#13 Tuesday, 8/27: Australian military, Pediatric ward, & Unit Coins
Good morning America! Hope y'all had a pleasant night sleep free from bugs, heat, lumpy beds and back pain. It was another glorious day in paradise perdition here at Munda. Lots of fun stories to tell. Heart warming and heart breaking. It's going to be a roller coaster ride so buckle up!
Today was our last full day in Munda working at the hospital. Bitter sweet for sure. Started the day off right with breakfast which has been fresh fruit every day, and toast with veggie-mite. More on veggie-mite later. After which we walked to the hospital. It's a pleasant mile and a half walk in the morning yet I always find a way to be drenched when I arrive. The first stop was at the "active" hospital site where we dropped off our dental colleagues and Jill the OB GYN went in to see if any women were in labor and just like all the other 7 times. There weren't any so while she was doing that I thought I'd pop into the pediatric ward one last time to give some gum and say my goodbyes to the kids and their parents. When I went in, Dr Ray was there consulting with the nurse and a parent. He asked me if he could run something by me about a patient. Sure, I thought. Well what followed next tested me as a physician. I'm not a pediatrician and I steer clear of kids any chance I get except when it comes to gum. He went on about a kid there who is 3 years old. Been there for awhile because he kept having seizures. Come to find out he is severely hypoglycemic. He has developmental delay. Can't walk. Only word he says is "mama" and is always super lethargic. So. Diagnosis that! That was basically what he was asking me. So there isn't any post partum DNA testing that is standard when you are born in the US and there is none of that even available. This is a kid with some serious medical syndrome that they nor I have any way of possibly diagnosing. What's crazier still is anything I say or do they will take as gospel truth and do it to the letter. I had no clue but it sounded like some very rare form of glycogen storage disease. I told them to feed him more often and check his blood sugars more often to see if his lethargy and seizures improves. That's all we could do. So sad. So dutifully they will be doing that and seeing if there is some testing they can send to Australia. That's it. So sad. And after that Dr Ray said "so I have this other kid patient..." my heart sunk. What am I going to do with these kids. This time it was a kid I had recognized giving gum who has been there for awhile. Apparently he stabbed himself with a knife in the knee and the wound healed over but then started leaking with drainage. Then the knee started getting big and swollen and 3 times it size. They showed me the knee. So swollen with a small area that was draining. This kid had what's called a chronic septic knee. Very bad deal because he could loose his mobility and function of that knee and entire leg if not already. The only and best treatment option is to do an open debreadment where you open up the knee and pull out all the infected tissue. Munda doesn't have that capability. He wasn't on a good antibiotic for that and I had found some antibiotic that is better that they started. The only thing i could try to do was irrigate through the hole which didn't work because it's to small. The other was to try and put a needle into the knee drain what I could and irrigate inside the knee to see if stuff comes out the fistula. This isn't something anesthesiologist do! But we had to do/try something. Wasn't able to get the needle in because the tissues were so inflamed. So next best thing is antibiotics and possibly sending him to Honiara. Not great but what could we do?
Well, something happened today that was quite miraculous. I'm skipping ahead of the day a bit but I'll come back here where I left off later. Okay so, after work today we came back to the hotel and instead of showering and changing we decided to go straight to the restaurant to order our food. Remember how it takes 2 hours? So we did that then went to go get water and I wanted to be more like Brooklyn and get a boba drink at a store nearby. We didn't change. Still in scrubs so because we ordered so early we thought surely our food won't take that long so we came back and sat down. No sooner had we sat down when one of the Australians who have been with us the entire time came up to us and asked "I see you all are in scrubs, are do doing some work hear?" Now mind you we haven't interacted with them this whole time. They wouldn't give us the time of day and we thought they were just not interested in Americans because we beat then so badly during the Olympics particularly in women's rugby. Very embarrassing for them. Anyway here, for the first time, they came up to us to talk. So we told them who we were. Why we were there. He looked at me and said what do you do? I told him I'm am anesthesiologist. And he said "me too!" What?!! I was confused why would they have an anesthesiologist there at all. Well come to find out they brought an entire surgical team with a general surgeon and an Orthopedic surgeon. Soon their whole medical team was sitting around us wanting to know all about our mission here. Interestingly, our whole mission was actually the brain child of an Australian army doctor about 2 years ago. They had the idea of doing what we're doing and coordinating with the Americans to help prop up the Solomon health ministry. They have a ton of army doctors in the reserves that are dying to be deployed to just do something like what we were there doing but their health ministry shut the entire thing down, but our government kept at it and thus why I am here now. They lauded our governments military and stick-to-it-ness. They said their government is always worried about the worse case scenario. "What if we hurt one of their people or we don't have the right things etc etc" the Australians are very frustrated by this and want to help these people. So long story short they are here in support of the joint US Australian mission Operation Render safe. Which is to find and blow up UXOs from world war 2 and these guys are support for them on the medical side. So.much so that unbeknownst to us they built an entire mobile OR! Right down the road from the hotel. They were dying to show us their stuff so we told them after we eat well go over there. Pictures to follow. Anyway I spoke to the ortho doc about this kid and he had the same sinking feeling I did about him. Unlike us however they are ordered not to touch any of the civilian population unless they accidentally hurt one of them. They can't do what we are doing. I guess their government is worried about liability??? Weird. I don't know and neither do they know either. So I told him what I did and tried which he agreed was the best we could do but also agreed to swing by the hospital tomorrow to see this kiddo! So awesome. Not sure what he could do but he said he might pull some strings to try and take care of him. Super random and neat experience that this happened like this. Otherwise we leave tomorrow and they would have had know idea what we did. Why we were there or that they could have possibly helped in a meaningful way. So this ortho doc is coming to Dallas for a conference and agreed to stay with us! Honey, I hope that's okay with you. I'm just finding out about this now like you are.
What's also interesting is their army took away their phones. All of them. They can't call home-nothing. So they gave me their contact info and said when they get back in 4 weeks they'll reach out to me. Super cool. Check out the pics below with the Aussies.
Ok back to my day. After the pediatric ward craziness we went back to radiology to re educate on scanning but there were patients in line there waiting to be seen. So we began by scanning the ones we could scan. Lots or random abdominal pain symptoms and all we had was an ultrasound which isn't the best imaging modality for that bit we did the best we could and identified two women with symptomatic ovarian cysts and possible ectopic pregnancy. Saw a guy was a larger than normal kidney but only had so random vague abdominal pain and we got to do a fetal scan for a women who had no prenatal care. Actually that is the norm. Most women here never get an ultrasound during their pregnancies. As in zero times. But now because we have this cool.new ultrasound machine and the word has spread through the villages these women are coming to get scanned and we were able to train the docs on how to do a basic fetal ultrasound scan to at least figure out their dates. These women never know when to expect to be to term with their pregnancies. They just go being pregnant until their bodies tell them "hey! I'm done being pregnant and I'm going to contract now to not be pregnant any more" so we told the women she was due between December 15th and 20th! Awesome. She had the biggest smile leaving radiology.
Came back for lunch to the hotel. Handed out more gum to the kids then went back to do more ultrasound scanning training. I worked with Dr Ray and Willie but also 2 new doctors who had just gotten back from Gizo. One is interested in doing anesthesia so he was very interested in learning the blocks. So we naturally scanned for doing blocks. My favorite!
While we were scanning Dr Ray was getting a little anxious because he said we had to go. I wasn't finished teaching them so I said we have to keep teaching. He told us the hospital staff had prepared something for us and were waiting. But this was our very last opportunity to impart teaching to them. We crammed the teaching and walked up to hospital superintendent's house (a lot of the hospital staff live right on or around the hospital. Almost like it's part of their job they get a place to stay nearby. Anyway they had some finger food and coconuts for us and a gift. They gave each of us a lavalava and it's customary for them to put it on us. See pics below. Very sweet of them. The doctors and the hospital secretary took turns standing up and thanking us for coming and teaching them. Super awesome! Then we came home and met the Australians.
We did end up visiting them in their mobile hospital. Was very cool for them to go over all of their capabilities and how they operate and do anesthesia in a combat hospital. Very similar to how we do things in the military as well.
When we walked in the hospital tent there on a stretcher was a game that looked oddly familiar. It was Axis and Allies Guadal canal edition! It was the game but just with Guadal canal!! Hilarious and awesome at the same time. So they also gave us some things out of their MREs to share. My kids will love that. But the coolest thing was as we left, Phillip, the anesthesiologist gave me their units coin. Now in the military coins are kind of a big deal. You give them to soldiers for at-a-boys or for special occasions and giving a coin to a foreign military is considered a great honor. My team knows me quite well by this point and my love for history etc and after he gave it to me CPT Escobar piped up and said "you just made his day!" They really did. Made my day! One thing that is very interesting is even though the Australians put the kibosh on doing this mission we are meeting with their foreign affairs minister tomorrow in Honiara to discuss how this mission went. The Australians here were shocked by that but not surprised. They said America has so many more resources and power and might that when we come to a place like this their government listens. They were excited because in their opinion if we are here then it means the Australian government will be more willing to want to do a joint mission which would be so great for the people of the Solomon islands and our militaries. We'll see what happens.
So I'm leaving Munda tomorrow at noon and heading back to Honiara. Then will meet with the minister of Australia and pack for my long trip home the day after. And that then will conclude the adventurous travels of LTC Teames. Stay tuned till next time! Enjoy the pics! 
A picture from the other day on skull island. Just got this from one of my team members.
My toe amputation patient from yesterday! I was curious how the nerve block that Willie ajd Dr Ray went. It lasted 21 hours!! He said he now has pain but "little pain. Little pain." Super happy for him.
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