we saw about fifty patients during the day in two 4-5 hour sessions. the day had ended around 10pm. we were all tired and talking about the crazy cases we saw. then, around 11:30 at nite (we woke up around 6am that morning), a guy walks in. sorry, more like is carried in by his friends. everybody screaming EMERGENCY! EMERGENCY! we all (all three of us - the person who set up, runs, and works the clinic, the site coordinator - non medical, and me) run out to see who’s walking in.
where the boys sleep (the girls sleep downstairs)
there’s a guy writhing in pain on the front porch. his foot is completely swollen and his big toe looks like it’s about to explode (everyone in this area walks around barefoot). we get the story that a scorpion stung him. his buddies (good buddies i might add) carried him AN HOUR overland to the clinic. they put some local herb mixture on it, which from the looks of it was making everything worse. they had also cut the wound with a knife to try and squeeze the venom out. i had heard this was really bad to do because it just increases the circulation in the area and makes the venom do its dirty work more quickly. i didn’t have the heart to tell them, just in case the poor fellow croaked, they might feel like they caused it. what was done, was done.
i can’t say i’ve treated any scorpion bites before but my teacher had told me how to a long time ago (he’s still saving lives!). of course, as usual, at the time i was thinking, when in my life am i going to see a scorpion bite? on sumatra of course! anyway, i had packed this special chinese medicine just in case of a toxic bite (many of my colleagues call me mr doom and gloom). very lucky for this guy. when he got to the our clinic, his foot and toe were very swollen, red, and painful. there was a darker band of red around the ankle joint, with a red line exending a couple inches up the front of the leg towards the knee.
now, according to everything i know, if that line reached the knee, the guy is dead. the line was moving up, and you could see it. it was a slow but visible progression.
like i said, i’d never treated a scorpion bite before (a couple spider bites, an odd centipede bite, one or two wasp stings). much less a scorpion bite in the middle of the indonesian jungle, deep inside the UN’s red zone, in the heart of rebel territory, with no road to speak of.
everything my teacher had ever told me had worked exactly as he said it would, but this was rough. one wrong move and the guy was dead. to confirm this i had the clinic manager call a doctor that comes to the clinic twice a week to treat the locals. i had treated him earlier that day, and he seemed pretty competent. we asked him how serious it was. he said not serious, just painful. we all breathed a giant sigh of relief, relaxed a bit, and did our best to clean and care for the wound.
five minutes later we get a frantic call from our doctor friend saying he checked with a friend of his, an expert from the hospital, and we had to get the guy to the hospital ASAP! as i had been taught, if the red line gets to the knee it’s curtains for our patient. the good news is that there’s antivenom at the hospital. the bad news is, it takes over an hour of off road driving to get to the hospital, the regular driver is down for the count with an absessed tooth, it’s 11:30pm, pitch black, they drive on the opposite side of the road, and i’m the only one that can do it! i figured that’s what i came for anyway so let me have at it.
during the brief period before the general panic, i had a chance to clean and dress the wound. after cleaning it, i applied my chinese medicine treatment to it as well. i figured that it couldn’t hurt, and if the information my teacher gave me was as reliable as usual, it could save his life.
the vehicle
anyway, there i was, the exhausted ambulance driver (it’s a four wheel drive jeep like contraption). we recruited the local site coordinator to navigate (trying to drive through the jungle at night is hard, even when you know where you’re going). we piled the screaming, writhing passenger into the back seat with his steadfast buddy, and sped off.
the first thing that happened was i got stuck in the mud. not even out of the driveway! everyone except scorpion man got out and pushed. it was raining lightly. that was bad. not because we were stuck in the mud, but because it floods really easily, and when that happens you can’t cross this river that you need to drive through to get to town. what’s just as bad, is that if you can get to town maybe you can’t get back. we made it out of the driveway, and my poor navigator’s night was just beginning.
the headlights were barely a help. the rain was obscuring our vision. the humidity had the windshield fogged. and i was driving on the wrong side of the road. countless times the navigator would scream as i avoided a hole in front of us by swerving this way or that, and come perilously close to going over an edge into a ravine, or raging river. the poor guy aged ten years in a single night. i was all business. we drove over a couple of coconut tree bridges (don’t ask). and finally made it to town an hour later.
we get to the hospital and it’s all the worst things you can imagine. filthy, body fluids covering everything, people smoking (the doctors!), a row of patient beds, a motorcyle (in between the beds), all in the emergency room. we put our man, who says he’s feeling much better, on one of the wet tables (eeech!), and the doctor comes over to look at him, cigarette dangling from his lips. he takes the dressing of and BAM! all the pain, swelling, and redness are gone! it feels totally normal to the touch. on top of that, the cut they made that was about an inch long was perfectly sealed. no scab, just the tissues starting to mend. incredible!
the doc pulls over a big, open plastic garbage can full of medical waste that i won’t describe (believe me, be happy about the omission). then he pulls a cart over with a bunch of medical instruments on it. they are all in a kind of tray that’s wet with a mixture of blood and what looks like mucus. he pulled out a pair of tweezers, wiped them off, and drove them straight into the perfectly fine and healing wound. he dug around in there for a few minutes, then said it looked good. he squeezed a bunch more blood out (it was already bleeding freely), and then put some antibiotic cream and a bandage on it. he told the guys in a completely derogatory manner that they were obviously not medically trained or they would have known to make the cut on the bite parallel to the ground instead of vertical (as i said earlier this is completely contraindicated). he then went to get the “antivenom.” he went in the back and come out with an already filled syringe. i asked to see the vial. he said he lost it. i asked again, he said he threw it away. what can you do? at least the wound was better.
my trusty navigator, who HATES to drive, decided that both of our life expectancies would go up considerably if he drove back. that was fine with me. the rain had let up, and the emergency was over. we took our patient and his friend and put him back in the jeep and headed off.
when we got to the coconut tree bridge in the jungle, we joined a long line of waiting vehicles. the bridge was out. someone had tried driving a giant truck over it and blew it out. my driving companion called ahead to base camp and had them send a scooter to take us all back one by one. first the patient and his friend, then me. he stayed with the car. i offered to stay with him. he said no, i needed to go back and sleep so i could see patients in the morning. i got back at 2am.
he later told me that he was a little nervous being stuck in the middle of the jungle, deep in rebel territory with a white guy and no one else around for miles…
ps - the patient came in the next day fine. complete recovery. he brought five of his friends for chinese medicine treatment with him.
