Tag Archives: medical evacuation

Old-fashioned community doctoring … virtually

Anyone who has tracked our recent medical dramas knows that we live a two-hour flight away from the nearest good hospital.

This doesn’t mean we’re devoid of options when we run into medical trouble.

For starters, there’s always Dr. Google. This good doctor’s wealth of knowledge is seemingly inexhaustible. You can ask Dr G anything. Anything. You can, for example, type in: “I’m 22 weeks and 3 days pregnant and I’ve thrown up 4 times in the last 6 hours and 6 minutes. I think I got sick after eating spring rolls from a street vendor in northern Laos 10 hours and 17 minutes ago. Should I be worried? What should I do?”

And chances are someone else has asked this exact same question, and someone else has answered it.

Granted, sometimes those answers run along the lines of, “drink a liter of goats milk seasoned with the blood of a three-day-old chick and stand on your head for an hour with your eyes crossed and you’ll be fine.”

But, still. Dr Google is on call 24-hours a day and always willing and eager to provide you with a wealth of useful information.

Well, information, anyway.

Then we have Dr Souphan, just down the road. Under protest, I went to see Dr Souphan just last week. To be fair to Dr Souphan, the protest had less to do with her than with the great inertia that seizes me when I’m afflicted with maladies that are more uncomfortable than dire. I just prefer to wait these things out.

Mike, however, is more proactive I am in the face of such problems, especially problems that have been going on for four days. So when we walked past her little clinic and saw that it was open, he gently suggested (read: almost frog-marched) that we stop in.

Dr Souphan’s clinic is one big room on the first floor of her house. While you’re waiting, you sit on chairs in the front half of the room. When it’s your turn to see the doctor you step to the back of the room where there’s a desk, two chairs, and a camp bed. No office door, though. Not that it mattered this time, because everyone else waiting was far more preoccupied with clucking over the little foreign baby with the big cast on his leg than with listening to me try to describe my intestinal disorders.

So we’re not entirely devoid of medical resources here, but what have we done when confronted with problems more severe than spending four days running to the bathroom? We haven’t relied on Dr Google or Dr Souphan. We’ve relied on good doctor friends in Australia, the UK and the USA. Just in the last eighteen months, these doctor friends have:

  1. Looked at photographs of Mike’s staph-infected legs and provided advice on which antibiotics to try and whether or not to seek medical evacuation to Thailand.
  2. Advised me about what to do when, at 22 weeks pregnant, I came down with a severe case of food poisoning.
  3. Let us stay in their house and use their car for a week while they were out of town (nothing to do with medicine, but much appreciated nonetheless).
  4. Given Dominic his two-month immunizations for free.
  5. Written very specific instructions for us on how to seek appropriate immunizations over here (including brand names) and answered our detailed questions about whether and how we could adapt the immunization schedule according to our shifting travel dates.
  6. Given me an entire course of appropriate antibiotics to take in case I get mastitis.
  7. Advised me via skype on splinting Dominic’s leg, appropriate pain relief, and how to make Dominic most comfortable until we could reach the hospital in Thailand.
  8. Reviewed pictures of before and after X-rays and written detailed letters explaining why the doctors in Thailand probably made the decision they did about Dominic’s care, we might have received conflicting advice about Dominic’s prognosis, and the pros and cons of additional corrective action within the next two years.

Ironically, Mike and I have found ourselves the recipients of more good old-fashion communal medical care here in Laos than we would have ever received (or asked for) if we had been living in Melbourne, yet all of this communal care has been delivered virtually. It’s all come from a “community” living on the other side of the world.

In the olden days, these people might have received some chickens or maybe a sack of potatoes for their help. Now they get nothing but heartfelt thanks.

Doctor friends,

Thank you. And thank you again. We’re so grateful that so many of you are willing to share some time and expertise via facebook, email and skype. You have eased the stresses that come with living somewhere with limited medical facilities more than you may ever know. Should you ever want to come to Laos, our guest room is always open and we’ll be happy to get some of those chickens and potatoes for you, too. Heck, we’ll even throw in a needy dog.

Love Lisa, Mike & Dominic

How have your friends reached out and helped you virtually?

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Dominic’s leg: The ugly, the bad, and the good.

We’re here at Bumrungrad hospital in Bangkok. I tried to organize this into some sort of coherent update by good, bad and ugly categories, but I not feeling coherent enough myself yet to pull that off. So, in no particular order and with no particular artistry, here’s what’s going on.

Good: Mike and I are overwhelmed by the amount of love and support people are directing our way from around the world. We are so touched and feel so loved. Dominic, of course, has no idea that so many people are thinking of him and praying for him, but we sure do.  Thank you. Thank you. Thank you.

Bad: Despite our insurer’s best efforts, it took us more than 30 hours to get Dominic to Bangkok after the break. During that time we splinted his leg using cardboard and gauze (Mike’s dad did most of that, actually) and kept him as still as possible. We slept him on the change-table mat on the floor and I fed him by kneeling over him. I also managed to feed him on the plane without taking him out of the car seat (which I think I should get some sort of acrobatics award for, and maybe an honorable mention for sacrificing dignity). During these last 48 hours there have been several times when I really wished I had not slacked off on yoga after Dominic’s birth.

Good: This is our second medevac with our medical insurance company, International SOS, and they continue to impress (and when I say “impress” I mean: I would like to kiss every single employee of that company plus anyone who sits on the board).

They made probably a dozen phone calls to Laos to keep us updated on their efforts and a doctor walked us through how to splint the leg ourselves. They flew a doctor up to Laos to escort us back to Bangkok on the flight. We were met at the gate and whisked through the diplomatic channel at immigration and customs and then met at the curb of the airport by an ambulance and two nurses.

Bad: In the ambulance the nurses and the doctor who’d travelled with us were in frequent communication with the team waiting for us at the hospital. They told me they didn’t want me to feed him after 4pm because they’d scheduled him for surgery at 8pm, and then they put the sirens on the ambulance in an effort to get us to the hospital faster so that I could feed before the deadline.

Running the ambulance sirens because the baby needed to kin nom (drink milk) would have been funny … except that it wasn’t. Also, the sirens were a nice try, but they didn’t make much of a difference in the middle of Bangkok traffic jams. We sat on the freeway within sight of the hospital for more than 30 minutes (which, if things have been dire, would have been mind-blowingly agonizing).

Good: Bumrungrad is the nicest hospital I’ve ever had the (dis)pleasure of spending time in. The place looks more like a nice hotel than a hospital and the staff seem phenomenally efficient. With one exception (see the next “ugly” point) I’ve never had a moment’s doubt that we are receiving top of the line medical care here.

Good: Dominic had been X-rayed and seen by two specialists within an hour of walking into the hospital. During the first consult they told us that they would take Dominic to surgery, set the leg under a general anesthetic, and put him in a spica cast (a both-leg rib-height body cast). Then they changed their mind. They could set the leg without surgery, they told us. This initially seemed like good news, but…

Ugly: They didn’t mention anything about a game plan for pain relief. When I strongly requested they make such a game plan the nurse went away and came back with … oral paracetamol – the same thing I’d been giving him for the previous 36 hours. I argued that they should at the very least give him paracetamol and codeine, but the doctors told me that they only ever use paracetamol or a general anesthetic – nothing in between – and they had no experience with giving codeine to infants so they just wanted to “do it natural.” As if there is anything “natural” about breaking the end off your femur. I was so angry. Mike had to be the one to take Dominic in to get the leg set. I couldn’t face it.

Ugly: The break is bad and complicated – all the way through the femur, right above the knee and in the growth plate area. For those of you who haven’t had a crash course in orthopedics lately, that’s bad news when it happens to a baby at this stage because there’s a chance that it’ll disrupt normal growth patterns. Dominic will have to be monitored annually by X-ray for the next few years (1 yr, 2 yr), then every two years (4,6,8) and then annually again up through the teens.

Good: The break was set by 6:30pm (less than 2.5 hours after our arrival at the hospital). And in the end they did not have to put Dominic in a spica cast, just a hip to toe cast, and that will probably only have to stay on for three weeks. X-rays today reveal that the set helped realign – even my untrained eyes can see the difference and the doctors seem pleased. They also told us that the specialist team met again and they think the chance of us having ongoing problems has dropped slightly. They’re not sure, but they think the break occurred just above (by 1 cm or less) the growth plate. If that’s the case, the long-term prognosis is better.

Good: Dominic slept quite well last night, all things considered, and has been relatively content today with only a couple of crying jags. We’ve even had some smiles. It is a huge relief to see him in less pain.

Good: Despite how harrowing the last two days have been, we remain acutely grateful that we have the resources and the networks that allow us to receive such excellent medical attention. These have been some of the worst days of my life, I cannot really fathom how much harder they would have been without the resources that are available to us.

So that’s some of the good the bad and the ugly from this end. To finish, here’s the “lovely”. The insurance company had flowers and a teddy bear delivered to the hospital. Dominic was a fan … of the ferns, anyway.

Love and thanks from Bangkok,

Lisa, Mike & Dominic

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