Small Cuts and Medevacs: My Unfortunate Trip to South Africa

During PST, trainees will have many safety and health sessions with the Peace Corps Medical Officer (PCMO). PCMOs are responsible for the in-country medical needs of all trainees, volunteers, and staff. Though they are medical doctors, they don’t have a large facility with fancy equipment (especially in Malawi!) and are more generalized in their practice. If a patient comes under their care that they can’t handle because of lack of resources and knowledge, the Peace Corps has a well thought out evacuation plan they can implement in conjunction with a regional medical hub and Washington D.C. For Malawi and much of southern and east Africa, South Africa is the only place where intensive care and major procedures can be done in a safe and effective manner. Medical evacuation (medevac) from a host country is a serious decision by the Peace Corps staff. It isn’t taken lightly and is done to ensure the safety of Peace Corps trainees, volunteers, and staff.

Of all the sessions the PCMOs teach, there are many where trainees often brush them off as inconsequential. Many think, “If the PCMOs could have their way, they would have all staff and volunteers doing their work in impenetrable plastic bubbles”.

 

bubble-boy

This is what PCMOs seemingly want us to be dressed in.

Many trainees say, “That will never happen to me,” but then it does. It happened to me.

The cohort was traveling to do site visits, where trainees are able to check out their new homes for a week before heading back to homestay to finish up training. My site visit puts me at one of the farthest traveling distances from where the cohort’s homestay training was. My future home would be in Nsanje. It encompasses a two-day trip with a stop in Blantyre (a major commercial city in Malawi).

I had a small accident during transport where my right hand got a small, superficial cut on the pinky finger knuckle. I thought nothing of it. I didn’t bandage it or but triple antibiotic cream on it. I thought the cut would just heal, no problem. It barely even bled!

The next day, the hand got increasingly more painful. I contacted PCMO later in the day when I had finally made it to the homestay hub in Kasungu. The PCMO said to go the night with it. He gave me instructions on how to care for it. If it got worse, then he would come to check it out.

Though I was tired from traveling, I still couldn’t sleep due to my hand. I woke up early the next morning to find that my hand was twice it’s normal size, my arm was beginning to become swollen and I couldn’t move my fingers. The pain was extreme!

I texted the PCMO who arranged to come as soon as possible. The order was to have me picked up and sent to Lilongwe, the nation’s capitol, for inspection and treatment. The trip is about two hours. I figured I would be home by dinner time and only packed the clothes on my back, a wallet, a jacket, and phone.

When I got to Lilongwe, the PCMOs face when he first saw it let me know that something was seriously wrong. He examined my hand and gave me the first of many pain medication doses. He arranged for me to go to a nearby hospital.

The hospital would do x-rays on my hand. They would put me on an IV drip with heavy antibiotics. The hospital was ran by an American missionary who the next day would be moving to Kenya to do HIV/AIDs work. It was declared that my situation was extremely serious and that plans should be made for my immediate departure to South Africa for intensive care. The next morning, I was boarding a commercial plane to Johannesburg, South Africa with a Peace Corps Malawi registered nurse named Anne.

We found the Peace Corps driver in Joburg and met the Regional Medical Officer, the kind and friendly Dr. Max. We were escorted 40 minutes away to Pretoria where I would be admitted to The Little Company of Mary Hospital.

The doctor that was contacted and scheduled to work with me met us in the lobby. Facts are a little blurry at this point because I was well drugged up on powerful pain and anti-inflammatory drugs. All I remember is him taking one glance at my hand and saying sternly, “He’s toxic.”

I become sober instantly. What does that mean?! Come to find out it means I had a case of sepsis and it was moving fast up my arm towards my heart and brain. Sepsis is nothing to mess with and action must be taken fast otherwise it leads to systemic failure of organs and eventually death. Sepsis is essentially an infection of the blood. Common symptoms of sepsis include those related to a specific infection, but usually accompanied by high fevers, hot, flushed skin, elevated heart rate, hyperventilation, altered mental status, swelling, and low blood pressure. I had all these symptoms.

I was rushed into surgery to open up the infection. The doctored commenced to clean the wound. He indicated there had been two tablespoons of puss-like fluid trapped around the origins of the infection! He claimed that if Peace Corps would have waited 24-48 more hours that the infection would have spread to the major organs and I would have gone into septic shock.

I came out of surgery with long tubes coming out of my neck, a painful catheter, and a wrapped, throbbing hand. I hadn’t even remembered going into surgery but apparently I was cracking good jokes right as they fed me the medicine that would put me to sleep! They had to double the dosage because I apparently didn’t react to the normal amount. The doctor bought me a Coke for all the good laughs I gave him and his team.

I woke up from surgery in ICU. I was watched closely by a nurse. On day two I would demand that the catheter and tubes be removed from my body. They were simply too painful, more painful than the hand that was twice its size.

I worked hard to get the hand to become mobile again and showed the nurses that I was capable of surviving on my own. I wanted to get out of ICU and down to the general ward, where I would have more freedom and a TV.

I got down to general ward. The IV bag machine would become a ball and chain for me. Any movement I made I had to adjust it with one hand (my other obviously not functional). To use the bathroom. To adjust a pillow. To eat. Everything took three times as long but I quickly figured that was okay: I was alive and I had all the time in the world to accomplish a task.

The nurses were kind. It was fun to hear them speak so many different languages! South Africa is really diverse and there are 11 different national languages!

I wanted to get out of hospital as soon as possible. Early on, I was annoyed and frustrated that I was missing time with my host family and cohort back in Malawi. I wanted to be in the sessions, laughing and learning with the group that I now considered a collective friend.

But going home wouldn’t happen soon. The following Monday, I would have to go back into surgery to have the wound closed with 20 stitches. The arm would get worse. The infection would move all the way to my neck. This made the doctors very nervous. They increased the antibiotics and IV intake. They checked on me frequently to make sure I was elevating my hand. For a week and a half, I laid down in a hospital bed with my hand raised above my head. As soon as the infection got as worse as it would get, it started retreating hastily. Within five days, my hand was operational (for the most part) and the swelling and fever had subsided.

The next step was to go to the Peace Corps guest house. This is a place volunteers go when they are discharged from the hospital and are waiting for doctor’s approval to commence work once again. I wanted to do anything that would get me out of a hospital gown and away from the IV machine. I pushed for the doctors to release me. I needed to get back to Malawi! My cohort would swear in as volunteers on May 7!!

I stayed at the guest house for a total of three nights. On Monday, May 5, I pushed to be released back to Malawi. I was granted permission! As I write this, I have a plane ticket in hand for a flight out of Joburg at noon. I should be back in Malawi by dinner and should have no problems swearing in tomorrow as a volunteer!

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After the second surgery, the hand was huge and swollen.

And that is my story of how I was medically evacuated during Pre-Service Training. Thanks for all the prayers and support!

Remember, listen to the PCMOs! They aren’t being silly or trying to scare you. They know from experience. I wish I would have listened better to the PCMOs. This whole incident could have been easily avoided by implementing a couple safety procedures. C’est la vie!

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