Here you would see patients (often farmers, or hawkers and rubbish collectors who spent hours on end treading on the streets) lying on the bed looking terrified and distressed, stiffed and twitching from muscle spasms caused by the tetanus toxins. They would have a tracheotomy (a breathing hole through the trachea via a cut in the neck) and be on mechanical ventilation for 3 to 4 weeks, followed by weaning off in a side room. Sedation is not a common practice in ICU here so you see patients obviously looking uncomfortable, being intubated wide-awake. There is also a general lack of knowledge of tetanus among the public - there was an instance where a female farmer stepped on a needle (probably discarded by intravenous drug users) in her allotment. She hurried to the local clinic to receive post-exposure prophylaxis for HIV (paid hundreds of dollars on end), only to be found to have tetanus days later and was in a critical condition for a long while.
I wonder if giving tetanus vaccine is a common practice here in A&E or in primary care setting if a patient present with open wound/injury/contact with soil or rust - that would be something to find out.
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Tetanus: from Ancient Greek: τέτανος, tetanos "taut", and τείνειν teinein "to stretch"
Clostridium tetani: Gram-positive, rod-shaped, obligate anaerobic bacterium
elo!
ReplyDeletebeen following your main blog for awhile now ( love the pictures! and love the way you write too!) got quite excited when you started this one documenting ur stay in vietnam. I'm a med student myself and in the midst of planning my electives (this december!) i have been keeping my eye on hanoi, but am a bit wary as will be travelling alone.
looking forward to your updates.
p.s, not too sure if id like to see tetanus sufferers, textbook pictures of the sufferers are gory enough. :(