My brother is the doctor in the family. The thought of me doing anything more than applying plasters and handing around paracetamol would probably make him laugh - I go green at the sight of blood and, if it is my own blood, have been known to pass out entirely. Needs must, however, and as the person with the First Aid certificate and the largest First Aid kit, I have been designated team doctor.
Caring for our trekkers is a relatively straightforward affair: they can communicate their symptoms and know the advantages (and limitations) of living on a diet of Immodium and electrolyte solution. They keep themselves relatively clean and drink plenty of water. My greatest challenge, therefore, was with the seven porters and guide.
One tiny, spartanly equipped medical clinic covers the whole of the Wakahn Corridor. The nearest hospital is at least two days drive away in Faizabad. Maternal mortality is the highest in the world, life expectancy at birth is just 44 years, and most people have never set eyes on a qualified doctor. Anyone who carries a bag of davai (medicine), therefore, is not only an extreme curiosity but also up there with the gods.
The first two sets of symptoms presented to me on the trip were, not surprisingly, upset stomachs and headaches. These resulted almost certainly from a) drinking dirty water and b) getting dehydrated. It was rather a catch 22 situation but I felt the latter to be more pressing, particularly given that even in the villages the water tends to come straight from the river. Having heard on the grape vine the miracles of davai, the porters in question were keen to simply pop a pill and wait for the effects. They seemed rather disappointed when I explained they needed to increase their water intake by a couple of litres a day. It was only when I offered a couple of paracetamol along with the water that they cheered up.
Of more concern to me were the infected cuts. Nobody had explained to these men the link between dirt and infections, so simple cuts and grazes quickly turn in to abscesses. Not only is this painful but here, where there are no antibiotics, it can be life-threatening.
I started by making each porter clean his own cut thoroughly with boiled water and then antiseptic, and became increasingly fierce as they cleaned around the wound but avoided the bit that actually hurt. In one case I actually got out the latex gloves and cleaned the wound myself as unless the dirt was removed it wasn't going to get any better.
Once cleaned I applied Savlon spray or a topical antibiotic cream to the wound. The non-comprehension of the importance of cleanliness was reinforced when one porter went to use his finger, black with dirt, to rub in the cream. I explained as best I could why this was a bad idea, but I think the lesson will take a while to learn.
To keep the newly clean cuts clean, I dug out giant plasters and surgical tape. They're both fantastic inventions. The porters could also show their plasters off proudly - proof they had indeed seen the doctor. Where appropriate I made sure that each man had sufficient sterile wipes and replacement plasters for the days to come. There was no point undoing the good work they'd done so far. In one case where the wound had already swollen nastily - the one in fact I'd cleaned myself - I dug out a course of broad spectrum antibiotics and explained in a hotch-potch of languages how often he needed to take them. Had we been in reach of a proper hospital it'd probably have been better to lance the wound, give him an injection of antibiotics and stick him on a drip for a few days, but there are no such luxuries here. You can only use what you have to hand.
Sometimes I become infuriated when I travel. The lack of access to basic healthcare and education always chafe most of all. It costs next to nothing to teach people basic things to help them keep healthy: boil dirty water before drinking it; wash your hands after you've been to the toilet; clean any cuts and keep them clean and dry if you want them to heal. It's not rocket science but if no one ever tells you whey you get an upset stomach, a headache or a skin infection, you can't prevent it happening next time. In parts of the world where the doctors don't reach, prevention is undoubtedly your best chance of survival.
Caring for our trekkers is a relatively straightforward affair: they can communicate their symptoms and know the advantages (and limitations) of living on a diet of Immodium and electrolyte solution. They keep themselves relatively clean and drink plenty of water. My greatest challenge, therefore, was with the seven porters and guide.
One tiny, spartanly equipped medical clinic covers the whole of the Wakahn Corridor. The nearest hospital is at least two days drive away in Faizabad. Maternal mortality is the highest in the world, life expectancy at birth is just 44 years, and most people have never set eyes on a qualified doctor. Anyone who carries a bag of davai (medicine), therefore, is not only an extreme curiosity but also up there with the gods.
The first two sets of symptoms presented to me on the trip were, not surprisingly, upset stomachs and headaches. These resulted almost certainly from a) drinking dirty water and b) getting dehydrated. It was rather a catch 22 situation but I felt the latter to be more pressing, particularly given that even in the villages the water tends to come straight from the river. Having heard on the grape vine the miracles of davai, the porters in question were keen to simply pop a pill and wait for the effects. They seemed rather disappointed when I explained they needed to increase their water intake by a couple of litres a day. It was only when I offered a couple of paracetamol along with the water that they cheered up.
Of more concern to me were the infected cuts. Nobody had explained to these men the link between dirt and infections, so simple cuts and grazes quickly turn in to abscesses. Not only is this painful but here, where there are no antibiotics, it can be life-threatening.
I started by making each porter clean his own cut thoroughly with boiled water and then antiseptic, and became increasingly fierce as they cleaned around the wound but avoided the bit that actually hurt. In one case I actually got out the latex gloves and cleaned the wound myself as unless the dirt was removed it wasn't going to get any better.
Once cleaned I applied Savlon spray or a topical antibiotic cream to the wound. The non-comprehension of the importance of cleanliness was reinforced when one porter went to use his finger, black with dirt, to rub in the cream. I explained as best I could why this was a bad idea, but I think the lesson will take a while to learn.
To keep the newly clean cuts clean, I dug out giant plasters and surgical tape. They're both fantastic inventions. The porters could also show their plasters off proudly - proof they had indeed seen the doctor. Where appropriate I made sure that each man had sufficient sterile wipes and replacement plasters for the days to come. There was no point undoing the good work they'd done so far. In one case where the wound had already swollen nastily - the one in fact I'd cleaned myself - I dug out a course of broad spectrum antibiotics and explained in a hotch-potch of languages how often he needed to take them. Had we been in reach of a proper hospital it'd probably have been better to lance the wound, give him an injection of antibiotics and stick him on a drip for a few days, but there are no such luxuries here. You can only use what you have to hand.
Sometimes I become infuriated when I travel. The lack of access to basic healthcare and education always chafe most of all. It costs next to nothing to teach people basic things to help them keep healthy: boil dirty water before drinking it; wash your hands after you've been to the toilet; clean any cuts and keep them clean and dry if you want them to heal. It's not rocket science but if no one ever tells you whey you get an upset stomach, a headache or a skin infection, you can't prevent it happening next time. In parts of the world where the doctors don't reach, prevention is undoubtedly your best chance of survival.
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