Blue Peter is alive and kicking

Photo of the week

Highlight of the week: We rustle up an ingenious Mexican meal and invite our friends for dinner

Lowlight of the week: Keith does not get home until 1830 after another busy hypertension clinic

Maximum temperature: 33 degrees Celsius

Rainfall: Nuffink

Keith and I are children of the 60’s. We grew up with few outdoor boundaries. We had to be home for lunch. Home for tea. Home before it got dark. But what we got up to away from those times was down to us. Tree climbing. Snowball fights. Siblings and friends. Sometimes up to no good. But mostly just having fun. When home, TV was a rare treat. 3 channels. Black and white for me. Colour for Keith. Kids’ programmes on late afternoon. A favourite for us all was Blue Peter. A strange collection of activities and stories. Involving dogs. The Blue Peter garden. And making the best toys ever. With old toilet roll inners and egg cartons. And double-sided sticky tape. Only our models were never a patch on those done by Peter Purvis, John Noakes and Valerie Singleton.

What do you want to be when you grow up? A Blue Peter presenter was up there.

It’s Sunday. We sneak out of town. To visit Steve and Anna at Chipembele. At the boundary of our limits. 30 minutes from the park gate. An evening to enjoy the sunset. Gin and tonic. A delicious meal. Since Monday is a “school day” we do not stay late. We head home at 20:00. Passing through a network blackspot. Just out away from Anna and Steve’s house. We emerge to the doctor phone doing its nut. 3 WhatsApp messages ping-in, in quick succession. All from the same camp. Then, a friendly voice rings us for a 4^th time. Our mate Kiki, from Nkwali. Could you come and do a visit? We have a lady who has fallen over. She may have broken her wrist.

Fortunately for us all, Nkwali lies on our route home. We will be there in 20 minutes.

During those 20 minutes we rehearse. What might be the nature of the injury? Hopefully, just a sprain. But if the wrist is fractured, then what should we do? What if the fracture is displaced? Some of you keen readers will recall that I wrote about fractured wrists last year. Let me refresh your minds.

It’s 1991. Keith and I are junior doctors. I’m in my first-year post-qualification. Pre-registration house jobs. 6 months medicine, 6 months surgery. Non-negotiable. Up north in Ashington, Northumberland. I am doing Orthopaedics. Keith is a year ahead of me. Starting his GP training. 6 months in Accident and Emergency. This is where we met. We are having an especially busy day. It is icy. There is a long line of patients, who have all slipped on ice. With fractured wrists. A classical injury. A Colles’ fracture. The wrist changes shape, as the fractured bones ride up upon each other. The wrist assumes the shape of a bent dinner fork. Diagnosed at a glance, without the need for an X-ray. But everyone loves a picture. So, they all have X-rays.If nothing is done, the broken wrist will heal in this position. The dinner fork buggered. Causing endless buggered dinners. A useless wrist and dodgy hand function. So the wrist has to be pulled. The opposing ends of bones realigned. To allow healing in a normal position. To allow for normal function, down the road. If time, expertise and resources allow, a general anaesthetic might be many peoples’ first choice. But drugs are not without risk.

During our training days, a Bier’s block was à la mode. The Bier’s block is a fancy, if complicated, local anaesthetic. Followed by controlled traction and repositioning. X-ray scanners were used to confirm that the bone was straight. Unnecessary radiation blasting junior doctors and patients alike.

See one. Do one. Teach one. That is our mantra back then. Keith is up to the teach one phase. I see him do one. Then he teaches me how to do one. Before the day is out, I have my own list of patients. And I competently reduce one.

Fast forward 15 years, and we reduced a Colles’ fracture, slap bang in the middle of the Pacific ocean. On a dive trip. No Bier’s block. No X-rays. A simple fracture block. By sight and feel alone. A skill not easily forgotten.

Back to this Sunday. As we drive along the dusty road to Nkwali, we reminisce over our romantic pulls at Ashington. Keith was pulling me. I was pulling Keith. Do we still have it if needed? As ever, on arrival at Nkwali, we are greeted with sighs of relief. As we walk through the gates of the camp, the monkey jumps, from one shoulder to another. A visible weight off the staffs’ minds. Stress and responsibility is seamlessly transferred. Now it is our problem. They can relax. The doctors are in camp.

We go to see our latest patient. A 77 year old lady. Jennifer. An unfortunate accident in the bathroom. She toppled over backwards. And landed on both her left wrist and her backside. She is now resting in bed. The wrist supported. And if not touched, or moved, she is relatively comfortable. Two tablets of oxycodone have helped. Her main grumble is her back. The wrist is at a funny angle. Like a bent dinner fork. Our eyes meet. An imperceptible wry grin. A Colles’ fracture. Just our cup of tea. We also do a thorough assessment of the back. No obvious bony tenderness. Mostly muscle spasm. But some uncertainty. There could be some mischief going on there too.

We top up Jennifer’s pain relief. And talk through the options. Jennifer’s daughter, Alice, in the loop. The wrist needs to be pulled into position. We can do that here, under local anaesthetic. Or we can transfer you to Lusaka tomorrow, for it to be done there? We go through the pros and cons of each option. If the wrist is stretched back into position, your pain levels will drop big time. But it will be an uncomfortable procedure. We can administer a haematoma block – a local anaesthetic into the site of the fracture? But pulling the wrist will not be a totally pain free option. Or you can wait 12 hours? During which time you will need to take stronger painkillers. And then you might need a general anaesthetic tomorrow in Lusaka. Jennifer did not think about this for long. Just go for it. Pull it here. I can cope.

And now our Blue Peter skills are called into action. Once the wrist is pulled, we will need to immobilise the wrist with a splint. The straightened dinner fork will need to be held in place. For comfort and for healing. At least until plaster of Paris can be applied. No X-ray. Just an eyeball and knowing fingers to confirm the fix. We warn Jennifer that she may need further straightening in Lusaka.

What might we use as a splint? I go and speak to the camp manager. Nothing is forthcoming. I return to the room. Keith is gathering up bits and pieces. A water bottle holder. Some hotel issue, white disposable slippers. A bandage. Some tape. Sticky, but not double-sided. But tape none-the-less. And before my eyes, he constructs a splint. Even using the water bottle holder’s strap as a sling. Ingenious.

And so we set to. Local anaesthetic. Words of reassurance. A firm grip at the elbow from me. Keith gently holding the wrist. And we pull. The bones move easily. Seconds of discomfort for Jennifer. And suddenly the wrist shape is back to normal. No longer a bent dinner fork. One brave lady. One reduced wrist. The splint works wonders. Securing the wrist in a perfect position. Within minutes, Jennifer is pain free. At the wrist at least. When I ask if her wrist hurts, she retorts: What wrist?

The back remains an issue. Muscle spasm. Tenderness. It is hard for her to get comfortable.

With an array of painkillers and instructions, we leave Jennifer and Alice. The camp team have already jumped into action. They book her on to the first flight out of the valley. Tomorrow morning. I book a hospital appointment for her. And tidy up our paperwork.

Heading home we reminisce. Ashington. Our youth. Some skills once learnt, are never forgotten. Thank goodness for Blue Peter. The source of our resource.

Update 1

The back mischief turns out to be a fractured vertebra. Too painful to manage bumping around on a safari. They head home. The wrist is perfectly aligned. No more pulling needed. The makeshift splint stays in place for 8 days. 

Update 2

Mary and Hayley touch base with us. Mary is making progress. They have an enforced break in South Africa for a few weeks until Mary is fit to fly. She received excellent care in Jo'burg. 

Healing in the best position

We get to grips with cervical cancer and breast cancer prevention

Double trouble. Mzungu meets the Honey Badger

The doctors are getting younger