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The boy with the bladder stone

I was standing in the courtyard outside the surgical ward, when a man approached me with his 14-year old son. Are you the surgeon, he asked? Then he went on to tell me how his son had suffered from recurrent urinary tract infections the past 4 years, resistant to the available antibiotics. They finally saved enough money to have an ultrasound examination that showed a 3*3 cm stone in the bladder. They came from a city 6 hours away by bus, and they had visited 5 hospitals already asking for advice, and everywhere they were met with the same answer: “No, this we cannot do. We do not do specialized surgery here.”

Hospital Duekoue Ivory Coast
Sterilized surgical equipment, Ivory Coast

In fact, the operation itself: A small incision, open the bladder, remove the stone and close again is relatively simple and takes no more than 15 minutes, however bladder stones are not common in the Ivory Coast and none of the general practitioners (with surgical competences) or surgeons had done it before. As recurrent UVIs may well harm the kidney on the longterm, there is good indication to remove the stone. I did not have access to ultrasound but I trusted the father´s description and scheduled the boy for surgery the next day where I removed the bladder stone uneventfully and inserted a normal Foley catheter. The only adverse event came after 7 days where it was entirely impossible to remove the Foley catheter as we could not empty the balloon, thus I had to open the bladder and puncture the balloon, remove the catheter, replace it with another Foley, wait another 7 days, after which this catheter was finally removed and the boy discharged. The last thing I remember was his father hiring a photographer for the money he did not have to take a picture of me together with his son as he was convinced that ”God and I had saved his life”:

Bladder stone Ivory Coast

March 2012, Duekoue, MSF supported hospital, Ivory Coast.

All stories and photograph with permission of the involved patients.

a day in the life of an offshore medic

Between 2013 and 2015 I worked as a rig medic on the Maersk Deliverer (Maersk Drilling) located offshore Cabinda, Angola.

Below a typical day onboard:

05:50 The Sick Bay is supposed to open at 6am. I get up at the last minute and walk the 20 meters upstairs from my cabin..

06:00 The daily rush hour in the Sick Bay is  6-8 am: The crew on night shift just got off, and if they have some medical concerns they will see me before they go to bed. The day crew also prefers to visit the Sick Bay early. Furthermore all the managers both off and onshore start working at 6-7am(and sending emails) and issues may come up at the morning meeting that requires my input: Questions about the status of medicine supplies, maintenance of medical equipment, advice on certain haphazard chemicals etc.

Drilling on the Maersk Deliverer
Drilling on the Maersk Deliverer

06:30 Daily water test: I test a sample of tap water in the Sick Bay. The water onboard is produced by a fresh-water generator.

06:45 Two crew members present with what looks like a common cold, both Angolans. I test both for malaria and both test negative.

07:00 I walk the 50 meter down the corridor to the galley, where I grab breakfast. Bacon and eggs..Breakfast is served between 5 and 7 am, and includes pasta dishes and french fries as this meal serves as “dinner” for the crew working 12 pm-12 am.

08:00 Via email I am advised of several crew member needing an update of their DMA Medical Certificate. I work with the RSTC to arrange appointments with them..

09:00 Time for coffee break in the galley with the Camp Boss and the Chief Cook. No issue is to small to be discussed here.

Abseiling, Maersk Deliverer
Abseiling, Maersk Deliverer

10:00 I go through the medical inventory.  This may takes several hours, and I perform one inventory per month. The autoclave failed the testing and it has been decided to replace it. I briefly go down to check some ordering issues with the MatMan.

11:00 Several crew members pass by and ask for seasickness medicine. It is crew change day for many of the Angolan employees who crew change by boat. They transfer from the rig via a basket to the boat, which then takes them onshore. Unfortunately I have never tried this basket transfer myself as I always transfer by helicopter.

12:00 Lunch is served in the galley from 11-13. There is actually a choice of healthy food, vegetables and salad next to the deep-fried foods. I make a sandwich.

13:00 The bimonthly Safety Meeting is held in the TV room. The Safety Officer presents the safety data and one topic is singled out for discussion. Today it was about wearing the correct PPE.  A monthly safety award is presented to a crew member who has made a significant contribution toward safety. 

Maersk Deliverer in Port Elizabeth
Maersk Deliverer in Port Elizabeth for the 5-yearly yard stay

15:00 Time for the daily afternoon coffee again with the Camp Boss and Chief Cook. The TV screen on the wall displays some of the key safety performance indicators such as days since last LTI (Lost Time Incident).

15:30-18:00 Time for the weekly safety inspection, which takes me all around the rig checking the various first aid equipment.

15:30 I am called on the PA system. It turns out one of the crew members have a headache.

18:00 I go down to the gym and run 8 km on the treadmill.

Casings, Maersk Deliverer
Casings, Maersk Deliverer

19:00 Dinner. Lasagne, my favorite dish. I asked the cook if he could make it.

21:00 Time for the weekly safety drill. This week the scenario was fire on the main deck. The four crew members acting as stretcher team and assistants to me are called to the site, to transport and move a dummy. After the drill, the team leaders meet for a debriefing on the bridge.

22:00 I take a walk on the helideck. Everyone around the deck is busy assisting the drilling operations and the PA system goes off every 20 minutes. The rig is active 24-hours, no difference between night and day.

General information: The basic things one should know about the job of an offshore medic.
Photogallery of my time as an offshore rig medic on the Maersk Deliverer is available on flickr.

Mediterranean boat migrants doctor in Greece: A typical day at work

A typical day in November 2015 on Lesvos, Greece:

09:00 It is olive harvesting season and I  liberate my car from under a huge net meant to catch the olives from the trees on the parking space. I share a house just outside Molyvos on the north coast of Lesvos with two other volunteers, respiratory therapists from the United States, who mainly work on the North Coast.

Treating patient at Moria Camp
C leaning a wound  at Moria Camp

09:10 On my way to Moria Camp I pass an interimistic  camp. 50 people, who had arrived by boats during the night waited for busses to transport them to the transit camps.

10:00 I arrive at Moria Camp.  Colleagues are already at work examining patients, who queue outside the tent. Many patients do not speak English. That seems to be the main issue right now. I then began the day by walking around the hill looking for translators: Farsi-English was the no. 1 need as the Arab-speaking Syrians were registered, and thus left for mainland Greece sooner than the other nationalities.

Treating patients at Moria Camp
Treating patients at Moria Camp assisted by a translator

10:30 I had succeeded finding three volunteer translators, all waiting to be registered them selves: A 21-yr old woman from Afghanistan, a 20-year old man, also from Afghanistan and another 20-yr man from Iran. Female translators were in particularly high demand, for cultural reasons.

11:00 I start to see patients. Most have minor illnesses, mainly  common cold and many ask for antibiotics. Tooth problems are another major issue, for which we as doctors can do little but dispense painkillers. Our pharmacy was remarkably well supplied as several volunteers had brought medicines with them. Furthermore, complete strangers would come by and donate medicines while others would buy medicines according to a list made by some of my colleagues at the local pharmacy.

Dentist at work at Moria Camp
Dentists at work at Moria Camp

12:00 A 20-year old Afghan male arrived with severely burned fingers, which he explained happened when lighting a campfire in Turkey. Luckily our extraordinarily well-stocked pharmacy had the items needed to treat him.

12:30 Out of the blue, two dentists arrived with their equipment. They installed themselves on a plastic table right outside our tent and started working.  This first day they performed five tooth extractions.

14:00 A young man, paralyzed from the lower neck and down arrived in a wheelchair pushed by his brother. The young man had been paralyzed for 11 years after he broke his neck falling down from a rock. The told me they had made the long journey from Afghanistan hoping his brother could be cured in Germany.

Treating boat migrants during night on Lesvos
Examining new arrivals in the evening

16:00 I left Moria and drove up to the North Coast. It was a quiet afternoon and I chatted with volunteers from some of the other groups.

19:00 A big boat with more than 200 migrants arrived at the harbor of a small fishing village as I drove by on my way home. I went out to have a look, but all seemed fine.