A recent Patrol Report excerpt
The ADI Patrol team’s accommodation at Masahet is in prime location – it is saddled perfectly by the Health Centre at the rear and a spectacular little reef right out the front door.
After a day of walking in the sun performing house visits at Mahur, we returned to Masahet where I enjoyed a tranquil snorkel around our reef. I rinsed off using a bucket of fresh tank water and changed into a clean laplap and meri blouse to settle down on the porch for some sunset report-writing.
Just as I sat down, a banana boat sped over the reef to shore and six young men jumped out, dragging a limp middle-aged man from the boat. I followed them to the Health Centre where Sr Albina, the Nurse in Charge, was thankfully sitting outside – she unlocked the Health Centre and led us to a small, dark and humid room with a single bed where the men set the soporose body down.
Under torchlight I could see that the man’s shorts were soaked with urine and his laboured breathing was accompanied by a stridorous moan – an indication that his vocal chords were contracted against the flow of air. He was having a seizure.
His son explained that he’d been like this for four hours already (status epilepticus – medical emergency) and Sr Albina informed me that he was a known epileptic, a devastating sequelae of having survived childhood cerebral malaria.
Despite an adequate supply of antiepileptics at the health centre, a number of reasons could have contributed to why the patient hadn’t taken any for months.
Glucose levels were normal, temperature was mildly elevated (likely a result of the seizure-induced increased metabolic rate), no recent head injuries, no recent alcohol/”HB” (homebrew) intake – no clear reversible causes of seizure were found. Thankfully, in her recent inventory of the dispensary, Sr Albina had almost sent her unused Paraldehyde back to the health centre at Lihir as she was not familiar with its use, but decided to hold on to a few vials – just in case.
After instructing Sr Albina to administer the paraldehyde into the man’s backside, the seizure eased and I used ADI’s pulse oximeter to demonstrate to Sr Albina and the patient’s family how positioning of the man impacted his oxygen levels. We rolled him in to the recovery position with a slight head tilt and his oxygen saturation picked up from 82% to 94%. He slept the rest of the night and awoke the following morning with only a sore behind.
Sr Albina later informed us that had the ADI team not been present to help, she would have had to transport the man across the open ocean at night for treatment at Lihir Medical Centre – a costly and dangerous trip for the patient and his family.
Sr Albina now knows how to manage status epilepticus with her own supplies and has scheduled a follow up appointment with the patient to support his adherence to Phenytoin.