Here in Burma / Myanmar for a 5 day stint.
I'm on call most of the port and staying on ship for most of the 5 days (I get India completely off in return). This port is the most industrial yet and we are almost 2 hrs from Yangon city center, too far to go and still be available on ship if needed. Feeling temporarily glum about being grounded here but getting a lot done. This will seem so mundane I'm sure, once we have all seen my family's photos from this amazing country, but my day yesterday consisted of working, climbing all the staircases on the ship several times to work up a sweat, playing ping pong with our counselor (we are on a cruise-like ship after all), catching up on email (blah), and recharging with a massage. It was lovely outside at dinner time as the the poor air quality unfortunately makes for gorgeous sunsets. A few of us ate outside and watched the fishing boats go by. At night you can see fires on the shore, not so far away, presumably people who live near by, burning brush or taking care of trash.
Working on a few evolving medical issues -- 1) fever and rash (diffuse, macular started on face and chest spread to abdomen over 24 hours) getting worked up in Yangon. There is a measles outbreak here in Yangon but she wouldn't have had time to contract it, incubation 6-14 days, plus she has been immunized. No joint aches or myalgias but history of dengue 3 years ago while traveling in north Africa, concerned it could same (and since course of Dengue is often worse, more risk for hemorrhagic course, the second time around, I was somewhat relieved when initial serology returned negative). She is on doxycycline, her only med and newly started as we enter malaria risk zone so it could certainly be a viral illness with or without concurrent drug rash (to med colleagues, would you stop the doxy? [update, I did stop it, out of an abundance of caution; there has been no change in the rash except to be slightly more itchy and not as distinct. Clinically she is now well).
2) rusty puncture wound 200 miles away at the elephant sanctuary, tetanus shot conveniently within the past 5 years (4 months actually) and childhood imms up to date. Initially we thought someone (unknown to this voyager) had also punctured his hand on the same rusty metal because of a blood stained napkin right next to the rusty metal and this voyager's companion was concerned for possible bloodborne pathogen exposure. Further investigation at the scene revealed that the napkin was with inked with red writing, not blood, and we all breathed a sigh; I had been set to call the national PEP hotline (there is such a thing, cool! and we do have 2 courses of PEP on board the ship, cool!). All of this communication is via spotty cell service and WiFi and takes 10 times longer than we are used to...
and 3) the biggie, considering medical repatriation of another voyager for recurrent respiratory illnesses (this would be our first voyager to leave the ship and though it's apparently very unusual we haven't had to send anyone home yet, five ports in, for either medical or disciplinary reasons, this would be a huge bummer for our community for lots of reasons). May be able to write more on this later.
More voyage updates:
I continue to love my health care team. Our counselors are getting busier as you might imagine (like any community, we are forming and storming, but not quite to norming or performing). The counselors make such a great pair, VERY different from one another but complement each other well and (of course, right?) are excellent communicators. Emily and I are staying busy down in clinic. A pattern is emerging where the first couple of days post-port are very busy as people recover from exploring and playing too hard, not sleeping enough and from their occasionally drunken exploits (a minority of students but the illness and injury that can result can be really time-consuming).
Crew medical works closely with us each day, rooming our patients, acting as our pharmacists (whatever you do, do not touch the med closet! It throws everything out of whack!) and offering wisdom about everything ship-side. Both RNs have worked here for over a decade and their institutional knowledge has been invaluable. Crew medical is also in charge of caring for crew medical issues, of which there are many fewer than passenger med issues. Only 160-something crew and they are not off exploring each port at break-neck speed. We are usually finishing up during crew clinic and get to see what's going on behind the scenes a bit - we've seen them care for a few occupational injuries (wrist pain in a kitchen worker, a sliced hand) as well as a few colds, coughs, rashes, etc, but it's quiet compared to passenger clinic.
Crew medical also is in charge of monitoring what I can only describe as crew hygiene. All kitchen workers visit clinic weekly so that Dr G can check the length of their nails and to make sure they have no cuts on their hands. She is very kind as she touches their hands, inspecting them and then signing off, giving each person a piece of chocolate as they go. It's pretty amazing from a food safety perspective (the Flahertys would approve), but it feels so invasive every time I see it.