Category → Soapbox
I need to Get This off my Chest ……..
This post is fat too long which is why I never published it. Please try and read it …….. pretty please ….. all 6 of you who still visit this site.
You’re first day in medical school: 3 subjects for 1 year, biology, physics and chemistry, mostly rodents, reptiles and Schiff bases ……. stuff I can’t remember anymore ……. nor will I ever need ………
Your second and third year in medical school: You’re finally seeing a human body for the first time, you see the parts (anatomy), the mechanisms (physiology) and the witchcraft (biochemistry).
You’re fourth and fifth year: you go through diseases through pathology and microbiology but barely see 20 patients a year …… half the time you don’t know what they are doing or what you’re doing to them just taking a history (interview) and physical exam ………. forget the diagnosis …. that’s miles off.
The final year: you read and read and read and read …… then realise that you’ve barely seen enough to know how to recognise what you’re reading if a patient even had it.
Graduation day: You’re happy! YOU ARE DONE! but what now? where do you go from here? you’ve passed, you know your stuff ………. but don’t know what to do next …….The reasons why you went to medical school in your first year are forgotten and you’re not all that inspired, you want to treat people …. but that’s it …… you don’t even know how to prescribe yet …….
That’s a summary of my medical “education” and as most of you can tell, I’m not exactly satisfied by it. Now, I’m not an educator, I’m no teacher. They need to inspire, to have that ability to make you trust them enough to guide you; they have to have that gift that lets them build a mental structure in which information can be stored and eventually made useful. Sadly, few of mine did and looking around at the new batch of interns from both Kuwait and abroad few of them seem inspired. Don’t get me wrong, they work hard, right to the bone, they have skills but not the useful ones.
How many of the young doctors you see/meet actually make you feel comfortable, know how to ask the right question at the right time, know how to tell someone they have cancer or that a persons father died minutes ago?
How many of the doctors reading this (if any …… ) actually feel a sense of awe at what they do? how many of us actually enjoy reading about how IV fluids (drip …. or drib) were originally made? Or how the inhalers (Ventolin) we use evoloved? or why we tend to wear green or blue or green scrubs rather then white or grey ones? Or who the first open heart surgeon was and what he did to get there? How many of us were taught the ethics behind palliative care? Contraception? and experimental treatments? or how clinical trails evolved and the difference between that and standard treatments?
Medical history isn’t the reason why you go into medical school, it isn’t how you save lives, but in that third year when all you know is the Krebs cycle (the gearbox of your metabolism) and the anatomy of the Brachial plexus (nerves in your arms) you need to feel inspired by people who’ve done it before you. You need to find a reason to read, to debate, to analyse and to understand and during that final year, you need to learn why trying out new treatments for MS and charging people for it is unethical and why the current mudeer is a douche and why patients blame you for cancer rather than try to understand it…….
You don’t learn these things in textbooks on surgery, rheumatology or internal medicine, and contrary to popular belief you won’t learn them by parading the hallways in your new white coat and seeing 50 patients in the emergency room ….. you learn them by reading the ethics, the sociology and other humanities that underpin our profession.
Kuwait University and others like it have the ability to reshape education and inspire us. The reason why they can is because unlike other institutions it was built from the ground up to educate us, other institutions need to attract research grants to survive,we don’t.
We also have experienced faculty, there are people currently teaching who were there when stomach stapling came to Kuwait and can tell us how they tackled it, who they dealt with mistakes made during that first cases, the second one and the third. We have people who saw Viagra become the drug du jour and who saw the eradication and rebirth or tuberculosis in Kuwait.
We need to reshape our education and have graduates who can debate, discuss and be knowledgeable in our field without feeling that reading ethics 1 day a week is a waste of time.
Maybe then we’ll stop hearing about how doctors who “don’t know my name’, “don’t spend enough time with me” or are “too brash” or “shyif nafsa” and maybe then doctors won’t get slapped around so much.
I’ll leave you with the quote that he read to me one afternoon years ago and introduced me to the sense of awe , the need to read on medical finance, history and ethics; humanities presumed dead by our colleagues and up and comers (yes, student ……. you’re not my colleague yet …..). It was by John Cardinal Newman who described a university as a citadel built with the purpose of:
‘raising the intellectual tone of society, at cultivating the public mind, at purifying the national taste, at supplying true principals to popular aspirations, at giving enlargement and sobriety to the ideas of the age, at facilitating the exercise of political powers, and refining the intercourse of private life.’
I only hope that I can one day see this in our local University who’s faculty and students should expect more from each other …….
Seeing Eye Dogs are soooooooo 2k9 ……..
I fucking loved daredevil growing up (I even like the movie …… which isn’t exactly the best Hollywood has to offer), one of the main reasons I like him is ’cause he never relied on anyone when he became blind, no seeing eye dogs, no Bengali guides (don’t lie I’ve seen it at least 6 times at outpatients …….. a blind old man/woman with a Bengali to show him/her the way), all he needed was his kickass Cain that was also his weapon of choice.
But daredevil wasn’t your typical blind person, he had the power to see sound and hear heartbeats and stuff so it’s not exactly fair to compare grandpa or grandma to him and yet I can’t help but feel that the blind among us haven’t exactly benefited from many of the advances in our field, we know how to prevent (well …. slow down) blindness in some cases but have never really found a cure for it ……. the best we could come up with was/is “go buy a dog and let him drag you around …….. oh and make sure you don’t step on his doo doo ……. ” and if you couldn’t afford one or in most cases can’t take care of one then you had to buy a Cain and trip and fall and fall again until you learned how to use it.
But thanks to the boffins in the US army and Brainport inc we finally have a solution …… or at least a better one than “Here’s a stick good luck and don’t poke any one with it”. And no it doesn’t require stem cells, a 16 hour surgery or a hundred billion dollars all you need is a tongue and a pair of glasses……..
It consists of 2 parts glasses and a plastic lolly pop you put under your tongue. The glasses have a camera that will take a picture and transmit it to the lolly pop which in turn transmitts the electrical signals to your tongue. The pattern of the signals tells you that the thing you’re looking at ……. well ….. looks like. It’s not super accurate yet and the current model only has 400 sensors but the “final production” model should have 4,000 sensors.
And if anyone is interested (I’m sure one person reading this must know at least one blind person) the brainport website is this and the cost to buy the device and train someone is around 18,000 pounds …….
It’s been a while
How have all of you been?
No new babies? No recent marraiges?, apologies for snubbing you all, I’ve been a little busy growing older and maybe a little more mature, thankfully the bald spots (yes there’s more than one) havn’t really grown despite my new more mature and (dare I say it) improved self……. Yes, I am a little less lurid, a little more sane and a little less angry,,,,,, don’t ask why ….. it just happens sometimes and is becoming a trend (mark has lost his shwarma fetish and has adopted a healthy life style, why can’t I decided I don’t want to write for free anymore and would rather spend my time sampling a new cereal everyday and filling my days with Bio-shock 2)
This will probably be my last post for a while but it’s only my second post in which I actually talk about my self …… being self centered is great, no wonder most of the Kuwaiti public do it 24/7. It’s therapeutic ’cause you get to complain and think that your opinion counts ……….
Having said that there are a couple of posts I’ve been meaning to write including my penis farts one, the prostate cancer needs no cure one and why it makes no sense that taking out your stomach will cure you of diabetes………..
The Problems We’ve Never Gotten Round to Fixing
Congratulations on surviving the first decade of the millenium and oh what an amazing decade it has been for healthcare, we have seen the advent of a slew of drugs including statins (lipitor) which have lowered our cholesterol, given us hard-ons that last longer than hangovers from the night before(viagra) and breath easier (the new generation of once a day asthma meds). We’ve also managed to make advances in medical imaging that have made it such that any cancer any where can be detected far earlier than ever before thanks to the wide spread distribution of PET and SPECT scanning and yet there’s still one aspect of healthcare that we have continued to fail epically at no matter how much is spent on it.
And (surprisingly) it’s not exclusive to Kuwait. I’ve seen it in hospitals in the UK, the States and even Thailand and Germany, infact I’ve yet to see any hospital find a way of fixing it……… the food sucks balls ……..
Lloyd Grossman ….. if he can’t do it no one can ……The man plays guitar, dresses like Steve Jobs and cooks!
You go to any hospital anywhere and try the food there ….. it always tastes like cardboard wrapped in turd sprinkled lightly with rabbit droppings ……..
and it’s worse ….. it CAN’T BE FIXED, 3 different chefs and fifty million pounds in the UK tried to fix the problem at NHS hospitals(Yes, the list includes Lloyd Grossman of Spaghetti Sauce fame) and gave up halfway through the 5 year program.
What’s even worse is the the food not only tastes like puke from last nights party but is also far worse for you, in two different surveys of hospital food 18 of the 21 NHS hospitals tested were found to have food had too much salt, too much fat and not much of anything else. Infact, 86 per cent of meals contained too much salt, 67 per cent too much saturated fat and 52 per cent too much fat according to Food Standard Agency guidelines.
Oh and don’t you go calling it prison food ….. it’s far worse ……. Dr. Edwards (Bournemouth University, NHS Food Services Czar ….. yes, they had to employ one things were so bad) did a side by side comparison and found that prison food is far more nutritious and is made in a far cleaner environment than anything served in any NHS hospital…….
Infact since the advent of this millenium (2000) 2,600 people have died of malnutrition in UK hospitals (I’ll be quick to point out that alot may have died because they simply can’t digest the food from extensive surgery or other malabsoprtion problems, but still I’m pretty sure that bad food plays a role) and although we can’t make the same claim in Kuwait, I think it’s because we simply don’t have the statistics.
Our problem in Kuwait is probably that nutritionists and dietitians aren’t given the freedom required to change/fix things after all if you look at places like Dietcare, Nutrition and Care and other places, their food is edible (albeit quiet pricey) but quiet healthy.
So perhaps we should add better food to the list along with a cure for cancer, AIDS and a flying car …………
Have a good year everyone ………
Super Secret Hoo Hoo Smelling Samurai death blow
I love sushi, you love sushi, we love sushi. We also love to travel to places like New York, Denver and Houston (well maybe not Denver …… but the rest …….) and once we get there we all tend to go for something exciting, novel and a wee bit different …… namely sushi.
But what do they put in it? It all tastes the same …… a bit smelly while going in but finishes off quiet nicely I think we could all agree ……
Does that yellow tail, nigri rolled, sumomaki ridden tuna actually contain tuna or is it the McDonald’s version of the real thing filled with tons of corn starch and what not……
Although many people would probably try and find out online or by simply asking the chef, very few people could actually come up with a clear cut litmus test to find out where their sushi comes from, you’d think that scientists would have the answer, but the PhD toting crowd are probably far too busy schlepping their secretaries while thinking about their students ………
But thanks to the genius of two girls trying to think of a final year school project we finally have the answer.All they did was order sushi from every where they could, take a sample of the tuna used in making it and send it to the international barcode of life consortium (or IBOL) ( a group of people who will trace any given tissue sample back to it’s species origin and tell what it came from (e.g. saliva that came from a specific dog bite etc) the consortium was originally founded to help track things like the trafficking of endangered species, but their technology can be easily used to trace back any raw meat anywhere in the world ……. kind of like a biological GPS).
It took these two 19 year olds (Kate Stoeckle (left) and Louisa Strauss (Right) to tell all you people that you’ve been eating killer fishies …..
The people at iBol then analysed the alleged Tuna and came up with some rather erm …… interesting findings; for one thing …..almost 30% of the sushi places that were sent off for analysis didn’t use ANY tuna and used everything from makerel, to endangered species (T. maccoyii) (so basically you and your girlfriend or for the more lonely of us, fat ugly porker of a friend were munching on the marine equivalent of a baby seal paw) and even fish that have been banned for being toxic (they were even banned in south american countries where cocaine comes in regular or lemon scented varieties) and potentially fatal.
What’s alarming is that the two girls weren’t allowed to submitted as their end of year school project and were told that it “lacked and form of logic” and did not fulfill the assignment ……. which sound a wee bit like the attitude people havein good old K-town, namely, if it isn’t something I would do or think then you’re wrong ……. now go back to twiddling your thumbs and let me gawk at the hot patients ………
But forTUNAtely (hehe ,,,,,, tuna ….. hehe) people far smarter than their school teachers managed to recognize their talent. The two 19 year old girls were recently accepted at Johns Hopkins and are due to start their legal drinking, pot smoking, jello shot infested college lives very soon.
The motto of the story is that rocket scientists aren’t the be all and end all of discovery and innovation. Most of the people reading this are probably very well educated, highly knowledgeable and have probably made numerous attempts at fixing things where they work …… but the problem lies in trying to recognise talent as opposed to degrees or senriorty because when talent is put in the right place and given the right tools that’s when you get innovation and that’s when you’ll stop hearing about people needing to spend 3 days waiting on a slip of paper from a ministry or crazy doctors who know nothing better than to prescribe adol an a weeks worth of Heroes and How I met Your Mother.
At the same time it’s also very hard for me to imagine any Kuwaiti hospital without at least one or two people who seem to have a slew of degrees and became heads of departments then sat back and let the whole place turn into that scene from Gangs of New York.
….. and here it is to refresh you memories …….
The Boys and The Girls
We’ve all been there, seen it or done it ….. Barbies …….. we’ve all heard of, seen, or owned a barbie doll at some point …….. this fact might be embarrassing to about half the people reading this right now. You see for girls this was the ultimate in awesome ….. the best-est thing ever. Most boys however, would be embarrassed by the fact that they like barbie dolls at the age of four, or harboured a secret collection of barbies dating back to the 80′s but what does it really mean?
If you ask people of our generation (well at least the more liberal folk) they’ll usually tell you it means nothing and that there’s nothing wrong with it; probably a “stage” the person you’re going through. However, those of us born in the 60′s, 50′s and 40′s would probably see it as blasphemy of some sort or other (yes, I am referring to the Kuwaiti population as opposed to the population in general and I know I might be over generalising …… but I can …. so live with it)
But is there really nothing wrong with it? Is it really just a toy or is there a difference between boys and girls and the way they see perceive toys? It’s very hard to pin point, in fact it would be damn near impossible if it weren’t for the magic of google ……
Using googles eye-tracking tech psychologists at Texas A & M took a group of 30 toddlers (3-8 month old boys and girls) and put a doll and a toy truck in front of them then gawked at them. The results of this admittedly less than scientific test are rather interesting.
For one thing most of the girls went for the doll and kept staring at the doll (particularly the face) and really wanted it where are boys just couldn’t decide, half of them went for the doll while the other half went for the truck, worst still …… the boys took longer to make their decision (about 25% longer) which means that we are probably born thicker than the girls are …….
But seriously, what could we gain from such an arbitrary study? Should we assume that we’re born liking trucks or dolls? Or that boys like both while girls like one or the other? That a girl is born a girl while boys might be open to gender identity disorder?
The authors of the study claim that it mirrors other such as the one of monkeys, the one where they compared pink and blue preference, in that it proves that gender identity dictates preference (boy like cars because boys are meant to, girls like dolls because they are meant to). I think they are wrong and am arrogant enough to say so.
The study could mean that girls like things that look like humans because they like role play (every girls fantasy is being the bell of the ball/princess/all dressed in white or something to do with role play), boys tend to enjoy playing, messing around etc …… even into adulthood. But that’s probably wrong too.
I think it illustrates a far more boring and mundane point; we are influenced easily by social interactions with our parents as kids. We don’t know what we want, but we know what our parents want us to want because of clues they give us. If my father plays with the toy truck while I’m around him and encourages me to do the same while he tends to ignore me when I play with the barbie doll or even take it away from me then chances are I’m going to go with the truck because I want human interaction. If my mother buys me a toy truck and smiles when she sees me playing with it and does the same when my sister plays with her dolls then it must mean that I’m meant to have the truck while my sister is meant to have the doll regardless of my gender and if my truck has brighter colors than chances are it will seem more interesting to me as a toddler, especially when compared with a texture less doll.
Now the naysayers and firm believers among us would counter that my argument doesn’t explain why boys took longer to decide than girls. The answer lies in how easily influenced we are as kids by our parents, boys may not understand social cues as well as girls do or they may not even get the same amount of attention which is why they tend to take longer to decide, just look at how much women say when they gawk at each other at the local Starbucks for gods sake …. isnt that proof enough ……
Still whether you’re with me or with the original authors you can let them know what you think by emailing them
Tee Hee – Keep Running you Dumb Dumb Sheep
I’ve finally given up …… sod it ….. I spent the summer trying to give my self buns of steel and pecks that scream ‘SPARTAAAAAAAAAN!’ and I’ve spent Ramadan running on a goddamn treadmill or cycling in one place like a fucking idiot and what do I have to show for it …… fuck all …… Not only has my largess not changed but I’ve managed to make myself even more revolting to the opposite sex the sweat marks that grow as you walk/jog/have a heart attack along the local walkway/mamsha/
And after all my hard work and the hard work of countless 13-60 somethings running around at the local walkways (mamsha) science has only just found out that exercise doesn’t really do anything for you whieght. A recent study published in the British Journal of Sports Medicine revealed that if you take 50-odd people of varying age who are over weight (BMI of 30 ish) and put them on a strict (witnessed by study organisers) aerobic/cardio exercise plan for 12 weeks, you’ll be lucky if they don’t gain 3 KG, in-fact the only weight loss that was noted came from about 5 people who lost between 2 and 3.5 KG then gained it back the week that they stopped. This means that our worst nightmares have come true …… we could have been watching family guy enjoying machboos diyay and instead have been running around like headless chickens……. damn you science …… damn you to hell ……
Having said that the study does advocate exercise for the overall health benefits and there have been other studies that say that although you won’t loose any weight when you exercise; you may find it easier to keep the whieght off if you do. So the trick is to starve your self, while watching family guy, loose the weight, then go buy yourself a treadmill and never use it.
Then there’s the other rocket scientists trying to figure out why we never loose weight no matter how far we run, or how fast we go. Apparently, it has alot to do with your energy balance (and I don’t mean karmically, although having said that, Karma may explain why my love handles have grown a second set of love handles …….) meaning the amount and type of food you eat BEFORE you use the treadmill for the first time and end up falling flat on your face snapping you nose runnig to the poly clinic (this is where the exercise come in), Where the doctor will refer you to the local casualty, who will do an X-ray and won’t know how to read it and refer you on to an ENT doctor at Al Sabah Hospital who will tell you to comeback and see him at his private clinic when the swelling goes down ……
Having said that ,there is a rather robust study that seems to support the fat burning role of exercise, the man even devised formulas to calculate how much you’re expected to loose ….. so perhaps there is some hope for the running, walking and cycling masses …… ‘course the only problem is that he only did it on healthy runners who’s metabolism is geared towards fat burning …… fucking pullock …….
4th of June 1981
You can thank the guy on the right, the guy on the left is just there ’cause white people look smart.
That was the year AIDS was born, well not born more like first recognised as a disease. Since then we’ve found out that it’s cause by 2 viruses HIV1 and 2, it kills white bloods cells (CD4- T lymphocytes … what all the soaps refer to as CD4 counts is the concentration of CD4 cells in a sample of blood) and that it originated in 2 different species of monkeys and subsequently mutated and became a virus that can attack humans (in a similar fashion to the way H1N1/swine flu did last year), we’ve also managed to make cocktails that stop the disease from progressing (the famous anti-retro viral cocktail) and people are now able to live full, long, healthy lives in-spite of or more aptly with HIV.
But we’ve yet to see a cure for it ….. a real sure fire end to it all ….. some silver bullet ….. 28 years and still we wait for an end to this pandemic (and yes, the WHO have officially declared it a pandemic despite the fact that we apparently don’t suffer from it in Kuwait). However there is a light at the end of the tunnel, a glimmer of hope if you will, we finally have an HIV vaccine that may actually work.
And no, it’s not made by some norwegian nobel prize winner living in the US and working in some Ivy league school on his third PhD; it was made by a group of run of the mill doctors in Thialand.
When I say made I mean they combined ALVAC HIV (prime) and AIDSVAX B/E (boost) (two different drugs developed by the US military research fund then abandoned because they thought they would never work) and gave them to 8,000 people in their community in Thailand and gave another 8000 a placebo (saline). They found that the virus reduced the risk by about 31%, which is no small feet for a bunch of GP’s working in Thailand and this is when you have confirmed inoculation with the virus in the correct amount which means the actual risk reduction is probably about 80 to 90% (multiple 0.3 by 0.25; you have a one in four chance in direct blood to blood contact and even less in blood/seminal spatter etc ….)
Since then 3 larger trails have been planned, one to combine the vaccine with circumcision, one to recruit 80,000 participants and test out a refined version of the vaccine and one to test it against a new prospective compound.
And to think that on that day in June the US Health and Human Services Secretary Margaret Heckler declared that a vaccine would be available within 2 years……… yeah right ……
Just goes to show it doesn’t take a rocket scientist or a slew of degrees to make a difference ….. all it takes is a little luck and a whole lot of effort ……
and you have the following people to thank the next time you decide to go for that funny looking something in Dubai/Bahrain/Thailand:
Supachai Rerks-Ngarm, M.D.
Punnee Pitisuttithum, M.D. D.T.M.H.
Sorachai Nitayaphan, M.D. Ph.D.
Jaranit Kaewkungwal, Ph.D.
Joseph Chiu, M.D.
Robert Paris, M.D.
Nakorn Premsri, M.D.
Chawetsan Namwat, M.D.
Mark de Souza, Ph.D.
Elizabeth Adams, M.D.
Michael Benenson, M.D
Sanjay Gurunathan, M.D.
Jim Tartaglia, Ph.D.
Supamit Chunsuttiwat, M.D.
Chirasak Khamboonruang, M.D.
Prasert Thongcharoen, M.D., Ph.D.
Stop Calling it a Disease for Fucks Sake ……..
You’ll never have a local community ans I really have no business writing this, I’m not in your shoes and could never imagine being in them but I figured a good kick up the backside (no pun intended) might help you savvy up and do something.
I could never be a great doctor, I could be a safe one, competent one, funny one but never a good one …… and that’s because I never know when to shut up.
Over the past two years I’ve seen a disease or a defintion of one raise it’s ugly head from the depths after it was quashed back in the 70′s by men and women far braver and more enlightened than I could ever be. Way back then some people, mainly in the medical community tried to formulate some kind of disease based on a broad definition, namely wanting to fuck, dress or sound like anything but your own sex. These people were the American Psychiatric Association (or APA) and they are the ones responsible for THE book on psychiatric disorders known as the diagnostics and statistics manual or DSM.
The way that modern psychiatry works is actually quiet interesting in that it has pretty much been standardised into a check list of symptoms for each condition and has all the conditions marked out in a book (known as the DSM) and every couple of years since the 1950′s there has been a new addition of the book with a new list of illnesses based on discoveries and reviews by committees formed and funded by the APA. The last version of the book with a deifintion of gender identity disorder was the DSM III back in 1970 and back then (as is the case with many ignorant bigots now) there was no clear difference between criteria for gender identity disorder (man in womans body/ woman in mans body) and sexual orientation (liking the hoo hoo or the pee pee or perhaps both).
Thankfully gender identity disorder was thrown out thanks to lobbying by many people in the field but more importantly people in the community who understood the implication of labelling sexuality as a disease and all that remains of it is a vague vestigial definition 4 lines long in DSM 4 that no body reads.
After all, where should the line be drawn when diagnosing someone with a disease and what diagnostic value does it provide? what is the mechanism involved? Chances are there aren’t any answers to these questions because there is no disease….. people have preferences, I can’t live without the hoo hoo, some of us can’t live without the dongle, other still wish the had one, but how does that kill anybody?
Unfortunately, as the APA began to formulate the next edition of their yellowpages of psychiatric illness and disease, they decided it’s high time they re-introduced gender identity disorder and form a committee of “experts” to do it and interestingly enough not only has the committee been charged with the task of making the windows 7 of psychiatry, they’ve also decided to formulate criteria for childhood and adolescent gender identity disorders.
Now, many of you might think that defining and trying to identify things like if your child is gay/straight/bi/likes new kids on the block is a good thing, but I’d argue that in your heart of hearts you really don’t care and you’ll love them just the same. Alot of people would also argue that you can save them, but that would only be true if it were an actual disease rather than simply a harmless preference similar to ones preference for alchol or a particular flavour of icecream. And some will argue that there’s nothing wrong with trying to “catch and treat them early” ……. chances are there is ….. people like the World Professional Association for Transgender Health wouldn’t know how to treat a head ache if you put panadol in their left hand and a cup of water in their right ….. like many ignorant bastards all they do is try to brainwash the young.
So if you are like me, these people and 9,550 others who can’t shut the fuck up and won’t let their kids be stigmitised and treated like leopars by a bunch of fuddy duddies and crazy teachers (not all of you are crazy ….. but some …… ugh ….) let your voice be heard and send these people an email …….
…. Just go Buy a Car …..
Following on from last weeks post the next think I’d like to talk about a minority we have in Kuwait ….. the pedestrian …… usually of bengali ethnicity, often with a lack of linguistic skills or clothing, lets face it the rest of the damn nation have a fear of using their legs to cross the road and with good reason …… who would want to sweat in the 150kd track suit ……..
Thanks to their inability to wait till the road clears and our inability to account for a fast moving dark figure in front of us at 2 am. Bengali’s and street cleaners account for possible 70% of all pedestrian car injuries and while most of this injuries tend to look minor (either a broken foot or arm and a bleeding cut wound) a fair number will have a secondary injury that we can’t really detect unless we’re more thorough when we examine them. (and by we I mean people in the medical community, usually a trainee or an assistant will be first on the scene, so this post is mainly for the people who read this, this and this as well as the people who write in them.
Pedestrians are funny creatures, specially bengali ones because when they are hit they tend to flail around and smack them selves on the hood and the bumper leading to more injuries. They also tend to have a very low threshold for pain and rarely if ever know how to speak Arabic (and you can forget about English) so nine times out of ten what you get in the casualty is a person who was hit by a bumper, slammed himself onto the windshield, broke the glass against his face and flailed around rubbing the shards of glass in subsequently falling to the ground and possibly being left there for about an hour or two before being brought into hospital and if you’re fortunate enough to have received the patient right after the accident then your are just as likely to receive your fellow country man or woman who has just hit him and will probably complain about how he needs as many x rays, pills and drips as the bengali does and will take up most of your time simply because he or she wont stop shouting at you or the nursing staff.
What’s interesting is that if you go purely by numbers (which is what the european health and safety network did) most of the pimary or secondary injuries you will see will occur either in the head or the legs. and of those most will be occult facial fractures that won’t swell up for a day or two. Very few will have actual brain injuries ’cause you skull can literally take a good kick from a premier legue footballer (about 9 Kilonewtons) and still not crack where as a baseball thrown in the right direction (0.8 Kilo newtons) will burst your cheek bone open and the same goes for your legs you’re more likely to hurt a joint than a bone and are more likely to hurt a nerve than a joint but how many of you woh have been through a car accident have actually been examined for knee joint injury or numbness? Very few doctors do it ……
Another thing that people tend to forget is that a pedestrian is 3 times more likely to hurt is chest than his abdomen and yet if you ask most general surgeons (you won’t see a trauma surgeon ANYWHERE in kuwait, all of them work as general surgeons for lack of a formal department or training) they’d be more concerned if you told them you didn’t order an abdominal ultrasound than if you didn’t order a chest x ray, they’d still want you to order it but will probably rubbish it off.
It’s things like ignoring facial fractures and loose teeth, not looking for joint damage and looking for fractures instead and ignoring rib fractures that lead to the horror stories like the guy who was in a car accident got his ankle fixed and never got his chest checked out. Three months later he was still in pain turns out he had a rib fracture, the reality is that ribs heal themselves for the most part but still ….. I’d like to know if I cracked a few …..
So the take home message here is that pedestrian car crashes which look minor usually are and do not required active resuscitation or ABCDE’s as was mentioned last week. But that doesn’t mean that they should be neglected. Pedestrians differ from major trauma’s in that they are more likely to have joint and tendon damage than to have fractures and are more likely to have facial fractures than skull ones. Another thing to bear in mind is that patients who have been hit by a bumper in their torso and are more likely to have rib fractures than abdominal bleeds, however if they are unstable then chances are your problem is in the abdomen oh and never forget there are 2 different types of injury to look out for, primary (car Vs. Human and secondary Human Vs the thing he fell onto after the car hit him/her)
All this information and more is available here in a report written by Dr Jikuang Yang of Chalmers University, Gotenburg-Sweden.
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