Tuesday, October 20, 2009

October 18, 2009 - Baramahamay Baie, Madagascar

We had a nice sail south from Nosy Sakatia yesterday. Late afternoon we anchored deep inside a protected, mangrove lined bay. No sooner had we dropped anchor than a dugout pulled up with a young boy paddling while a man about our age rode in the bow. We did the usual introductions and then the man took off his shirt to show off a gaping wound on his back. As our French is pathetic (we'd come to rely on Suzy interpreting for us), we couldn't get a line on what had happened. The wound over 3 inches long and a half inch deep and wide. The flesh around the wound was swollen and red, while the wound itself was yellow and goopy with some dark spots that looked like old coagulated blood. Neither of us had ever seen anything like it.

After some rather comical attempts at communication, Sten came to understand that the wound was four days old. Our offshore medical book assumes that wounds will be treated quickly (such a western notion) so we were unclear on how to proceed. We were tempted to try to close the wound as it was easily large enough to warrant stitches or steristrips. I gave them a Coke to drink while Sten called up his dad who told us it was too late to close it and gave us a rundown on how to treat an infected wound. I ended up cleaning the wound using a large irrigating syringe and iodine sterilized water. Yellow flecks of putrefied flesh were flying everywhere. I had on gloves, but when the flesh started flying, I wished that I'd thought to put on my shades. Then I bandaged him up (making sure his son was watching so that he could replicate the procedure at home), and we sent them on their way with a full complement of oral antibiotics, dressings, tape and antibiotic cream. We really wished that we had some French for this one. Trying to explain with hand signals and drawings that he needed to take 500mg of antibiotics twice a day with food for five days was quite an experience.

Later that evening the son returned, asking first for rum and then for fuel (we think). Sten negotiated (again in broken French and hand signals) an exchange of 1.5L of gasoline in trade for a delivery of crabs today.

After the best night of sleep we've had in Madagascar (no wind + flat calm = good sleep), we woke to find a very long drying sandbar just to the east of our anchored position, which was not on the chart of course (the CMAP charts for Madagascar are the most inaccurate and least detailed of any place we've been). We set out this morning to explore the mud flats and sand bars exposed by the low tide. After running out of navigable water at the east end of the bay we turned around and headed out to the mouth of the bay to explore the beaches. We found one beach strewn with agates released from softer surrounding rock that had eroded away. I filled my pockets with chunks of rose and smoky quartz while Sten hid in the shade of several large palms, shaking his head at my magpie tendencies.

While we were zipping around in our dinghy, we watched the residents of the bay making their way from village to village in their traditional outrigger canoes. For one old man, the current was so strong that gave up paddling. He got out and walked his canoe, which was loaded with children, along the edge of a long sandbar as he could make better progress by pulling the boat by hand than by paddling.

This afternoon the father and son returned, the son still doing all the paddling. The wound looked a bit better today. We would like to have irrigated it again, but Sten's dad and my mom put the fear of god into us about exposing ourselves to something nasty, so we just dressed the wound again and confirmed that he would continue to take his oral antibiotics.

In the absence of better information, we've been speculating about how the wound occurred. Due to the nature of the wound, Sten figures that our patient was in a machete fight with one of his neighbors. Due to the placement of the wound in the center of his back, I've come up with a theory involving our patient, a woman, and a man who was tired of being a cuckold. But this is a family blog, so I won't go into details.

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