Bush Medicine 101: Lesson 10 - The One That Didn't Get Away
Congratulations, we delivered a treble hook! And Long Live Robin Hood!
Dear Family, Friends, Mentors, Colleagues and Jane-Your-Younger-Self,
I hope you are well? We are well.
Being a doctor in the rural town of Fort Dauphin on the south east of Madagascar, there is rarely a dull moment.
I could do with dull. But we can’t all have what we want.
This weekend’s not-dull-moment involved delivering an embarrassed and shameful slightly intoxicated but lucid expat from a treble (tri) fishing hook which he hooked himself with during a mildly merry and tipsy episode of fishing with his merry mates.
Which is trebly embarrassing for him.
Particularly once less drunk. And more lucid.
ABOVE: Diagnosis? Stooo…
This weekend I was having a rare repose and lazy lunch out at one of our local restaurants with my family, a friend and a visiting Emergency Care New Zealand nurse (long story of how she washed up on our shores to learn some rural medicine at my clinic).
Fort Dauphin is a small town, the last official head count a few years ago was around 80,000 people, however unofficially I think it’s closer to 100,000 - 120,000 people.
ABOVE: Fort Dauphin, a beautiful remote beach town on the south east coast of Madagascar.
I started my dream Robin Hood community clinic (aka Centre Medical de Taolagnaro) in Fort Dauphin 12 years ago when the population count was around 60,000 inhabitants.
ABOVE: (left to right) Dr Honoria (Medical Officer), myself, Dr Patric (Chief of Hospital), Dr Higor (Chief of our Community Programs), Molly (visiting New Zealand nurse), Dr Fetra (Medical Officer) - some of my special peeps who make my Robin Hood community dream a reality - of doing good and no further harm in our community. These guys keep me doing what I do.
My intention in starting my clinic was, and still is, to treat the have’s who can afford to pay, and at the same time treat the have-not’s who cannot afford to pay.
The business principal is that if we see enough paying patients we can always pay for our own free community programs including free family planning, free pregnancy care, free post-pregnancy care, free childhood vaccinations, free burns dressings, and free malaria treatment.
As an aside to any Bush Doctor wanna-be’s, the reality and failure in my self-imagined Robin Hood business model (where I do not steal from the rich, but I am not shy to invoice their medical insurances or charge fair prices for patients who can afford it) is that we can never make enough money to afford all the free life-improving programs that I desire to offer.
However, thanks to a few particularly generous and loyal investors (I hate the title donors because donors don’t expect anything in return for their money, investors expect results): thanks to Professor Hengge from Joachim Kuhlmann Stiftung in Dusseldorf, Dr Frank & Dr Heike & Dr (PhD) Sebastian Melzer from Melzer-Madagaskar Projekt in Leipzig, Camille & Lucas Scherpereel from ANDAO Maternal & Childhood Program in France, and a few significant private investor-donors we have been afforded the opportunity to develop our Robin Hood community clinic and continue offering our free community programs for the past 12 years.
Back to our small and beautiful rural beach town, it’s a fairly compact expat community, so basically everyone knows everyone, or, everyone knows OF everyone. And most people know me and my family.
Which is why one of the reasons I love to travel is just to be anonymous and not be stopped in a local shop to look at little Johnny’s rash or wound, which is better than being asked to look at big Johnny’s rash.
The group of older merry “lads & dads” seated next to our table at the restaurant had had a few beers, noted by their merriment, and few empty bottles left on the table at their departure.
I also noted their conspicuous lack of eye contact after their rapid greetings.
I am one of “those” doctors who tell patients as it is and I had told a few of the merry men in the group to stop smoking and start getting their weight and health in order otherwise their wealthy expat life would be short lived and their children would be responsible for taking care of their soon-to-be ailing unhealthy bodies if they didn’t change their ways.
I went on to advise 7-8 hours of sleep, and HIT sessions, which I find is always a good place to start for people who are serious about changing their ways.
In my professional opinion, if you are overweight, you smoke, and you go to the doctor, the doctor must consider mentioning that you are officially in a virtual resuscitation ward awaiting your premature death due cardiovascular disease, cancer, or chronic obstructive pulmonary disease, or all of the above.
FYI all of the above mentioned are the top 3 causes of death worldwide.
My patient-doctor conversation continued something like this, in my enthusiastic and not-trying-to-be-judgy tone of voice…“because you’re only…how old did you say again? Only 42, WHAT, ONLY 42 and you’re looking like…well, not 42, you still have a chance to turn your lifestyle around!”.
Over the years of working in Fort Dauphin I regularly receive requests by international doctors, medical students and most recently New Zealand Emergency Care nurses, to work with me and learn a little bit about remote medicine and how I’ve set up my clinic.
During this time that these international volunteers work with me they attend each patient consultation and get to observe my style of bedside manner, patient care, and patient treatment plans, most of which I start with prescribing 7-8 hours of uninterrupted sleep, and intermittent fasting (which I think should not be called fasting but normal non-excessive eating).
I’ve had a few qualified professionals tell me that my style of patient consultation might not be acceptable to patients in the first world because I tell patients directly, for example, that they are overweight, and their fate is a premature death, or worse, disability.
I proceed to unashamedly, enthusiastically, and systematically go through my check list of contributing factors to their weight gain and how to successfully and sustainably loose their weight including:
Sleep deprivation (less than 7 hours per night, or frequently interrupted sleep)
Stress
Smoking, alcohol, drugs and other addictions including sugar
Loneliness & social connection
Device & screen time
Diet (food quality and quantity)
Daily eating routine (timing)
Monthly eating routine (with regards to women and their hormonal cycle)
Exercise (the most powerful antidote and treatment for stress and life problems in general)
Cold water therapy
Meditation / prayer
Gratitude
Non-sleep rest (NSR) or 15-30 min power nap
Motivation (short lived and unreliable for weight loss)
Discipline (irrelevant of how you are feeling on the day)
I’ve developed a passion for helping people to loose weight because for the past 2 years I’ve been reading around diets, exercise and weight loss and I’ve stumbled upon absolute gold nuggets of life-changing information that has lead me to feel empathy for patients struggling with weight gain.
I now better understand (better than when I was newly qualified) how hormones, addictions and an unbalanced lifestyle impact so completely, severely and obstructively on someones quality of life, weight and ultimately on their kids lives who will have to either live without a parent, or live with an ailing or physically disabled and dependent parent (from a stroke for example), and the financial consequences there of.
My motivation has become patients kids. Trying to save them from having to live with the consequences of their parents poor health.
As parents we will do anything for our kids. It’s time to do everything for our kids and get our health in check so that we never burden our kids with our poor lifestyle choices and medical expenses.
These merry fishing men had received my informal version of my medical advice at an expat kids party a few weeks ago when we got onto the subject of health and fasting, though I couldn’t really see that fasting was working out for them.
However it’s like what Dr Peter Attia says (author of Outlive: The Science and Art of Longevity), regarding patients discussing vitamins - patient’s shouldn’t discuss vitamin supplements if they haven’t got the basics sorted (basics as in diet and exercise).
It’s the same for smoking. Let’s not discuss anything further until we can reduce and stop smoking and alcohol consumption. Non? And perhaps a daily walk to reduce the stress which drives you to smoke and drink.
Getting back to the merriment. The merry men left the restaurant after their few beers, again giving their quick farewells with minimum eye contact lest The Doctor noted that only beers were consumed and no food stuff of significant nutritional value.
Not that I was counting calories, beers or cigarettes but rather trying to have a rare reposing day with my family.
A while later I got a WhatsApp call but the signal was bad and the line cut, which was when I noted that the same number had sent me a couple of photos and was asking my urgent medical advice.
Advice for the treatment of a treble fishing hook, 2 of the treble which were embedded in the patient’s arm.
We eventually made direct contact. I asked the merry men not to try to remove the treble hook. They’d done a good and sober job on their own by securing the entire fishing hook to his arm with a strap so that it didn’t swing from where it was embedded in his skin causing more injury and pain.
And that is how they arrived at my Medical Centre where I got to deliver a not-so-merry man from his fishing hook which he had managed to hook himself with while casting.
Not to sound like a doctor, but it reiterates that drinking while fishing (et al) should be avoided.
In comparison it was so much better than delivering a bloody baby. Which is what I did on Friday night which ended up being particularly bloody.
The long and short of that particular delivery was that our Mother of her 2nd pregnancy went from 6-10 cm dilated within 1 hour, and upon delivery lacerated / cut her cervix (birth canal) and bled. A lot.
Oh Lord WHY ME? Maternity is my kryptonite.
But, that is a story for another time. Just to say that the woman and baby survived the bloody ordeal.
As did our merry fisherman.
On the bright side, all the merry men were forced to sit in my clinic and make prolonged eye contact (longer than their hello and goodbye greetings in the restaurant earlier) while I removed the hook with a Leatherman and some common sense, leaving only 4 puncture wounds which will not scar so one day, some day, if his friends and family let him, he will be able to forget his fun fishing adventure.
And the best part, a few merry men got to support my clinic, and I got to have fun delivering a man from his treble hook (but not his shame).
Long Live Robin Hood!
Kind and mad regards,
Mad Madagascan Mum & Medic,
Jane
Oh, how fantastic!! You are brilliant and hilarious at the same time. What interesting opportunities. 😄 Much love Sanlea from PE, SA.