Medical Evacuation

28 - 31 January 2009

My dog bite wound was almost healed when last Wednesday it started to get a little painful. It soon became obvious that I had an infection in it. Talking to VSO I was told to talk to the doctors in Bali. I was advised what antibiotics to ask to be prescribed. The doctor give a choice of three in case the 1st and 2nd choice were not available on the island. They also asked for me to come to Bali as soon as was practicable. Unfortunately this time of year is not good for trying to get too or from Rote. There was no ferry on Thursday or Friday. As the infection was not responding to the oral antibiotics they asked if I could have a swab for culture and sensitivities – the answer was definitely not whilst on Rote. As there was no prospect of a ferry over the weekend the decision was taken by the insurance firm in consultation with the VSO medical unit in the UK that I should be medivaced out on Saturday. The doctor in Bali recommended I started intravenous antibiotics prior to arrival in Bali so I had treatment in our UGD (A&E). UGD is open 24 hours a day but when John went down to check they had the recommended IV antibiotic there was a trolley across the entrance and no one in the department – eventually he found a nurse who told him the doctor had gone home for a wash. So John went over to her house to talk to her. When I arrived in UGD I was taken into the doctors room rather than one of the treatment rooms. The doctor wanted to put up an infusion – the standard first line treatment for every patient irrespective of diagnosis. We then had a detailed discussion over why I did not want it and why she was offering it to me. She was certain the antibiotics would hurt without the infusion – it did not. That it would stop me becoming dehydrated – I was drinking well so this was not an issue. Patients expect it – I assured her I did not and that it was not routine in the UK. Before I got back to my house the bush telegraph had got to work and my neighbours were able to tell me about my observations, the drugs I had received and wanting to know what time the plane was coming to take me to Bali. During the morning we had a steady stream of visitors including Jude the other VSO volunteer on Rote. I am just pleased I was not feeling too unwell otherwise this would have been horrendous; instead it was really touching. When it was time to go to the airport I was escorted by 2 doctors, 1 nurse, 1 dentist, a child – who had never seen a plane and John.

When we arrived we just went as far as the control room and there was still no confirmation of the plane leaving Kupang. The staff were out on motorbikes clearing cows off the runway. Although there is a barbed wire perimeter fence it only goes about 1/3 of the way round the runway. When we did get told the plane was just 10 minutes away John noticed there was another herd of cows just approaching the runway and pointed this our. The airport staff sped off on their motorbikes to move them along rapidly. If you have access to Facebook use the following link to see the obstacles on the runway after the pilot had announced he was only 10 minutes away. http://www.facebook.com/home.php?#/video/video.php?v=571092196738 The plane did a high pass at which point we moved onto the departure hut. There was a luggage X-ray machine that we passed most of our luggage through. Then walked through the detector – which went off as each of us went through but no one did anything about it. Several other people had turned up to see this unscheduled plane arrive and they just went through a gate at the side of the hut with no security checks. The plane was just taxiing up as we got through. Once the plane’s engines had been shut down the doctors and child were down on the tarmac checking out the kit. The nurse came up to meet his patient as Dr Meli returned so I invited her to give him a handover of my care – trying to make up for not taking her advice to date. The nurse was taking lots of pictures of us and everyone else was taking pictures of the plane and crew. Finally made it onto the plane. I chose to sit in the back seat so I could elevate my leg – I turned down the stretcher. Sadly this meant I could only look out of a window on the right of the plane and apparently missed seeing some amazing beaches. The flight took about 1 hour 50 minutes. Throughout the flight the crew and nurse were using their mobile phones. As we came into land the co-pilot was taking pictures out the window. It was quite bumpy at the start and end and flew so much lower than I have become used to. When we landed an ambulance drew up and had the stretcher out before realising I was mobile. I was part way down the steps when the nurse told me to stop ran off to give a member of the ground crew his camera and then came back and posed again. Into the ambulance and did lye on the stretcher to keep my leg up. As we arrived at the hospital again a stretcher came out, then a wheelchair which I walked straight past. Straight into A&E – John was shown through to dump the luggage elsewhere.