AS you can imagine, there are a lot of topics covered in medical school and I must confess I may not have learnt as much as I could.
But one thing I know I wasn't taught was to fetch buckets of water to change the dressings of a patient with toxic epidermal necrolysis.
It was during the usual doctors’ morning handover of patients with Dr Sharon Brandon that we received word a heath patrol in remote Middle Fly had identified a young man with leprosy who would be referred to Rumginae Rural Hospital for treatment and care.
Leprosy is a scourge of rural and remote Papua New Guinea especially in Western Province.
For the next few days I was on the lookout for this patient with leprosy. The days went by and the patient didn't turn up.
Then two weeks later, while in outpatients late one Tuesday afternoon, I was notified the patient had arrived.
He turned out to be a healthy young man, very strong and the only ailment was a few anaesthetic patches of skin.
As I admitted him into the leprosy treatment program I was glad he didn't have any serious complications of leprosy and felt confident that, apart from his fever, once he commenced leprosy medication he would be fit for discharge.
One evening I was awoken by a call on my two-way radio that the patient was having epistaxis (nose bleeds). I stopped one of his medications.
In the morning he had a blistered lip also but was still in good condition.
But by Sunday morning his condition had deteriorated and when I went to do my ward round I found him sitting on the floor next to his bed crying in pain, his brother kneeling next to him.
His face and lips were blistered as well as his eyes and ears. I needed to see the extent of the damage to his skin.
He was wearing a blue shirt, one of his only possessions, and I asked him to take it off so I could view his skin.
It was then that I realised his skin had melted, sort of peeled off and stuck to the shirt.
If I removed his shirt I would take off his skin. It was an unbelievable situation on a calm Sunday morning.
As I tried to remove his shirt, the pain was too much to bear as the skin peeled off his body. In agony he cried out for me to cut off his shirt.
Gingerly I got a pair of scissors and cut off his shirt in pieces. It was disturbing to see both his skin come off like wax and the pain he felt seemed like a man being tortured.
It became clear that the skin on his entire body had peeled off. A truly devastating scenario.
His brother was also distraught and his tears fell down his cheeks.
Finally his shirt was removed and so were his trousers which also resulted in skin peeling off.
I washed his body with IV fluid bags and with bandaged his entire body so all the wounds were covered.
Dr Sharon and I concluded that this was a rare allergic reaction to leprosy medication: toxic epidermal necrolysis (also known as Steven Johnson Syndrome).
The next day, when it came to time for changing the dressings, the same excruciating process of removing the bandages had to be followed.
The pain was going to be so severe I medicated him by injection and got water to pour over the bandages to help prevent them sticking to his skin.
The buckets of rainwater were put into service.
By this time, the patient’s mother had arrived from remote Aeyambak and bore witness to the procedure of removing the bandages to which was stuck skin that was peeling and a body raw and red.
He was again overcome with pain and crying despite the pain relief, His mother also wept at the awful situation of her son.
He had to be naked from head to toe to remove the old bandages and also to wash him prior to applying the new ones.
This terrifying procedure had to be done each day. It was a stressful situation for everyone.
As the days passed he began to curse his skin for the trouble he was in. He lost six kilos and was a shadow of his former self. He was not the strong vibrant man I had first seen in outpatients. He was also hungry.
I bought him doughnuts and okari nuts at the small market beside the hospital.
Rumginae is a remote location and there is not a wide range of food available and no shops to speak of apart from the Rumginae community health worker school canteen.
Another patient bought a piece of pig at the market and gave it to his mother mom to cook.
After two weeks the skin was repaired to the point where changes of dressings were easily done. Every day I bought him doughnuts and okari nuts at the market. It seemed to be the least I could do.
When I went to the ward today with some ice cream, I was pleasantly surprised that, for the first time in two week, he was not in bed.
Medical school hadn’t really prepared me for the pain and desolation that illness can bring in remote Papua New Guinea.
And I have to say thank you to Sister Daniels and community health worker Epami Tu'u for helping change the dressings and bearing the cursing from the patient. Also for cleaning up after the procedure was over.
This was a rare occurrence and I don't know if I'll ever see another patient with such a serious disease. I hope I don't.
Had he died, it would have been another wound to my heart. But he survived and instead my heart is blessed.