|The days are just filled here. I have not been bored once yet or had "down time".|
The last time I wrote, I did not know my friend Dorothy had gone on a biking trip during which she took a spill resulting in a lip laceration and road rash on her chin, hands and knees. This resulted in a trip for her to the hospital, complicated by Galungan so most clinics and hospitals were closed (almost as major as New Year's Day in the US). So instead she ended up being taken to a government hospital where she was seen and treated and had her lip stitched with something absorbable. Total price: $6.50 USD. About $5 was for the consultant, and then they itemized everything for her, including 20 cents for lidocaine, 18 cents for the syringe, and so on. She was sent out with a little packet of Amoxicillin, tylenol, and some sort of NSAID. I heard what happened to her at the end of the day and thought I'd use my headlamp for a good exam (since I hadn't really used it for much else during this trip!)
Dorothy was worried about the level of contamination and about infection causing her to abort her trip, so I went with her to what was supposed to be the best pharmacy around, Kimia, in a town called Mas. Let's just say, I was not impressed with their selection or inventory. She did manage to get some Augmentin to cover the mouth flora and the fact that she'd sort of bitten herself via her braces, I gave her some of my Doxycycline to also cover MRSA, and she got some Bactroban to apply topically. The two she had to buy were not cheap because they were not available in generic form. At least I was able to help her with the communication issue -- I didn't have any problem in Bahasa at the pharmacy. While I was there I stocked up on some omeprazole, cipro, and imodium for future travels -- these were generic and came to less than a dollar US. Pretty amazing! Dorothy is healing up slowly, by the way, and so far no major infection has set in. More about this on her blog: www.thebrowndot.com.
My next medical adventure involved meeting up with a guy named Nyoman who is a doctor locally -- I found him through the CS network. We had lunch with him
and it was very interesting to hear about what his career as a general practitioner is like here. He thinks he might rather be on Java than Bali, and also has dabbled in other types of work such as news reporting (a completely different topic!) Very nice guy, and he invited me if I wanted to see his clinic an hour away in a small village tomorrow, and I would have, it's just that cooking classes are going to get in the way ;-)
My dermatitis issue flared with this stupid thigh irritation after having worn a sarong all day to the temples, and I mentioned it to my host, Elsha, who immediately summoned her Balinese healer, Jero, before I had a true chance to say "but it's so superficial that I feel this would barely be worth addressing in the context of his holistic view of the universe"... Jero spoke not a word of English, and apparently had developed his knack for healing shortly after someone else inflicted black magic on him -- he wasn't from a family of healers as I would have imagined. Instead she describes the acquisition of this specialized knowledge as "like downloading information with your computer -- he just had a sudden download." Hmmm, I'm sure board certification doesn't differ too much. Elsha is also using him to try to rid her house of the black magic that has been put on it by people who didn't like the philandering owner she is renting from...
Anyway, though the steroids and the powder were starting to help, I decided to give it a go. Jero wanted to know my whole past medical history, so I had to relate it through Dayu who was interpreting. He asked me the very wise sounding question about whether I suffered from frequent insomnia or interrupted sleep, and I told him I sleep like the dead, sleep all night, and have not yet had trouble falling asleep. He then had to reconsider his approach. I made the mistake of telling him I had past kidney issues and he decided he needed to focus on my kidneys primarily, though my problem this time truly WAS skin deep! His diagnosis was, unfortunately, made once again through .... foot torture!
Jero squeezed my toes so hard I thought they would pop off. I really had trouble tolerating the pain. On the plus side, it did distract me from my skin problem! After all the diagnostics, he made a few suggestions: a massage, which would be much like the foot torture only more prolonged, to help me with the kidney problem which honestly hasn't seemed like a real major problem this decade. I explained to him that I currently had enough pain already. Then he suggested as an alternative an extremely bitter broth that he would make by boiling certain leaves, fruits, and tree bark, and I would have to drink 2 liters of it. I pondered it for a moment, closed my eyes and thought of the number of patients I have seen present with acute renal failure after ingesting herbal concoctions from other countries, and decided there was no way I could explain myself without being ridiculed beyond belief should this happen to me. So, another polite but resounding "no." I did, however, agree to try the topical preparation he suggested for my dermatitis which he would prepare from sandalwood oil.
It was all very interesting, and I tried to think of myself from an external viewpoint and decided that in his world view and context, I was just another typical noncompliant patient. Kind of like the ones I deal with in the world of biomedicine and tampering-with-nature that I visit every day. He, and I, both make recommendations to people that make absolute sense to us, and then it's still up to them whether to follow what we say... I guess at least in this case I was honest with him about what I was and wasn't willing to do.
My next medical adventure of sorts involved teaching a class for Elsha and Phil's staff, which I should have entitled "First Aid in the Third World". They asked me when I arrived if I would teach this, and I thought it sounded like a fun challenge. I needed to teach it to a group of people some of whom did not speak English, some of whom spoke a little English, and all of whom live in conditions where sadly when an emergency happens the first response of a person would never be to call 911 -- first of all it's "118" here in Bali, but secondly the considerations of how much the ambulance will cost and how long it will take to arrive always come into place. So I had to present my suggestions that are based on ideal conditions, and translate and adapt them for real conditions in the developing world. All this without belittling people's naturalistic and animism-based beliefs.
No amount of internet review of the Heimlich maneuver would have prepared me for this.
But it was incredibly fun! My biggest concern was engaging the audience instead of boring them. I started with asking them to relate their own experiences of emergencies they had encountered -- which included the driver always driving past people who'd had motorcycle accidents, another guy having had a serious burn, a third guy having seen a girl unconscious at the beach but didn't know what to do ... So I used these as examples and got my audience involved by asking them to portray victims. They totally got into it and had fun and somewhere in there I got to teach about bleeding, wounds, hygiene, animal bites, nosebleeds, falls, the recovery position, unconsciousness, choking, burns, and I can't remember what else. I first asked what they would do in a certain situation and got answers like 'we would chew a certain leaf and then spit out the juice and rub it into the wound to stop the bleeding..." or "get an old person to make a chalk-like paste...." Tough to reconcile all of this with sterile technique! I tried hard to be respectful, and said "here is another thing you could possibly consider..." Anyway -- it was really endlessly fascinating, and almost endless! What was supposed to be an hour review turned into three, but we all had a great time.
See her blog entry about the class at http://ezinbali.blogspot.com/2009/10/chew-leaf-or-use-hydrogen-peroxide.html. I've got to add this to my CV for sure ;-)
Other fun, nonmedical things I have gotten to do include going to an amazing Kecak performance (see http://en.wikipedia.org/wiki/Kecak) , also known as the "Ramayana Monkey Chant," which is a trance dance with over 100 men chanting as the musical accompaniment (instead of the usual gamelan music that accompanies many traditional dance ceremonies).
It is very very powerful and at the end, a solo performer dances through coconut husks that have been set on fire. Pretty wild stuff.
This morning Dorothy and I went on a really amazing walk through the rice paddies,
stopping at Sari Organik restaurant for yummy pancakes made with beetroot, cashew nuts, banana and pineapple and a nice baba ghannouj and salad. The restaurant is situated in the rice fields and they have their own organic farm.
We got to climb up and get a really nice birds-eye view of the rice fields.
The next distraction was various artists' shops along the rice field path (not unusual as everyone in Ubud seems to be an artist), and some purchases made by me.
I wanted hooks installed on the back, so the guy says he will deliver to my guesthouse -- we'll see if that happens. I do have good vibes about it :) We walked for about 5 hours punctuated by all these stops, passed some locals carrying a whole lotta stuff on their headds, and ended up at a yummy Babi Guling place called Ibu Oka (Koren will eat her heart out if she translates this into English ;-))
Since then, more wandering around. We have *NOT* yet bumped into Julia Roberts, who is here in Ubud for a month shooting the "Eat, Pray, Love" film. Perhaps because I heard she's staying at the Four Seasons and does not hobnob with proles such as us. By the way, I feel that that book (and its whiny, self-absorbed author) have had an influcnce on this area that has not been positive. It has changed the lives of some of the characters that featured in the book and made them way more greedy and self-important, I have been told. It has brought more "women of a certain age" to Ubud who are looking for enlightenment and a prince named Felipe. Having read it, I wouldn't recommend reading it.
But to end on a much more positive note, here's the menu for the dinner we're attending tongiht : http://rumahroda.com/roda/buffet.html. Enjoy :) We will -- even if Julia isn't there!