not true. I understand why it frustrates her and when we meet up with people we’ve not seen for a while she has learnt to say to me ‘Dominic you remember ….?’ The stock answer is obviously ‘Of course I do! So lovely to meet you again.’ Unfortunately, if I’m not very careful I’ve forgotten almost immediately. Not that I’ve forgotten the person, only the name and I can go on chatting about past memories, but not using names! Well, in truth, it’s not quite as bad as that but you understand. On the other hand hand I have little trouble remembering the events of our previous getting to know each other.

Don’t you think she’s beautiful? I do. Don’t you think that she’s skinny? I do. Besides her malnutrition can you pick her diagnosis? We have a lady come in every second Friday afternoon to help a bit. She is a nurses aid. So I showed her the picture and asked her what was wrong with the girl. She said ‘you mean apart from her being malnourished?’ She is pretty skinny but I don’t think is actually malnourished but certainly a bit underweight. But look at her left shoulder. I’ll bet that there was more than 100 cc of pus in that abscess. From the way she is sitting leaning on her elbow I’d be surprised if it is a pyo-arthritis; more likely an abscess in her deltoid muscle. Still pretty painful but not as bad as if there is pus in the joint. And it looks as if the glands are affected in her axilla.

I know how it hurts to get ‘bitten’ by a rose thorn. And if dad or mum couldn’t get it out, a child in our land would be taken to the hospital emergency or the doctor’s surgery. They obviously were not the poorest of the poor, (look at that pretty pillow), but even so she didn’t turn up at the hospital until the abscess was this size.

Seriously thank God and the government and a slowly changing attitude to illness, things are a lot better than they were fifty years ago. But the need in Ethiopia and many countries is still huge. At least momentarily it makes you wonder if you or I can make any useful difference. Our grandkids and great grandkids have already so much more than we did or our kids did when we/they were young. So we have (except when they are very small) stopped giving presents. So for Christmas in all their names we give a larger gift to an organization who we believe we can trust to deliver aid on the ground. For birthdays we tend to give smaller gifts in the person’s name to a worthy cause – and there are so many of them around. Do any of you have good suggestions to pass on? If so please let us know.

Cain years ago try to fob God off when he was asked a question about his brother Abel (whom you might remember he had murdered) by saying ‘Am I my brother’s keeper?’ Well I’m not going to run around wringing my hands because I can’t solve every problem, but the question is thought provoking.

Two loveable imps. One having lost most of his right arm; the other with half a thumb gone and having lost his scalp to a hyena. You can see the dressing under his cap. Lovely kids!

Dominic Cartier.