#46 - The Fridge on the blink, and Mite allerts

When in a community like this one, there are a few health themes that crop up n a daily basis.  I have posted on ARF and the Rheumatic Heart Disease that results from these nasty bacteria.  Two other issues that are rife in the Torres and other parts of Indigenous Australia, are Diabetes, and Scabes.

Diabetics are numerous in this community, and when a diabetic gets sick enough, tablets no longer work.  The patient must be commenced on type of a hormone replacement called Insulin.  Insulin transports sugar in the blood into cells of the body, thus bringing down the blood sugar, which when too high, causes blood vessel and nerve disease, leg ulcers, blindness and in extreme cases, kidney failure.  High blood sugar also increases the risk of heart attacks, high blood pressure and strokes .  If you get diabetes and are poorly controlled, you better hope that you die quickly because a non fatal stroke or heart attack can turn you into a full care cripple with next to no quality of life.

Well The Torres has lots of diabetes, more than I have ever seen, and whether I am just more aware of it here, or perhaps this Island has so many diabetics, it is a very hot topic.  We have many type 2 diabetics (the type you get from poor diet and lifestyle choices) who have had to be commenced on Insulin, as their diabetic tablets no longer work.  Thus the medication fridge in my Pharmacy is full of Insulin.  There is Boxes and boxes of it, If I had to guess how many, Id suggest 4 shelves full with 100 or more insulin devices on each shelf, the crisper at the bottom, where we usually store the suppository medications is full of insulin and the milk shelves in the door are jam packed full of insulin!!   So why does it have to be in the fridge; Im glad you asked.  Insulin is a delicate human hormone made of protein similar to egg white.  Heat denatures it, and stops it from working.  It must be kept in the Fridge between 2-8 degrees like vaccines.

Well.  A back order of 100 insulin pens came in from TI pharmacy yesterday, and I packed them into the fridge...stuffed them in the fridge...and in a similar manner to someone sitting on their suit case to get it zipped closed prior to going on holiday.  But I learned another lesson.  If you over stock a fridge, it cant circulate air, and wont maintain it's temperatures.  When I arrived at work this morning and went through my morning routine of checking the emergency gear, immunisation fridge, 1st cup of coffee, and Medication fridge...It is sitting at 18 degrees C!!!!  Note to self, to avoid ruining $30000 worth of product, DONT  OVER  STUFF  THE  FRIDGE!!!

Luckily I had the the Diabetes Educator right there this morning, and I could seek her advice.  Liz offered to take an Esky of Insulin back to TI Pharmacy for me on her flight down to Thursday Island.  Relief!  I cleared out the gross over stocking, and made a little space for air to circulate.  The fridge was sitting at 7 degrees 2 hours later, and I was to learn that Insulin is not as delicate as vaccines...so dodged a bullet that time.

My afternoon was interesting, A family came in with a infestation of Norwegian Scabies.  These tiny mites burrow under the skin and lay eggs in their burrow tracts.  When the larvae hatch, they cause intense itching, which results in uncontrollable scratching, which results in open sores, that get infected.  These two little girls 2, and 4 years old were absolutely covered in purulent wounds, and scabies burrows.  I have never seen anything like it.  There would have been at least 50 wounds on each limb, of both children.  The scabies is notorious when the mite affects us it is called Scabies.  When it affects dogs, it is called Mange.  Hence the term "Mangy dog".  Over crowding and poor hygiene is the underlying issue.  One kid with scabies will sleep on the same mat or bed as 2-3 other children, and it is highly contagious.  I am still feeling itchy just thinking about it.  To treat it, the bedding needs to be washed in near boiling water, every member of the house needs to pan themselves with a mite killing cream, and leave it on their body for 8 hours before washing it off.  Then the whole process needs to be repeated in 7 days time.  Now that just kills the bugs.  The next BIG issue is healing the infected wounds left behind after the scratching.  That is where my old mate Penicillin comes in to a staring role.  So as you can imaging, our stocks of penicillin must be big right?  Well Yes, right you are.  BUT, Penicillin syrup (what I use for kids) is the only antibiotic syrup that comes ready made, and as a result , must be refrigerated.

Remember the medication fridge?  Yup...full of insulin.  After diligently repacking the fridge this morning, a task that took more than an hour, I discovered that I had pushed the penicillin syrup to the back, and I wasn't sure exactly in the back of the fridge it was located.  Those poor kids had to wait half an hour for me to get them sorted.  But they did wait, and were so gracious with me, after a "big esso" from the Aka who brought them up the 4 year old went to give me a hug good bye, which I returned, but in view of the presenting problem, resulted in me having to take an iodine shower for half an hour.!!!

I am still itchy!!

Well that is it for this post.  Week one on Yam Island down.  Im off to watch the Broncos with a group of rowdy island boys.  Yawo!!