Thursday, May 24, 2012

Snake bite in Kulban

     I was standing on the clinic porch going through my mental check list of things that needed to be done for the day when a teenager walked up. "Bing Bing" told me that a man named Ma' aw was sick because he had been bitten by a snake and that he needed medicine.  I asked when this had occurred and Bing Bing replied "sambatu lingu," about one week ago. I asked if he could walk and he said no. "Is there anything else wrong?" I asked. "Yes," Bing Bing replied, "His leg is really swollen, and his face feels like it is on fire."  I asked what type of snake had bitten him, hoping I could identify it and possibly read up on the problem, but Ma' aw had been bitten at night and did not see the snake.  I tried to explain that I did not have medicine I could send for Ma' aw and that they needed to bring Ma' aw to the clinic where I could assess the problem and possibly send him to the hospital.  Bing Bing gave me the usual look and said "Oh Chris, it's too far and steep to carry him".  I kept insisting that they needed to bring him to the clinic and finally Bing Bing left.  He never said if he was going carry Ma' aw or not.  I figured that 1 of 2 things would happen.  Either they would carry Ma' aw to the clinic if he was really sick, or I would never hear about it again and I would assume it was not a big injury.  I had thought about hiking to this village to see Ma' aw myself, but a few months ago people from this same village asked for medicine for a man who could not walk due to a skin disease. I decided to hike the hour and half trail that is extremely steep only to find the patient reclining outside and perfectly able to ambulate.  His only problem was he had a skin rash in his groin area and I had a suspicion he was to embarrassed to walk to the clinic.  Unfortunately this jaded my trust in this village and I was not so willing to rush out and see what was wrong with this new patient.  However, later that day Bing Bing's father also came to the clinic and asked me to come.  I called Leonda, the career missionary, and told her the situation and she thought it would be a good idea to check it out. I brought the clinic backpack with supplies in it and also a box that generates electricity for snake bites.  It's a water tight ammo can with an alternator inside that is turned with a handle on the side to produce electricity. The electricity is then delivered to the skin via two cables tipped with a pen like object.  It's very medieval and I heard from another missionary that it really hurts.  It's the only snake bite therapy we have, though according to the pamphlet inside it has not been proven to work. 
     I found Elias, a fellow missionary, and asked, "How would like to go on an adventure?"  He was up for it and dropped off his back pack. I asked, "Don't you want to bring your water and stuff?"and he said "No, it's not that far."  I shrugged and said "O.K." assuming he knew where we were going.  Later I would found out that he had misunderstood and thought we were hiking only about half an hour away.  Needless to say he was very thirsty by the time we made it to Kulban.  We arrived to find Ma'aw on the porch, and I could already see his right leg was massive.  Elias volunteered to wash the leg while I got vitals and asked other medical questions. Once the leg was clean it was obvious that the main problem was that the bite had become infected and he had cellulitis and an abscess.  His leg was very red and hot, with three out of four pitting edema.  I could express pus from the bite site so I decided to drain it.  I made a 1 cm incision over the area and was able to drain about a cup full of purulent material.  By this time it was dark and Elias and I were using our head lamps to finish up.  I packed and dressed the wound and then we stated our case that Ma'aw needed to be carried to the clinic.  We explained that his wound needed packing everyday and that I had not brought enough antibiotics to give him a complete course.  They agreed and said that when they got enough people they would carry him.  They offered to feed us and we enjoyed palm heart and potatoes with rice.  I was thankful and ashamed that I did not trust that these gracious people would take care of us.  Elias and I asked if we could sleep in the village and they showed us a hut.  I had only brought a very tiny blanket and our clothes were wet with sweat.  Elias and I laid down and tried to share the blanket but it only covered our upper bodies.  Bing Bing later brought us two more small pieces of material that we wrapped around our legs and feet. Needless to say it was the coldest night in Palawan since my arrival. Morning finally came and with a reminder to bring Ma' aw to the clinic, Elias and I headed home.  Three days later two church members who were passing by finally carried him to our clinic.  Ma' aw spent 15 days at the clinic so we could pack and dress his wound before he could walk home. 

Chris Kinney

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