Fieldset
Some Medical Matters

As the months pass, examples of significant medical and surgical cases amongst the people boarding our good ship Phoenix are accumulating. I’ve drained several impressive collections of pus so far, in various parts of the body.

As the months pass, examples of significant medical and surgical cases amongst the people boarding our good ship Phoenix are accumulating. I’ve drained several impressive collections of pus so far, in various parts of the body. These abscesses are relatively common due to prior unhygienic conditions and clothes unwashed and unchanged for weeks. We also transferred a young man to hospital one blustery night via the Italian Coast Guard, suffering, and that is the precise term, from a spontaneous testicular torsion.

One young woman arrived on board wild-eyed and babbling, wrists gently bound with a scarf by her fellow passengers, struggling with some psychosis after who knows what experiences. Injections of the sedatives haloperidol and diazepam calmed the mental storm enough to allow her some much-needed rest. She was admitted to hospital shortly after our arrival in Sicily, yet another example of treatment provided without regard to ability to pay, or nationality, or anything but human need. Molto grazie, Italy! If only the rest of the reception process for new arrivals could be handled so adequately. Italy, and especially Greece, struggle to cope with this ongoing crisis. The rest of the world should step up.

Another younger man reported unusually frequent urination (polyuria) over the preceding month. His blood glucose was normal, but there were abnormal amounts of protein and blood in his urine. He’d had an untreated severe throat infection a couple of weeks before the onset of the polyuria, and I suspected an immune cross-reaction between the throat infection and his kidneys (post-streptococcal glomerulonephritis and subsequent nephrotic syndrome). Fortunately this often resolves over time. If only he could have received appropriate initial treatment, he wouldn’t have been exposed to the risk of permanent kidney damage.

There are also the disturbing cases of women recently raped in Libya, or en route there, who bravely share this information. We can treat for most of the possible resulting infections, provide some attentive counseling, and test for pregnancy, but the healing road ahead is long and uncertain.

Some patients have taken me by surprise amongst those with obvious skin conditions, sea-sickness, dehydration, post-traumatic injuries, effects of sexual violence, respiratory infections, general anxiety and body aches, and so on. One such was a 28 year-old fellow complaining of headache, nausea, and... changes in his vision. I was shocked to discover that his blood pressure was 260/180, easily twice normal and with his symptoms, well into the definition of a hypertensive emergency. After treatment it improved to 227/156 and his headache and vision were somewhat improved, but of course I referred him directly to hospital upon disembarkation.

The final patient of mine for today’s “medical matters” had no functioning kidneys. That is correct. To stay alive she’d relied on hemodialysis twice a week for the previous three years. As the situation in Libya and her financial resources both deteriorated, she saw no option but an all-or-nothing gamble on a place in an overcrowded and unseaworthy wooden boat to Europe. By the time I saw her shortly post-rescue aboard the Phoenix she didn’t look good, not having had any dialysis for three weeks. Her breathing was shallow and rapid, her movements slow and weak, and she’d focus on any question seemingly from a great distance, responding in short sentences.

An EKG tracing showed the ominous and characteristic changes of excess potassium levels in her blood, tall peaked “T” waves and and an irregular rhythm. Intravenous calcium gluconate and other initial treatment had some good effect, but we prepared further medications and equipment for the real possibility of cardiac arrest. Happily, within the hour we transferred her to a nearby Italian ship, from where she was promptly flown by helicopter to Lampedusa and life-saving hemodialysis. I consider this a fantastic team “save”, for a condition I never expected to encounter in this context.

I didn’t meet the last person I’ll close today’s blog with, mentioned in a late-July bulletin of another MSF team’s efforts. The unconfirmed but credible report is that on a wooden boat at least thirteen people crammed below near the engine were found dead, presumably from the heat and fumes. Meanwhile on deck, a legless amputee in a wheelchair was said by companions to have passed away from unspecified causes, just minutes prior to the start of the rescue operation.

The kinds of “medical matters” described above, and the prevention of mass drownings and deaths due to heatstroke and dehydration, are just part of what MSF is attending to in the summer of 2015 on the Mediterranean Sea.