adventures of a day already lived

One of the best things about backpacking is that you are instant friends with everyone. I rocked up to the first hostel advertised at Honolulu airport having forgotten that crossing the international dateline would give me an extra day (duh!). Within 10 minutes I was asked if I wanted to fill the last spot on a road trip up to the west and north coast of Oahu (also called "Main Island" amongst the four islands in Hawaii). Having no plans whatsoever for a day I didn't plan to have (I liken it to that great feeling of when you unexpectedly find money you left in your pocket), I immediately said yes and we were off!

I had heard that Honolulu was another big city - the touristy beach of Waikiki, hotel villages (eg 5 Hilton hotels with their own shopping complexes..!) and supermalls etc, and so was keen to check out the less populated coastal areas of the island. Knowing next to nothing about the island means that every new thing was a discovery!

First up we dropped by Oahu's famous 'Dole' pineapple plantation and picked up some pineapple sundays

before rock-hopping along a beach known to be full of green sea turtles. They were huge and looked like the rocks that surrounded them (which meant that if you weren't careful you could easily step on one!). The one in the first photo was right on the shore and there were coastal volunteers who made sure that nobody was within 5m of a turtle. If you rock-hopped around the corner, there were 10+ turtles just feeding on the seagrass and  warming up on the rocks. I believe there are 5 in the last photo - hard to spot!  

We moved on to Waimea Bay, which is well loved for the 5m+ rock that you can jump off and for the humpback whales that pass through on their way back to Alaska! We saw one breach (blow air out through its blowhole) in the not so far distance (tiny black thing in the photo). They come down to the warmer waters here to breed and have their babies (between Nov-late April), and return to the nutrient rich cold waters of the north once their calves have enough blubber on them to survive there. The mothers apparently don't feed the whole time they are near the equator, and can lose up to a third of their body weight feeding their calves fat-rich milk. 

On a rock cliff just overlooking Waimea beach was this old guy singing on a uke - it was so funny how much he epitomised the stoned, laidback, chilling, "this is Hawaii" stereotype. I asked if I could jam with him and he turned out to be a nutty professor oncologist named Bob who had slept upon the said rock last night. He told me he had his 'grandmother's eye', and it was as if she had predicted that we would meet. He had inherited much money from his grandfather, was going to give it to away to charity and needed me to help him with it. My Aura, Life force and Spirit were apparently very bright, even with his eyes closed he could experience it. He was looking for a 'Bobette' and didn't care how old I was, his meat suit was 'a-calling'. IT WAS HILARIOUS! He had apparently written a book about surrealism, and had worked in Sydney's RPA for a time. I had to leave, and so he entrusted me with his beloved ukulele, Sarah, and told me he had to see me again. Sarah was the most beat-up ukulele anyone had ever seen - he had added turtles to it and because he took it surfing often, the wet wood had expanded in many different places so he had glued it back together with foam glue. The best thing about Sarah was that he said she always finds her way back to him. I didn't take it with me when I flew to Big Island (the island of Hawaii) the next day, so I believe it should find its way back to him!

We stopped by a food truck for some excellent value thai food and dropped into an native art collector's gallery. This was a paddle to scoop out the first serving of brain when a monkey was killed. 

An obligatory photo with perfumed roadside frangipanis. While visiting a few of the beaches, it was so clear how entrenched surfing was here. So cool to see sun-leathered surfer mums driving their surfer kids to the beach on a Friday afternoon, it's a whole other lifestyle. 

We ended the night watching evening fireworks off Waikiki Beach and chatting away.
Sharing one short day of adventure and leaving it at that is a pretty sweet memory.

x

Ma dernière semaine à Nouméa!

This past month has been such an adventure! So many firsts in so many ways. I remember thinking at the start that my ambition was going to bite me in the butt - I just couldn't see how I'd be able to manage! I don't really feel proud of myself very often, but looking back, I do feel really happy that I challenged myself this way - language, medicine, loneliness and independence. One of the lessons I've learnt is to ask for help. It's very humbling to see the kindness of friends when you're in need. I have so many people to thank for the guidance, help, conversation, insight and laughter over this month.

In my last couple of days in Nouméa we went to watch 'Les Seigneurs' in a beachside pop-up cinema that was literally just around the corner from my place.

N and H

Visited the (kanaky) Tjibaou Cultural Centre, esp renowned for its interesting architecture

Played pétanque for the first time and had a taste of the obligatory matching aniseed liqueur, 'pastis'. It's a wonder how the french version of lawn bowls became so popular amongst young frenchies - i think this is aided by the fact that drinking makes you better at the game, haha. We played in 2 teams where each person bowls 2 'boules' as close to the red ball as possible, and at the end the team who bowled the ball that is the closest to the red ball gets the points for that round. The winning team gets as many points as they have balls that are closer to the red ball than the other team's closest ball.  This pitch is lit up every night - every time we passed it previously there were always ~3 pétanque games happening at the same time. pretty sweet spot considering it's just by the beach! 

Clinical diaries pt 2

In my last week at the hospital I sat in on some interesting cases/consultations. 

1. Delusional parasitosis (aka Ekbom’s syndrome or Mogellons)

At times, I wonder if medicine has failed patients when we start labelling them as crazy. Epileptics were once ‘crazies’ too. Only 3 months ago, this ~40yo lady was ‘normal’. Since she started having the sensation of worms crawling underneath her skin, especially around the time when she has sex, she’s been documenting her discomforts in a diary and sending them nearly daily to the doctor. She’s been through all the normal tests for parasites (blood, stool, skin) and has repeated courses of anti-parasite medication, so if she ever had parasites, they should now be gone. <insert argument with the doctor> Her neighbour advised her to start taking MgCl2 to fix the problem, but it had limited effectiveness on her symptoms and she’s getting diarrhoea. The doctor’s advice was to stop her self-prescription of MgCl2 and see a psychiatrist.

     2.  Miraculous bone marrow biopsy without extra pain relief

My first encounter with a bone marrow biopsy last year led me to believe that it could also be called prescribed torture (we drill into the back of the hip and take out a ~1.5cm piece of bone marrow). The poor patient was trying to refrain from crying out in pain, and despite the ‘green whistle’ analgesic he let out blood-curdling cries that made me persevere and watch the whole procedure because for some warped reason I feel that patients deserved to have us know their pain as a reminder of why we should work our butts off.

Having had only one traumatic experience of just watching a bone marrow biopsy, my heart rate increased significantly when one of my colleagues told the 30yo lymphoma pt that he wasn’t going to be having any patient controlled analgesic (the green whistle). She’d just anesthetise the area locally and that they’d proceed. I was really worried for him and not looking forward to watching. 

Miraculously however she managed to retrieve a perfect piece of bone marrow with the patient telling her that she could push harder if she wanted! The technique is apparently slow and steady, but you have to be forceful to drill into the bone and then to snap the piece from its base. Make sure it is completely dislodged from the base by aspirating the drill piece with a syringe so that when you remove the drill piece, the piece of marrow is in the drill piece and not left behind (what a scary thought that you’d have to repeat the procedure!).

I was seriously so impressed. I wish I will be able to do biopsies like that one day. 

      3. pyoderma gangrenosum on her shins – a systemic presentation of Crohn’s disease (a systematic inflammatory disease that commonly affects sections of the bowel). Painful pus filled 1cm wounds that burst out all over her shins, treated with corticosteroids because it’s an inflammatory reaction. Pretty horrible!

     

     4.  Erythema nodosum – bruise like skin lesions all over the arms and thighs of a scleroderma patient.

     

     5. Subcutaneous metastases that started bursting through skin and from under toe nails in a terminal prostate cancer patient. Varied from small white lesions through the skin of the arch of the foot to red and black bulbous ‘angry’ ones from under toe nails. 

sign on the door of the office for medical staff

2 specialists, 2 specialists to be and me in the medical office. All doctors wear white coats, and a lot of the allied health workers wear white scrubs so it's near impossible to tell who's who! 

nurses' room

Raoul Follereau Leprosy Centre

I must admit, the first thing that really attracted me to NC was the fact that there was a leprosy colony on the island. I had no idea that leprosy still existed – wasn’t it an ancient disease of the Bible that tore apart the faces of crusader kings? Apparently there are 200,000 new cases per year around the world– awful when you think of how it can be cured with antibiotics if it is caught early. It’s one of WHO’s ‘diseases to eradicate’ – I’ve been looking into the definition/process/logistics of disease eradication of late, pretty interesting. After learning that it is quite difficult to catch leprosy if you’re immunocompetent (healthy) and that the very rare flipside is 6 months to 2 years of antibiotics, I thought I’d put on my adventuro-medico hat and see the place before it turns into a museum.

The centre is 30min out of Noumea, and the first thing I saw when I got off the bus was a deer carcass (not unusual road kill victims here). After a good 20min walk down an isolated path that gives you the feeling that they wanted the colony to be very far away from civilisation, I found myself at the edge of a bay. New Caledonia is very physically beautiful, and this bay is no exception. 

I had a long conversation with L, the only patient who is still mentally 'with it'. A lot of the medical problems that the other leprosy patients have are actually to do with their age rather than leprosy (they range from 65-90yo). Many have alzheimer's for example, and aren't really present. 

L is an 82yo who has been living at the centre ever since he contracted leprosy at the age of 30. He told me that both brothers and one of his two sisters also had leprosy, the youngest having caught the disease at 8yo! what a life sentence. Antibiotics to treat leprosy only came into full swing in the 70s. He is the last one of his family to survive leprosy, but he thinks he will be buried in the cemetery behind the colony because there will be no one to take his body up north where he was born. 

He has 'classic leprosy' hands that are stuck in a flexed position, almost making a fist but he can move his thumbs and therefore can write. His right leg is amputated and he can't feel anything with his left leg (since the form he has is more a neuropathy). He has a few open ulcers and his toes are all in different fixed positions. Later I saw him with a fake leg and walking with crutches. He is missing all his front teeth, so when he talks his upper lip flaps. He loves talking so it was a bit funny. His eyes were really watery (they have something wrong with their eyes as well. I think they become very dry so they give him something so that they're always watering). While he has a more neuropathological form, there are 5 main categories that vary between the spectrum of neurological and dermatological presentations. 

he's holding a PEP device to help keep his airways open

This Australia day weekend was also International Leprosy Day, and a trip to the aquarium was organised for them which is nice because they don't get out much. He told me about the different ways they pass the time there, and how that has changed over the years. When I was in the Isle of Pines I met the manager of several of the luxury hotels there and he told me that he installed a vegetable garden about 15 years ago. Unfortunately I don't think it's used very much any more. Now they just kind of sit there on their veranda, they have carers who help them bathe etc and they watch TV. He said he's sick of reading. Before you could talk to the other lepers since there were so many, but they always had the same stories to tell. They used to listen to the radio (started at 5am and ended at 9pm) and he told me about the first time they had a TV at the colony/centre - how extremely excited everyone was and how everyone rushed down to see the black and white pictures flashing inside a box. He told me that he had a wife there too, her name was Irene and she caught leprosy when she was 18. They didn't live together - there was gender and race segregation (Europeans and Melanesians/aka the kanaky) despite all having the same disease.

The site itself has a couple of buildings - one for the 5 remaining leprosy patients and one for the diabetic patients (now that there are very few cases of leprosy, the centre has been turned into a reeducation and treatment clinic for diabetic patients). The old houses that used to cater for the 35 or so leprosy patients are now empty. There's also a chapel - a nun comes to visit on a regular basis. Before there was a cure, nuns used to run the leprosy centre themselves (and some did catch the disease). Brave. 

the chapel

~14 bed diabetes centre

twin room inside the diabetes centre

Ultimately the leprosy patients here are well looked after, though you get the sense that they felt their time was up a long time ago and now are waiting to die. It's more than an eerie feeling. One of the carers asked me if I was afraid of leprosy and I replied in the negative. I think healthcare workers are used to seeing people with many diseases, and this one is as cruel as the next. I definitely hope that treatment becomes more available in the more remote parts of the world, it'd be great to see leprosy finally eradicated. 

Je suis l'externe à Nouméa

Salut à tous et à toutes!

It's currently my second week at the hospital here. I'm with the department of internal medicine here - pretty much means that in the 20 bed ward and in the consultation rooms we see a huge variety of cases that can come under this enormous umbrella (infectious diseases, rheumatology, dermatology, haematology, oncology..) It's a small hospital with branches of cardiology and internal medicine. The 2 main hospitals in Noumea and the private day/elective surgery clinics service all of New Caledonia and its islands, as well as surrounding pacific islands like Wallis. X-rays and ultrasounds are done here but they don't have the facilities for CTs or MRIs. These have to be done at another hospital and so patients are often shuffled around. There are no radiotherapy facilties on the island, so the drs here liase particularly with the haematologists and oncologists at RPA! lots of emails that use google translate, but in the end everyone understands everyone.

There is 1 head honcho, 2 specialists and 2 specialists-to-be (called interns but the system in France is very different ours. They have one year of premed - easy to get into but with a brutal exam at the end. something like a 10% pass rate. Then 6 years of 'undergraduate' med and at the end of the 7 years and depending on their marks/preferences they get into a speciality right out of med school. It takes 3 years to be a GP and then 4-5 years to be a specialist. As a med student, I'm an 'externe' who is doing her 'externat' and once you finish med school and are in your speciality training you're an 'interne' doing his/her 'internat'. I'm pretty much the only student here because all New Caledonian med students have to complete their studies in (European) France or more specifically 'en metropole' (since NC is actually a French island like Mauritius or Reunion Island).

Things were pretty damn challenging at first - everything was going so fast and I couldn't catch a thing!
There are a lot of words that are similar (thank goodness), words that are different (many many many) and words that are 'faux amis' - words with different meanings in different languages - the bane of all learners of any language! for example - a 'ganglion' in french is actually a lymph node (rather than part of the nervous system)! Rx stands for X-Ray instead of treatment. Things are getting better day by day and for the most part I can catch what is going on, even if I don't speak a lot. Taking histories is suddenly 100x more difficult, I lose all structure!

Half the cases during my first week were due to dengue fever (there's a seasonal outbreak atm), then lots of diabetes (patient compliance with meds and treatment is very poor here), classic scleroderma, spondylosis, haematological cancers, terminal neoplasia, lots of gout and polyarthritis due to rheumatic fever. Idiopathic thrombocytopenic purpura that was refractory to corticosteroids, rituximab (anti-CD20) and splenectomy! A Jehovas' witness who agreed to imunoglobulin therapy in the event of a significant bleed after a very very low platelet count (normally you can't transfuse any products into their blood but since the IVIg is completely synthetic..)

In total, has been very challenging but interesting and cool! I went horse riding with one of the doctors at the hospital this weekend, twas my first time and it was awesome!! so many firsts on this trip, woo!

gotta go,
take care folks!

Lifou, a trip of many firsts!

I feel like I winged this whole trip, ahah! On the day I arrived in Nouméa, I pretty much had no solid plans for how to get to Lifou (one of the 3 Loyalty Islands west of NC), who I was going to go with, how I was going to get around the large island, where and how I was going to sleep etc. Everything worked out splendidly, I am especially lucky to have avoided the cyclone that hit the islands the week before!

As I said in my last blog, I stayed at the hostel in Noumea in the hope that I'd meet people I could travel with. I met a lovely couple from Lyon there and they basically adopted me for the week! Quelle chance!

Managed to borrow a tent and snorkelling gear from one of my future housemates, and OOP-LA! I found myself at a camp site in the tribe of Xepenehe (TRÉ-PEN-NÉ-HÉ) in the north west of the island.

  

Lilo Rêve is a play on words - ilôt is a small island and when followed by rêve is a bit like "the little island of dreams" ie Lifou?

These 2 guys are stage lighting technicians from Lyon, 10 months into their year and a half long journey around the world. They've pretty much been camping, caravaning and couchsurfing their way through US, South America and the Pacific (so far). I'm so glad to have bumped into them because they were really welcoming, share everything and really looked out for me.

Lifou is a pretty difficult place to travel to if you're by yourself and if you aren't fluent in French. Everything is done over the phone (only the capital of Lifou has internet) and the only way to get around the island if you don't hire a car is to hitch hike. Pretty much every car or every second car will stop for you if you put your thumb out - a pretty amazing culture/way of life really! It's not recommended for single girls at night, because it's not uncommon for the locals to get drunk and violent after nightfall. On the whole, everybody says bonjour to you, and if you walk past someone's house and you didn't see them, they will call out to you just to wave.  



one of the cats at LiloRêve made me think of the Aristocats' line: "Everybody wants to be a cat, because the cat's the only cat, who knows where it's at!"

apart from showing me how to put up my first tent (or.. my first in about 8 years), my travel buddies showed me how to dehusk and then crack open a coconut with a knife and rock. Took me about half an hour of tearing, pulling and insistence that I do it by myself. coconut trees are everywhere, I think we had one every day as a pre-dinner apéritif haha. the brown ones (above) are sweeter than the green ones that you can cut more easily. 

20 days each month, a cruise ship brings hundreds (thousands) of mostly Australian tourists to Lifou and the island temporarily doubles in population. This also means that it's quite difficult to hitch hike because a lot of the locals take advantage of this and charge tourists to take them to the sites such as Les falaises de Jokin (the Jokin cliffs, pronounced Dokin). After about 1/2-1h of no luck, we decided to turn around when someone picked us up! woo! We had to ask permission from the local chief to go down to the cliffs and swim in the bay. 

the others agreed that the snorkelling at the falaises de Jokin wasn't as good as that at the baie de Jinek so we went there and joined the hundreds of Australian tourists who had come to visit. For some reason they seemed to be very overweight and very bogan. They bought overpriced twisties and coke off the locals (apparently my travel buddies met a girl on the Isle of Pines (another island) who makes 1500 euros per day off them!) 

This is what the Baie de Jinek looks like without heaps of tourists. 

an epic conch with a mollusc inside! 

A beginner's dive is called un baptème in french - a baptism. Neat!  

There are heaps of turtles around. I only managed to see two, but you can see (and touch!) loads of them in the morning or later afternoon if the sea is calm. 

2 well camouflaged clams

There are many of these traditional 'cases' on the island. many people sleep on rolled out mats. My current housemates showed me a picture of a case surrounded by many many marijuana plants - they were told that New Caledonia is second only to Jamaica in terms of weed consumption (or production? not sure). The domestic airport has no regulations/scanners of any sort. You could literally bring anything you want (explosives) on board. 

This is a pretty common site along the roads - colourful hedges. There are a lot of frangipanis and hibiscus here, as well as coconut trees and papaya trees. oh and there are heaps (hundreds) of butterflies - everywhere! it's a bit enchanted at times. 



 There's an empty catholic church about 5 min walk from our camp site in Xepenehe, and behind it is this little tropical secret garden style pathway that leads to this! a huge 20m whole in the ground turned open top jungle. vines everywhere, and a cave with water underneath.

Super impressed by the versatility of coconut trees!

The local town hall in the capital, Wé

Coconut crabs (crabes de cocotier) caught by the people who owned the second campsite that we went to (in Luengoni). To catch them you put a cracked coconut as bait on the ground near coconut trees - normally these crabs have super strong pincers and can crack open a coconut by themselves!  

 

This dog decided to join me in the front of my tent

C and J! lovely french couple who were awesome to me. J said that his moustache tattoo made a lot of kids in South America laugh. We had some interesting conversations with other campers - we had a barbeque with some other french people and some Kanaky people that they invited.

The kanaky culture (native people) is interesting. I only managed to learn a bit, but if you ever get invited into one of their tribes or homes (they often live in thatched huts on the islands), you have to do this thing called a coutume, where you present a gift of money and tobacco wrapped into tissue paper as a sign of respect before you enter the house. they're quite timid people, don't talk much to strangers except to say hello (they'll actually call out to you as you walk past their house), quite dark skinned, lots of kids, no shoes. on the islands, marriages are quite an extended social ritual - so much so that there are 3 months in the year when weddings aren't allowed to occur so that people can just take a break, haha. the month before the wedding is taken up by family members who come to eat and give their blessings. the wedding itself occurs on Mondays, and the following days are full of food as well. it's the groom's family that hosts the weddings/food/costs here. 
They drink this plant root called kava here, it's a bit like alcohol in that it can make you woozy. you're supposed to drink it straight (as a shot) and its effects are potentiated with or by alcohol. apparently it takes like dirt and you want to wash your mouth out afterwards.. so... there was really no incentive for me at all to try this famous drink.

The Champignon or the Mushroom - a rock/island in the middle one of the bays near Luengoni.

These rock formations were outside the Caves of Luengoni. It was all dark inside so photos didn't turn out so well but the caves were amazing! stalactites (organ pipe ones that are in layers) and stalagmites above and below water that was light blue and crystal clear. The pool must have been 6-7m deep and 15-25m long. amazing!

on the whole, Lifou was fantastic. I wasn't sure if I could manage on my own but I'm kinda pleased and proud of myself that I went anyway. a great week off before starting at the hospital! 

x