Bush Medicine 101: Lesson 9 - Spray Knowledge. Be Amazing. Cause an Avalanche.
And don't think too hard about your next orgasm.
Dear Family, Friends, Mentors, Colleagues and Jane-Your-Younger-Self,
I hope you are well? We are well!
You don’t know what you don’t know.
Thankfully this life provides mentors who often know what you don’t know, and guide you to learn what you don’t know so that one day you do know, and then you can pay it forward and help someone else learn what they don’t know so that they can arrive 24 years later knowing what they didn’t know.
My intention today dear Bush-Doctor wanna-be, dear reader, dear Family, Friends, Mentors, Colleagues, and Jane-Your-Younger-Self, is that you never know the avalanche-impact you will have on someone’s life.
I watched an hilarious yet thought provoking video on YouTube years ago by Tim Minchin, British-born Australian comedian, actor, writer, musician, poet, composer, and songwriter which he gave to his old school at the age of 37.9 years on his “Live to Learn” 9 Life Lessons.
Amongst other things he said “don’t seek happiness, happiness is like an orgasm, if you think about it too much it goes away”.
And.
“Be a teacher, please please please be a teacher, even if you are not a teacher and if you do not know what you want to do with your life be an amazing teacher. Share your ideas, don’t take for granted what you know or your education, but rejoice in what you learn and spray it”.
I agree, on both and all 9 points that he makes and I highly recommend watching the 7 minute clip on YouTube.
Regarding “spraying” information and being a teacher. You know what they say, "The flapping of the wings of a butterfly can be felt on the other side of the world".
One just never know the cascade and avalanche of events you can cause by sharing the right information at the right time, or the right information at the wrong time which changes the course of a life for the better.
I say the beat of Huey Helicopter blades can contribute to a cascade, an avalanche and a series of events that can be felt 24 years and one Bush-Doctor wanne-be career later.
I consider myself a Bush Doctor wanna-be. The title Bush Doctor is a journey and not a destination, hence I say “wanna-be”.
I’m not sure if anyone arrives at being a Bush Doctor, this title is auspicious, hallowed even, in my opinion.
In the world of medicine, there are many generalists, several specialists, fewer super specialists, and very few real Bush Doctors.
I neither elevate nor diminish the title of Bush Doctor, merely state that this rare breed of Bush Doctor is few and far between. We are a breed of doctor unto our own which can make us quirky, but also uniquely and bizarrely skilled, because we function in low resourced settings, with limited support, no specialists to turn to, hardly a referral system, limited senior supervision, using what we have to make a plan in order to achieve our objectives.
Our main objective which is to do good and no further harm. And to remain mentally stable and with our sense of humor intact throughout.
I have used an ET Tube (endo-tracheal tube which is a tube to put into the patient’s breathing pipe to help him/her to breath) to drain a patient’s chest pneumothorax (air in the chest where there should not be air in the chest). I did this because we did not have a thoracic drain kit and the ET Tube was the next best solution.
I have used an empty rum bottle and a clean urine bag amongst other containers, to drain blood into from the chest (usually we drain it into a sterile graduated bottle made specifically for drainage of intercostal drains).
I considered the rum bottle sufficiently sterile.
I have used a low costs 16 gauge needle and an intravenous giving set to drain a pleural effusion (liquid around the lungs) of a Tuberculosis patient (usually this would be done with a proper chest drain kit).
I have had some incredible Bush Doctor mentors and role models in my time teaching me their remote Bush Medicine trade secrets, one of the most influential and significant at a life-changing point in my career was Dr Stuart Boyd who molded and shaped our paramedic class to become National Diplomat Advanced Life Support Paramedics to graduate in 1999.
ABOVE: Dr Stuart Boyd - without who’s moral support I would probably never have got into medical school, never mind 24 years later being a Bush Doctor wanna-be.
Stuart was also one of my biggest medical supporters at a pivotal time in my young career who encouraged me to keep applying for Medical School after having been rejected on my first application, and he wrote a letter of recommendation for me for my second and finally successful application attempt.
I’m not sure if it was his letter or the fact that I visited the Deputy Dean of Durban University every month to inquire about my application, to the point that the kind secretary knew me on a first name basis, and I got a personal telephone call from her to inform me that I had been accepted (and great job, but I didn’t need to keep stopping by to follow up my application).
My Mum was my biggest non-medically trained supporter. I will never forget the conversation we had when I was finishing my 3rd and final year of paramedic training.
I had come home from Durban to Pietermaritzburg for the weekend and I told my Mum that I could already see that my paramedic career would not last longer than 5 years (which is about the average time that most paramedics can work before becoming burnt out unless they diversify and go into roles in training or management).
My reason for already seeing the end of my paramedic career in 5 years was that I had assisted with a resuscitation of a patient, and after having worked for over an hour on the patient and driving with him in the back of the ambulance, we delivered the patient to the hospital and the fatigued receiving doctor (who had probably already worked a 24 hour shift plus) half-halfheartedly accepted the patient to his overflowing casualty department and finally said to us that the patient was not for resuscitation and the patient died.
At that point in my young paramedic student career I was finishing 3rd year of my 3 year Diploma.
I was young, idealistic and headstrong, and I didn’t want someone else up the medical food chain making that decision for my patient that I had worked so hard on. I wanted to be higher up the food chain to take that decision.
“Be careful what you wish for”, comes to mind, because now I realize that deciding that a patient is not for resuscitation, or stopping an unsuccessful resuscitation can make one feel like the Angel of Death.
In retrospect with now 24 years of health care experience the fatigued receiving doctor was probably correct in his decision and the patient was probably not going to make it anyway.
Dr Boyd, one of my most memorable and significant mentors during my formative paramedic years prior to me becoming a doctor, was reputed in the province of Kwazulu-Natal South Africa and beyond, to be one of the province’s Emergency Care guru’s and medical cowboys.
I will never forget fortuitously being at the Paramedic College on two separate occasions when he got called out to assist with the disembarkation of two patients off a vessel.
I overheard him discussing the cases on the phone (cell phones were the size of bricks in those days) and I literally begged Dr Boyd to take me with him on the cases.
He repeatedly said no.
I repeatedly begged.
And eventually I think he decided he would never get rid of me if he didn’t take me as his assistant.
I was that kind of student that I would have driven behind his response car all the way to the heli-pad just to be taken on the case.
I have a few Superpowers:
One is sleeping and power napping.
The other touch-typing and swimming.
And my last but certainly not least superpower which has got me where I am today is being annoyingly persistent.
Very annoying.
VERY persistent.
FYI math and science are not my superpowers. But here I am, still a doctor.
To all those wanna-be’s who wanna be a doctor, don’t limit yourself if math and science is not your strong point, it’s a means to an end. And it ends. And then you qualify and the most math you need is to calculate drug doses.
Annoying persistence is the same way I got into medical school, because let’s face it I wasn’t getting in on my less than average Matric (final year) school marks nor my brains. I was not an A-student. Rarely a B-student. Often a C-student.
I’m going to let you into a rather big secret about doctors, we don’t have to be clever. Some are really really really clever. Others not so much. I fall into the category of “not so much”.
We have to be stubborn, persistent and disciplined to get through 8 years of studies, internship and community service.
One does not need brains to be stubborn, persistent or disciplined.
We have to know where to find the information we need when we need it, because we sure as heck cannot remember it all. Ask any doctor today, Google is our best friend.
Perhaps most importantly, we doctors have to have common sense, as in not-putting-a-knife-into-a-toaster, not-licking-your-mobile-phone-charger-connected-to-the—electricity-mains, and wash-your-hands-after-each-patient common sense.
It’s the simple common sense things that count.
Overhearing Dr Boyd talking to the Call Centre about a patient needing to be disembarked off a vessel, I employed my “annoying persistence” technique.
It paid off and he finally agreed to take me with him.
The disembarkation involved flying in a Huey helicopter from Virginia Airport in Durban to the vessel off the Durban coastline to airlift the patient to a hospital in Durban for further treatment.
I will never forget these two cases when I got to fly with Dr Boyd, it felt like I was in a surreal movie scene complete with awesome sound effects.
Flying in the back of the Huey Helicopter into the horizon, the turquoise-grey sea below us, with the deep rhythmic whoowh-whoowh-whoowh beat of the blades of the majestic Huey and the unique kerosene smell of jet fuel which, even if I smell it now, triggers the sense of adventure and with it the excitement.
ABOVE: A Heuy Helicopter - loud, rhythmic and majestic in nature.
On arriving at the heli Dr Boyd helped me to put the headphones on which are usually the way that one communicates with the crew and pilot on board the heli.
I informed Dr Boyd that my microphone on my headset wasn’t working. He smiled innocently, shrugged his shoulders with his palms facing up, and said something I couldn’t hear because I already had my headset on with ear muffs which muffled out the sound of the heli and his response.
Looking back, I think he must have switched my microphone off so he didn’t have to tolerate my incessant exuberant excitement, commentary and questions from my peanut gallery regarding the heli, the patient, the vessel et al.
In lieu of my microphone being off (or broken, since I will give Dr Boyd the benefit of the doubt), I resorted to writing down all my questions and thoughts on a sterile glove packet.
To his credit he tolerated my enthusiasm and my scribbles on the glove packet, but he never turned my microphone on. I cannot to this day figure out why.
Last week I took a small fixed wing aircraft flight to go to a clinic I have set up in two shipping containers for a new mine in the middle of nowhere (literally) called Molo Mine which is in the south between the east and west coast of Madagascar.
ABOVE: Bekily in the south of Madagascar, officially in the middle of nowhere. Molo Mine is a 2 hour drive, approximately 45-50km.
ABOVE: Google Maps estimation of drive time. It’s wrong. It’s 2 hours and 45-50km depending on whether one takes the “scenic route”. Go ahead, challenge me on this fact, I dare you (to go to Bekily to drive to Molo Mine).
ABOVE: The small snaking dirt line in the middle of the windshield IS the bush runway in Bekily. Believe it or not there is a thriving town in Bekily.
ABOVE: Clearing the bush runway of cattle, goats and stones (same runway you see in the photo above from the air).
ABOVE & BELOW: Bush landing in Bekily, everyone comes out to see.
While taking off on the dirt runway I had vivid memories of flying with Dr Boyd on my first Huey Helicopter flight and first experience of disembarking a patient off a vessel.
This experience last week left me reminiscing about my introduction to Emergency and Bush Medicine by Dr Boyd and having the privilege of having an Emergency and Bush Medicine extraordinaire who helped me believe that I could actually become a doctor in the first place.
I still pinch myself to remind myself that I’m actually a doctor. It’s the best job in the world.
24 Years later I’m living the life I dreamed of when I was but a young bright-eyed-wet-behind-the-ears paramedic student.
I’m flying to remote sites, establishing a medical clinic (this has been such a privilege as few doctors get to do this in their careers, I’ve had the privilege of establishing two medial clinics in my career), running a Robin Hood community clinic, teaching anyone who wants to listen, spraying my knowledge and education, doing good and no further harm, and hopefully being the mentor that Dr Boyd once was to me when I didn’t know what I didn’t know.
But Dr Boyd did (know what I didn’t know, which was how great being a doctor was).
And now I know what I didn’t know 24 years ago and I’m so grateful to have had Dr Boyd as a mentor, believing that I could be a paramedic, a doctor and now a Bush Doctor wanna be.
I come back to the YouTube video which I highly recommend: “Live to Learn” 9 Life Lessons by Tim Minchin, “don’t seek happiness, happiness is like an orgasm….oh wait, sorry, the other lesson….
“Be a teacher, please please please be a teacher, even if you are not a teacher and if you do not know what you want to do with your life be an amazing teacher. Share your ideas, don’t take for granted what you know or your education, but rejoice in what you learn and spray it”.
Spray your knowledge. Be amazing. Cause an avalanche. You never know the impact you have until 24 years and one Bush Doctor wanna-be later.
I’m so grateful for those 2 hugely avalanche-impactful Huey Heli medi-vac’s I got to go on with Dr Boyd.
I’m sure he never knew then what I know now. The impact he had on a 20 year Paramedic wanna-be looking for her path in life.
Kind and mad regards,
Mad Madagascan Mum & Medic (and now Bush Pilot wanna-be)
Jane
ABOVE: 1 x Bush Doctor wanna-be (and now Bush Pilot wanna-be) and 1 x real Bush Pilot (Norbert Determann). You know what they say about old(er) pilots? They’re the best pilots (because they’ve survived to tell their flight tales).
Wow! Such an amazing story. Thank you for sharing these with the world.
You are a force of nature Jane. Someone I have looked up to for years, and even though I'm now in my 50s, I aspire to be like when I finally grow up.