Preparation Meets Opportunity and Betadine

Preparation Meets Opportunity and Betadine

They hadn’t eaten since before starting work that morning and by the time they arrived at the clinic, it was late in the afternoon, the hottest time of the day.

This is when I met him for the first time.

“Doc Shazam, we need you.  We have a  machete injury…” said the 3rd year resident.

While minor trauma and fractures is run of the mill for me, the family practice docs that typically staff the medical clinic in the rural mountain village seem to find relief with my presence whenever the presenting complaint is trauma.  So a machete laceration that is right up my alley is gladly referred to me by the other docs.

This was the first machete injury I’d seen on this particular trip. Usually we have at least a handful.  It makes me wonder what the villagers do the other 48 weeks out of the year when there is no physician present, let alone an ER physician who is happy to poke around in tendons and muscles and such.

I had prepared myself for this patient’s visit more than a year in advance.  18 months ago, during my last trip to the mountains of Honduras, I had seen a similar case.  A young man with a machete laceration, this one due to carelessness, and not a snake, had lost the use of his index finger. I performed a gentle and timid exploration for a proximal tendon without success.

Upon returning home I consulted with my unc

le, an orthopedic surgeon with over 40 years of practice.  He’s very familiar with my global antics, even from before I went to medical school. I’ve asked him about the very situation I was now facing.  Having never done an extensor tendon exploration or repair during my residency and subsequent clinical practice, I have since visualized the exploration I would do and the repair that would be needed.

When these boys and men have no other recourse aside from what they find at our clinic, how can I go wrong but to do an exploration, with the worst possible scenario that they recieve a sterile incision (due to my exploration) and leave with an injury no worse than when they came (only cleaner)

So the senior resident, 2 months away from starting her sports medicine fellowship and I began an exploration in anticipation of an extensor tendon repair.  Others were skeptical…”Are you going to try and repair that?” they asked.  “Why don’t you just send him down the mountain?” another questioned.

I knew that sending him down the mountain was an expensive proposition.  First of all, he had no money for the ride down in the pickup truck.  It would have to be gathered from the group of us, or deducted form the health committee funds, which are limited considering a clinic visit is the equivalent of 50 cents, which sometimes covers a family of six or more.  This boy had no money at all.

Had I been assured that once down the mountain he would be able to see and follow up with an orthopedic surgeon, I would have given the $20-$40 dollars it cost to take an “emergency” ride down the mountain in one of the three pickup trucks in town.  (More than a months wage for many people).  But i knew that once he was in the Emergency Room in El Progresso, and had sat there for many hours, all he would get was a few superficial stitches in the skin, and he’d have lost the use of his left hand for good.

That was not an acceptable alternative for me.  So, betadine in hand, bandana on head, and LED headlamp in place, I began my exploration for the extensor tendons of his 3rd, 4th and 5th digits on his left hand…

 

This is  a 3 part series
Read Part 1 Of Machetes and Snakebites
Now Reading Part 2 Preparation Meets Opportunity and Betadine
Continue Reading Part 3 Extensor Tendon Repair

Tiled clinic porch in the tropical rain

Of Machetes and Snake Bites

Of Machetes and Snake Bites

I just returned from a 2 week trip to rural northern Honduras where muddy roads twist up steep mountain sides, and where farmers manage near vertical fields of corn and beans where mahogany trees once grew.


A fifteen year old farmer leaned over in the beating sun, swinging his machete in his right hand while gathering ripe corn with his left.  His 10 year old brother picked up the ears that had fallen to the muddy ground.  The older boy suddenly felt a cool touch on the back of his neck…followed by a slick sensation running down his left arm.

 

With an automatic reaction fueled by terror, the poisonous snake was killed with one swift  swing of his machete.  His left hand began spurting blood from the deep laceration left by the machete.  The snake was dead, but he could no longer move the last three fingers of his left hand.

The younger boy ran to the edge of the field yelling for the other workers.  The older boy stumbled down the hillside corn rows in shock, cradling his left hand across his chest.  One of the older men doused the bleeding hand in gasoline to prevent infection and wrapped his hand in a towel.

With no choice but to maintain composure, the two boys began the five hour trek to our clinic where I met them for the first time.

Continue reading:  Part 2 Preparation Meets Opportunity and Betadine
Read Part 3 Extensor Tendon Repair

 

New Server Migration

New Server Migration

If you are seeing this post, it’s because Doc Shazam successfully migrated to a new server, and none too soon! I”m off to Honduras again for 2 weeks, and the last thing I needed was to deal with a testy host. One of the OTHER sites on my hosting account was having bandwidth problems, but they shut this site down since it’s the main site with them. No problem…I just moved it to a new host and server.

So if you are looking for a great host, try Host Gator
. I recommend the baby Croc package…unlimited domain names, $7.95/month if you buy hosting in advance. Only need one domain hosted? Try the hatchling at $4.95. I’ve got several sites with them, and now Mr. Hassle is here as well.