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Wednesday, 01 May 2019

How They Patched Up My Head in Luang Prabang, Laos

Written by Paul Michelson
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Mardena knew what had happened, she said, as soon as she heard that “thump, thump, thump.” It was my head, bouncing down the staircase of our guesthouse in Luang Prabang, Laos.

I’d gone downstairs to check that the night clerk had requested a tuk tuk to take me and my wife Mardena to Luang Prabang airport at 6:00 the next morning. Our flight to Phnom Penh, Cambodia, was scheduled for 7:30, and I wanted to make sure that we’d get to the airport in plenty of time.

The clerk confirmed he’d ordered the tuk tuk, and I headed back up the stairs. Ten or twelve steps up, my right hip gave out; I grabbed for a nonexistent railing and fell head first back down the staircase.

My wife rushed down from the second floor and the clerk hurried over. “I’m okay,” I mumbled.

My blood was smeared all over the hardwood floor, my ribs hurt, and my left wrist was throbbing, but I was able to push myself up to my hands and knees. Already I knew it could have been worse.

It was obvious what had happened. I’d had a right hip replacement six months earlier. The hip had held up through the first couple weeks of travel, but the stairs had been too much. Ironically, the hip had come through the fall just fine; it didn’t hurt at all.

More than anything, I was embarrassed. I pulled out a piece of Kleenex and started wiping up the blood. “Don’t worry about that,” my wife said with a hint of irritation.

The clerk hurried back to his desk and called a tuk tuk to give us a lift to the local hospital. I hated all the fuss, but I didn’t stop him. I remembered a guy I’d known a few years back in the U.S. who’d taken a blow to the head, had been examined within the hour at a local hospital and then released, but had collapsed and died a few minutes later in the hospital parking lot.

My wife helped me to a bench outside the front door. We talked while we waited, but I could hear myself slurring my words.

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When the tuk tuk arrived, Mardena and I squeezed into the little open cart attached to a motor scooter—our Lao ambulance. “Luang Prabang Hospital” Mardena told the driver, and we puttered off through the night, bouncing over bumpy roads, past dusty, dimly lit parts of town we’d never seen. It took awhile--tuk tuks aren’t exactly Maseratis--but finally on the outskirts of town we came to the hospital.

The driver pulled up in front of a one-story building I assumed was the emergency clinic. I paid and tipped him, and we got out and pushed through the glass doors.

The room was huge and dim, a dreary contrast to the bright, sparkling clinics I was used to in the U.S. Except for a wooden desk with two metal chairs in one corner and two gurneys covered with white sheets in the other, the room was empty. The place looked barren, almost bereft.

Two chunky middle-aged nurses in white uniforms motioned us over to the desk. A thin younger man in glasses and a white lab coat, a doctor I guessed, was with them. Neither Mardena nor I spoke Lao apart from a few amenities, and the nurses and doctor clearly didn’t speak English. I pointed to my bloody, matted hair and tried to convey that I’d fallen down stairs. One of the nurses put some papers in front of me. I filled in some personal information, and they guided me to a gurney.

I lay there on my stomach while the three of them stood over me a few moments and talked, probably about how to proceed. Then one of the nurses began shaving off the hair over my wound with an electric razor. When she finished, the other nurse applied sterilizing fluid to my scalp with a gauze pad. They stopped working and the three of them consulted again.

After a couple minutes, one of the nurses said “sting,” repeating the word a second time to make sure I heard, then injected my scalp with painkiller. She waited a minute and began stitching the wound. Lying there unable to communicate I felt about as passive and childlike as I ever had.

I’d assumed I’d need an x-ray, but I didn’t know how to ask. That, plus the fact that the facilities looked so bare-bones, made me feel a bit shy. The bleak, barren room, the dim lighting, and the absence of the sort of gleaming medical equipment you’d typically see in an American clinic suggested a distinct lack of resources.

Another patient, a big bearded fellow in jeans and black boots, hobbled over toward us alongside his wife and lay on the other gurney. He sounded Australian. According to his wife, he’d injured his leg when he fell off a motorcycle. One of my nurses walked over and started attending to him. It all seemed very matter of fact. I had a feeling the nurses and doctor were used to seeing travelers like him and me, western types who’d managed to injure themselves in all sorts of inventive ways. I wondered if they ever got exasperated.

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As I lay there, I noticed a series of charts on the opposite wall that spelled out step by step how to administer an x-ray. It looked like an on-the-job refresher course for someone who might be shaky on the details. X-rays, I gathered, were not as routine in Laos as in the U.S.

The nurse finished stitching, and she and the doctor helped me over to the desk. I was to leave the stitches in for ten days and avoid exercise and washing my hair during that time.

Mardena and I thanked everyone profusely. I had no idea how my ribs and wrist were, but I deeply appreciated how quickly they’d got to me and patched up my head.

A young woman assistant in jeans and a smock appeared and ushered Mardena and me out into a dim hallway and down to a reception window. We waited a few minutes while the window receptionist disappeared. When she came back she handed our assistant, who spoke a little English, two vials of pills and an invoice. I was told to take the pills for ten days until they were gone.

The assistant handed me the hand-written invoice: 240,000 Lao kip, about 30 U.S. dollars. Was I reading it right? I wondered. “For everything?” I asked, spreading my arms to indicate my surprise. She nodded. She looked a little sheepish.

I was pleased, but inwardly I was shaking my head. It was no secret that Laos was poor and that health care in the U.S. was miles beyond exorbitant, but still, the inequality of it all—the negligible cost of the treatment and medicine, the absence of fancy medical equipment (the electric razor was the closest thing to high-tech I’d seen), the careful, quiet efficiency of the nurses and doctor, and the likelihood that none of them got paid much—seemed pitifully unjust.

Mardena and I walked out into the huge, dimly lit parking lot to wait for a tuk tuk. “You look like you have a cigarette on your head,” Mardena chuckled as we stood there. She took a mirror out of her purse. Sure enough, the tightly rolled gauze cylinder on my head looked like one of those candy cigarettes I used to buy as a kid.

Back at our guesthouse we talked about continuing our travels or cutting them short. I resisted awhile but finally gave in. I knew if there was some sort of delayed reaction to my head wound we’d be no more able to communicate with the medical people in Phnom Penh than we were here. We flew back to California the next morning.

I spent a good portion of the next couple weeks contriving how to hide that cigarette whenever I went out. Finally, ten days after we got back, I went to my doctor to have the stitches taken out. “I’ve never seen it done like this,” he said as he unlaced the stitches. “But it works.”

A year later, my wrist, ribs, and head are fine. Sure, I’d probably have felt more secure if they’d taken a couple x-rays back then, but my own doctor didn’t think they were necessary, either. As for the low-tech, high quality work those nurses did? I have nothing but admiration for that.

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©Paul Michelson





Last modified on Wednesday, 01 May 2019