Bali hemodialysis

Imagine your kidney as a filter and waste disposal machine of your body.  The human body produces and metabolizes several substances.  Blood transports the waste of metabolized substances to the kidney which will filter and remove extra fluid and toxins from the body.  When the kidneys fail to work, which can be caused by several conditions, including infection, chronic diseases, stones, and many more, the body needs to find other means to do the job. Fortunately, medical scientists have developed a machine to replace some functions of the kidneys.
The hemodialysis machine can help maintaining the equilibrium of your body by:

• Removing waste from blood
• Restoring the proper electrolyte balance in the blood
• Eliminating extra fluid from the body

Dialysis comes from the Greek word “dialusis” which means dissolution.  Blood flows through tubing into the machine, where it passes next to a filter membrane.  A specialized chemical solution, dialysate, flows on the other side of the membrane.  The dialysate is formulated to draw impurities from the blood through the filter membrane.  Blood and dialysate never touch in the artificial kidney machine.

Significant planning is required if hemodialysis is to be considered as an option.  Your doctor, which may include a group of specialist: kidney specialist, internal medicine specialist, and possibly a surgeon, will discuss the necessity of the treatment. Even though there may not be many options when a patient has reached the end stage of renal disease, some risk of hemodialysis should still be considered.
Possible complications may include:

• Low blood pressure (hypotension).  This is the most common complication of hemodialysis.  It is seen more often in women and in people older than 60.
• Muscle cramps. If cramps occur, they usually happen in the last half of a dialysis session.
• Irregular heartbeat (arrhythmia).
• Nausea, vomiting, headache, or confusion (dialysis disequilibrium).
• Infection, especially if a central venous access catheter is used for hemodialysis.
• Blood clot (thrombus) formation in the venous access catheter.
• Technical complications, such as trapped air (embolus) in the dialysis tube.

While long-term complications of dialysis may include:

• Inadequate filtering of waste products (hemodialysis inadequacy).
• Blood clot (thrombus) formation in the dialysis graft or fistula.
• Cardiovascular disease (heart disease, blood vessel disease, or stroke).

As good as any machine, the dialysis machine can not perfectly replace your kidneys. Studies show it only replaces 10% of your kidney’s function.  However, in severe kidney failure or end stage renal disease, it may improve your quality of life and increase your life expectancy.  If hemodialysis is an option, you should discuss with your doctor to evaluate the risk and benefit of having the treatment.

dengue fever bimc bali

Watch out for Dengue Fever!

We think it’s time to remind you about dengue fever… again.

The tropics and the rainy season… One unique combination that reminds us of dengue fever.  Indonesia is an endemic region of dengue fever.  This disease can be found in almost every region and anytime of the year, with a higher incidence during rainy season, which is generally October to April (the highest incidence usually is during February and March), because it gives a better habitat for the vector, the mosquito, to breed.  For information about the disease, the symptoms and others, go to our archive.  In this article we’ll discuss more about mosquito bite prevention.

DEET. This remains the gold standard of currently available mosquito and tick repellents.  Comparison studies suggest that DEET preparations are the most effective insect repellants now available. Recommended concentration:

• 35 % or more for adults who are in high risk regions for prolonged periods
• 20% - 35% for most adults and children over 12 years old, provides complete protection for an average of 5 hours
• 10% or less for children ages 2 to 12, but some experts believe that these are safe even for infants over two months old.

DEET has been used for more than 40 years and is safe for most children when used as directed.

Remember! The effectiveness of DEET varies from individual to individual and depends on climate changes.  For example, it can be washed off during swimming or by rain.  High temperatures make it less effective.  DEET, particularly in very high concentrations, can also dissolve plastics, including those used in glasses, watches and some synthetic clothing.  DEET then should not be put on clothing.

Overexposure to DEET at any age has produced toxic effects, including itching, rash and in severe cases, irritability, insomnia, and confusion.  It should be noted, however, that it has been intensively studied for 40 years and used in billions of applications.  Only 50 such toxic reactions have been reported and most of them resolved without any consequences.

When applying DEET, the following precautions should be taken:

• Do not use on the face and apply only enough to cover exposed skin on other areas.
• Do not over apply and do not use under clothing.
• Do not apply over any cuts, wounds or irritated skin.
• Parents or an adult should apply repellent to a child and not let the child apply it to him or herself.  Parents or an adult should first put DEET on their own hands then apply it to the child.  Avoid putting DEET not only near the child’s eyes and mouth, but also on the hands (since children frequently touch their faces).
• Wash any treated skin after going back indoors.
• If using a spray, apply DEET outdoors–never indoors.  Spray repellents should not be applied inside or directly on anyone’s face.

Other Insect Repellent Products

• Soy-based Bite Blocker, is safe for infants and gives protection that averaged over an hour and a half.
• Citronella - or mixed oil based products, protects for an average of 20 minutes or less.
• Synthetic insect repellent IR3535, provides protection for 20 minutes to an hour.
• Repellent containing eucalyptus, offers protection that averages 2 hours and is a good alternative, particularly for children.
• Bayrepel, a piperidine derivative, mainly used in Europe, may prove to be very protective.
• Bath oils, all wristbands (including those that contain DEET or emit sound), garlic and vitamin B1, are proved to offer very little protection or none at all.

Permethrin. It is an insect repellent used as a spray for clothing and bed nets, which can repel insects for weeks when applied correctly.  Electric vaporizing mats containing permethrin may be very helpful.  A permethrin solution is also available for soaking items, but should never be applied to the skin.  Side effects from direct exposure may include mild burning, stinging, itching and rash, but in general, this agent is very safe and its use may even reduce child mortality rates from malaria.  Travelers allergic to chrysanthemum flowers or who are allergic to head-lice scabicides should avoid using permethrin.

Other Preventive Measures. Other preventive measures include:

• Wearing trousers and long-sleeved shirts, particularly at dusk.  One survey suggested that this measure may significantly reduce the incidence of mosquito-born disease.
• Sleeping only in screened areas.
• Air-conditioning may reduce mosquito infiltration.  Where air-conditioning is not available, fans may be helpful.  Mosquitoes appear to be reluctant to fly in windy air.
• Don’t wear perfumes.
• Minimizing skin exposure after dusk.
• Washing hair at least twice a week.
• Burning citronella candles reduces the likelihood of bites.  Indeed, burning any candle helps to some extent, perhaps because the generation of carbon dioxide diverts mosquitoes toward the flame.  Smoke from burning certain plants, including ginger, beetle nut and coconut husks, have also reduced mosquito infiltration, but the irritating and toxic effects on the eyes and lungs may be considerable, such as the citrosa plant.  To date, no evidence shows much benefit but such methods are not harmful.

For people living in Indonesia, the health department recommends to prevent mosquito breeding sites.  Mosquitoes usually lay their eggs on still water.  It is advised to:

• Drain out water from desert coolers/window air coolers (when not in use), tanks, barrels, drums, buckets etc.Remove all objects containing water (e.g. plant saucers etc.) from the house.
• Collect and destroy discarded containers in which water collects e.g. bottles, plastic bags, tins, used tyres etc.
• In case it is not possible to drain out various water collections or to fully cover them, use temephos, an insecticide, ( brand name Abate) 1 part per million according to the local guidelines to prevent larvae from developing into adults.

Medical evacuation in Bali

Bali Medical Evacuation
Medical evacuation or often referred to as a “Medivac”, was initially developed to transfer injured soldiers from the battlefield to a proper medical facility for better treatment.  The military were first to establish a specially designed aircraft for medivacs.  By time, air medical evacuations have became available for civilians and operated by non-military companies.  Since the indication of evacuation is usually due to the necessity to get to another medical facility urgently and where time is also a crucial factor, most medivacs are by air, either by aircraft or helicopter.

Although it’s mostly for urgent or emergent cases, arranging a medical evacuation is not as easy as dispatching a ground ambulance in seconds after receiving an emergency call.  Many factors are considered, not only involving medical, but also technical and administrative aspects.
From the medical point of view….
Altitude causes changes in the human body.  Some important changes are:

• Volume expands. Now imagine, if there was free air in the chest cavity or what is medically known as a pneumothorax.  This can be caused by many factors, one from a fractured rib puncturing the lung.  The free air that was initially a small volume giving no symptom, can expand severely pressing the lungs and heart.
• Less oxygen in the blood. Now imagine, if someone had a heart attack and already does not have enough blood supply and oxygen to the heart muscles.  With additional reduction of oxygen, more heart muscles are in danger and at higher risk for heart failure.

The doctors need to anticipate all of these changes and the patient’s condition.
In addition to that, the medical staffs will need to consider which equipment to bring.  They have limited space to work, limited baggage to take and limited equipment suitable for the cabin air pressure.

From the technical and administrative point of view….
The team must evaluate the condition to transport the patient, i.e. is it possible to land an aircraft or helicopter, weather conditions, flight clearance, legal documents for inter-country medical evacuations, etc.
And the options are …

Commercial flight medical evacuation.
This means the patient’s transfer will be by a commercial flight with medical escort.  The patient can be seated in a regular seat and the medical escort seated beside the patient.  This is usually possible when the patient is able to mobilise, can sit in an upright position for a prolonged time, is not in a severe disabilitated condition and not anticipated for any severe deterioration during the flight.  When the patient is unable to mobilise or unable to sit in an upright position for a prolonged time, but is also generally stable, the evacuation team can also arrange for a stretcher case on the flight.  This involves putting a stretcher on top of some economy class seats (usually takes 6 seats).  Oxygen supply is also available, but in a specially designed container suitable for the cabin air pressure.  The medical staff will need to calculate how much oxygen supply is required and inform it in advance for the airline to prepare.
The plus is that it is a less expensive type of evacuation and more comfortable for the patient (only applies for the ordinary seat evacuation)
However, it is only for mild to moderate medical conditions where the patient can tolerate the altitude pressure, has limited area coverage depending on the flight route, the time of flight will depend on the flight schedule and usually takes a longer time to prepare, generally 24-36 hours.

Air ambulance evacuation.
A chartered aircraft will be arranged to transfer the patient.  The plane will be equipped with medical equipment and it will even be possible to be set up as a small intensive care unit for critical patients.
The good thing about this aricraft is that almost all patient conditions can be transported, though it’s usually not a priority for mild cases due to its expense.  The pilot can fly at a lower cruising altitude when the patient can not tolerate high altitude pressure.  The aircraft has a larger area of coverage, able to transport patients from remote areas, as long as there is suitable landing and take off area and is able to transport patients to far distances.   The aircraft usually takes less time to arrange, generally less than 24 hours and the flight schedule can be arranged accordingly.
The disadvantages, the flying time is longer time, especially at a lower cruising altitude.

Helicopter evacuation or Helivac.
The advantages of a helivac is its flexibility of access to remote areas, it’s usually faster to dispatch and you do not need to worry about altitude pressure.  It also can be arranged quickly, usually within hours.
Most helicopters however have very limited space thus limiting (medical) people and equipment to carry.  The helicopter is less comfortable because the patient will be strapped in to a secure position due to the unstable movement during flight.  It has limited time to travel, sometimes unable to operate after dusk, therefore also has limited range of distance.
Although a complicated process takes place once medical evacuation is recommended, it is not the patient’s or their family’s place to worry.  It is more important to anticipate any unwanted events because these unfortunate incidents are possible anywhere in the world, where ever you travel.

So when you plan to travel, one thing is to be sure is that you always take out a comprehensive travel insurance policy to be certain it also covers for you for a medical evacuation.

Should medical evacuation be necessary while you are in Bali, BIMC Hospital Bali will handle all arrangements, either by commercial airline carrier, helicopter or private air ambulance charter. Working closely with aircraft operators and insurance companies worldwide, BIMC fully facilitates the medical evacuation to place the patient in the safest hands

Home pregnancy tests are designed to detect the presence of hCG, the hormone manufactured by the blatocyst (the name for the hollow clump of cells resulting from the meeting of sperm and egg) following implantation. Enough hCG is present in the urine to allow a pregnancy to be confirmed as soon as two weeks after conception, although it takes some pregnant women a little longer to test positive.

Although home pregnancy tests are proven to be about 97% accurate, false positives and false negatives can occur. The accuracy of home pregnancy tests varies because:

• The days of a woman’s menstrual cycle and ovulation can vary each month.
• The exact day of implantation of the fertilized egg can vary.
• Each home pregnancy test kit has a different sensitivity to detect hCG.

There are three basic types of home pregnancy tests.

• Dipstick or test strip. The most common types of home pregnancy tests that you either hold in the urine stream or dip into a sample of urine.
• Collection cup test. This test uses a urine collection cup or well with a testing device. To use this type of test, you place several drops of urine into a well in the testing device or you immerse the well into urine that has been collected in a cup.
• Chemical mixing test. A less common type of test which involves mixing a sample of urine in several tubes or cups with a powder or liquid to produce a chemical reaction. The presence of hCG causes a chemical reaction that produces a color change.

General instructions
For any home diagnostic test, you should follow some general guidelines:

• Check the expiration date on the package. Do not use a test kit after its expiration date.
• Store the test kits as directed. Many kits need to be stored in a refrigerator or cool place.
• Read the instructions that come with your test carefully and thoroughly before doing the test. Look for any special preparations you need to take before doing the test, such as avoiding certain foods or limiting your physical activity.
• Follow the directions exactly. Do all the steps, in order, without skipping any of them.
• If a step in the test needs to be timed, use a clock. Do not guess at the timing.
• It’s best to use your first morning urine (it has a higher concentration of hCG than the urine you pass later in the day). An alternative is to use urine that has been in the bladder for at least 4 hours. Usually you have to perform the test within 15 minutes after collecting the sample.
• If you use a test that requires that you collect a sample rather than test your urine while you urinate, be sure to use a clean, soap-free container.
• Many home kits require that you be able to see color changes on a test strip. If you are color blind or have trouble distinguishing colors, have someone else read the test results for you.
• Record the results of the test so you can discuss them with your health professional.

When to check
Home pregnancy kits can be used on the first day of a missed menstrual period. However, the test results are more accurate if you wait a few days longer.

Results
Negative. What you should do is repeat the test in one week if your menstrual period has not started. If it is still negative, consult your doctor why you aren’t having your period yet.

Also consider a false-negative result. This means the test shows a negative result, while actually you are pregnant and it should be positive. It may be caused when:

• It is a very early pregnancy and the hCG level is too low, not detected by the home pregnancy test kit.
• Using urine produced after drinking a lot of liquid (dilute urine)

Positive. What you should do is consult your doctor to confirm your test and arrange follow-up care.

Also consider a false-positive result. This means the test shows a positive result, while actually you are not pregnant and it should be negative. Some might be due:

• Detergent or soap residue in the urine collection cup.
• Reading the test at the wrong time.
• Exposing the test equipment to heat, sunlight, or vibration
• Having excess protein or blood in the urine, which could be from a urinary tract infection.
• Having hCG hormone in the urine from some other cause (such as a very rare type of ovarian or placental cancer).
• You are taking certain drugs, especially fertility medications that contain human chorionic gonadotropin.

Your doctor would perform further evaluation if it is suspected to be a false-positive result.

• Being inactive for long periods. This can happen when you have to stay in bed after surgery or a serious illness, or when you sit for a long time on a flight or car trip.
• Recent surgery that involved the legs or belly.
• Some diseases, such as cancer, heart failure, lung disease, or a severe infection.
• Pregnancy and childbirth (especially if you had a cesarean section).
• Taking birth control pills or hormone therapy.
• Smoking.
• Age. Older people tend to have a higher risk.
• Overweight.
• Some people are born with blood that clots too quickly.

Pulmonary embolism is difficult to diagnose because the symptoms may occur with or are similar to other  conditions, such as heart attack, panic attack or pneumonia. The symptoms may include:

• Sudden shortness of breath.
• Sudden sharp chest pain.
• Rapid heart rate.
• Rapid breathing.
• Sweating.
• Coughing up blood.
• Fainting.

Pulmonary embolism is also a condition commonly found in travelers because a long period of inactivity, such as sitting a long time on a flight or car trip. This type can be prevented with these measures:

• Wear compression stockings if you are at risk for deep vein thrombosis.
• Avoid wearing short, tight socks or crossing your legs for long periods.
• Get up and walk around every half hour to an hour.
• If you can’t easily move around, pump your feet up and down by pulling your toes up toward your knees then pointing them down, do this frequently every half hour.
• Avoid sitting with your legs crossed.
• Drink extra fluids.
• Avoid drinks that have alcohol or caffeine in them, because they cause you to lose fluids. Caffeine is found in coffee, tea, and many sodas.

If you are unsure of the risk and plan to undertake lengthy travel, you should discuss it with your doctor. Your doctor might recommend you take some medication or an injection prior traveling to prevent blood clots.

• Cancer - Nearly everyone knows that smoking can cause lung cancer, but few people realize it is also a risk factor for many other kinds of cancer as well, including cancer of the mouth, voice box (larynx), throat (pharynx), esophagus, bladder, kidney, pancreas, liver, cervix, stomach, colon and rectum and some leukemia’s.
• Lung disease – It is associated with a higher risk for nearly all major lung disease, including pneumonia, bronchitis, flu, and emphysema.  It is also linked with night time chest tightness, breathlessness after exertion and exacerbation or worsening of asthma.
• Heart and vascular problems – The risk of getting a heart attack is up to twice than nonsmokers, because it lowers your HDL levels, causes stiffness and inflexibility of blood vessels and increases risk of blood clots.
• Appearance – premature wrinkling of the skin, stained teeth, yellow fingernails, bad breath, bad smelling of clothes and hair.
• Dying young – It reduces life expectancy by 15 to 25 years. One in three smokers dies early because of their smoking.
• Others – Smoking has been linked to almost every organ in the body and scientifically proven to have a role as a factor to cause Alzheimer, osteoporosis, sexual dysfunction, infertility, peptic ulcers, thyroid dysfunction, cataract, hearing loss, baldness and premature gray hair and many others.

Think about the health of your loved ones
Smoking not only harms your health but the health of those around you.  Exposure to secondhand smoke (also called environmental tobacco smoke or passive smoking) includes exhaled smoke as well as smoke from burning cigarettes.
Smoking by mothers is linked to a higher risk of their babies developing asthma in childhood, especially if the mother smokes while pregnant.  It is also associated with sudden infant death syndrome (SIDS) and low-birth weight infants.  Babies and children raised in a household where there is smoking have more ear infections, colds, bronchitis and other respiratory problems than children from nonsmoking families.  Secondhand smoke can also cause eye irritation, headaches, nausea, and dizziness.
In general, passive smokers have about the same risk of active smokers.

When Smokers Quit - What Are the Benefits Over Time?

• 20 minutes after quitting: Your blood pressure drops to a level close to that before the last cigarette.  The temperature of your hands and feet increases to normal
• 8 hours after quitting: The carbon monoxide level in your blood drops to normal.
• 24 hours after quitting: Your chance of a heart attack decreases.
• 2 weeks to 3 months after quitting: Your circulation improves and your lung function increases up to 30%.
• 1 to 9 months after quitting: Coughing, sinus congestion, fatigue and shortness of breath decrease; cilia (tiny hair like structures that move mucus out of the lungs) regain normal function in the lungs, increasing the ability to handle mucus, clean the lungs and reduce infection.
• 1 year after quitting: The excess risk of coronary heart disease is half that of a smoker’s.
• 5 years after quitting: Your stroke risk is reduced to that of a nonsmoker 5-15 years after quitting.
• 10 years after quitting: The lung cancer death rate is about half that of a continuing smoker’s.  The risk of cancer of the mouth, throat, esophagus, bladder, kidney, and pancreas decrease.
• 15 years after quitting: The risk of coronary heart disease is that of a nonsmoker’s.

How to quit?
Several sources can give guidance to quit smoking, but the most important thing is your own decision and will power to stop smoking.  Always keep in mind the health problem it causes, the benefits of quitting and believe that you can quit and have a better life without it.

• Pick a good time to quit.  Don’t try to quit when you’re under a lot of stress or around holiday times.
• Be aware that smokers have different experiences when they quit.  They may feel sleepy or very excited, lightheaded, nervous or irritable, or they might crave tobacco or sweets or have headaches.
• Be sure to get some exercise every day.  For example, walking is a great way to reduce the stress of quitting.  Exercise is a big boost toward feeling better, improving spirits and keeping trim.
• Get plenty of sleep, eat a balanced diet and drink lots of water.
• Ask family, friends and co-workers to help.  Having someone to take a walk with or just listen can give a needed boost.

If you seem to face problems in your self-help stop smoking program, seek professional advice and don’t hesitate to see your doctor.
What will happen when I stop smoking?

How you feel when you stop depends on how much you smoked, how addicted your body is to nicotine and how well you prepare to stop smoking.  You may crave a cigarette or feel hungrier than usual.  You may feel edgy and have trouble concentrating.  You also may cough more at first and you may have headaches.

These things happen because your body is used to nicotine.  They are called nicotine withdrawal symptoms.  The symptoms are strongest during the first few days after you stop smoking, but most go away within a few weeks.
If you feel you can’t cope with these withdrawal symptoms, ask your doctor for nicotine replacement products or medication.
Many smokers do gain some weight when they quit.  Even without special attempts at diet and exercise, however, the gain is usually less than 10 pounds.  Women tend to gain slightly more weight than men.  There is evidence that smokers will gain weight after they quit even if they do not eat more.

You are more likely to be successful with quitting smoking if you deal with the smoking first and then later take steps to reduce your weight.  While you are quitting, try to focus on ways to help you stay healthy, rather than on your weight.  Eat plenty of fruits and vegetables and limit the fat.  Be sure to drink plenty of water, get enough sleep and regular physical activity.
What if I smoke again?

Don’t feel like a failure.  Think about why you smoked and what you can do to keep from smoking again.  Set a new stop date.  Many ex-smokers did not succeed at first, but they kept trying.
The first few days after stopping will probably be the hardest.  Just remember that even one puff on a cigarette can cause a relapse, so don’t risk it.

More than 45.7 million smokers have quit. Many of them tried several times before they were able to quit.  They made it and quit for good.  You can, too.

Although surfing is thought to be a relatively risk free sport, with an incidence between 3 - 4 injuries per 1000 days of surfing, we think it’s wise that you know what to expect and what to do before riding the waves.

Surfing is an ancient sport originally from Hawaii. There is written evidence as far back as 1500 AD of surfing rituals or in Hawaiian it is called “he’e nalu”. Since reaching California in the early 1900s, the popularity of surfing grew rapidly. Bali has also been a major attraction for surfers. Kuta, Uluwatu, Padang Padang, are just to name a few of the favorite surfing “hot spots” in Bali. BIMC Hospital, which is located less than 30 minutes away from these surf locations, receive surfing–related injuries on a daily basis, especially during the months of July and August.

Below listed are the most common injuries in surfing seen at BIMC Hospital.

Laceration
This is the most frequent type of injury. These injuries were mostly caused by the surfers own board, contact with another surfer’s board, or contact with the ocean floor.

What to do?

• Flush the wound with clean water.  You can use mineral water, the best choice is to use normal saline sterile water.
• If possible, gently scrub the wound with soap and water. Do not use alcohol or hydrogen peroxide, because while these are very good antiseptic solutions, scientific research also show they kill the tissue which lines a wound. This effect will leave a wound lined with a layer of dead tissue that is a perfect environment for bacteria to grow in.
• Stop the bleeding by applying direct pressure on the wound with a clean cloth. Do not use a cotton pad because the cotton fibres will stick on the wound and are difficult to remove.
• If you notice a large stab with a foreign object, do not attempt to remove it. Try to stabilize it and seek medical attention ASAP.
• Superficial wounds can be self-treated with thorough cleansing, a topical antibiotic and good wound care afterwards.
• However, you should remember: even small superficial scratches can lead to serious infection, such as cellulitis, if not handled properly. Whenever you have doubts you should seek medical attention soon. Read our previous article about cellulitis.
• Generally the “golden period” for skin wound is less than 12 hours. This means if you get treatment, ie. sutures, staples, etc, within that time, you can expect good healing or as it is called, primary healing. Read our previous article about wound sutures.

Head Injury
With reference to the most common injury, laceration, surveys show that the most common site of a laceration is on the head. Every trauma on the head should have special consideration.

What to do?

• One rule you should remember: Every trauma to the head should be seen by a doctor. Read our previous article about concussions.
• Seek medical attention ASAP.
• Also remember the possibility of neck injury, avoid neck movement as much as possible after the trauma, until the doctor confirms there are no serious cervical injuries.

Sprain, strain and dislocation
A sprain is an injury which occurs to ligaments caused by a sudden overstretching. The ligament is usually only stretched, but sometimes it can be snapped, slightly torn or ruptured, which are more serious and require a longer time to heal. While a strain is a similar injury which occurs to the muscles.
Dislocation is a term to describe a condition when bones at a joint moves from their normal position.
What to do?

• Remember RICE: Rest, Immobilize, Compress, and Elevate, if it’s on an extremity.
• Seek medical attention.

Shoulder dislocation is quite a common sport related injury, not only for surfers. Read our previous article about shoulder dislocation.

Fracture
The most common fracture type for surfers are nose fractures. Usually this is due to contact with the surf board.

What to do?

• Wrap ice in a towel or cloth then apply it on the nose. Do not apply ice directly onto your skin.
• Seek medical attention.

For fractures on the extremities, such as arms or legs:

• Try to immobilise the extremity. If possible apply a splint or sling. You can use a rolled up newspaper or strips of wood as a splint. Immobilise the area both above and below the injured bone.
• If you notice an open wound, possibly caused by the broken bone, you may attempt to rinse it with clean water and remove the dirt, but do not flush it as you would do to a simple laceration wound.
• Seek medical attention ASAP.

Ear drum rupture
Perforation and rupture of the ear drum occurs occasionally, with an injury incidence of 5%. Although the eardrum would usually heal by itself, it is advised to see a doctor when you suspect you have this problem. If it is not managed properly the eardrum defect can be permanent and the middle ear will be easily infected causing chronic middle ear infections that can lead to serious complications, such as meningitis.

Safety equipments, such as nose guards, helmets, etc, are actually important to prevent these injuries. However, most surfers think these equipment and devices are “uncool” or would cause difficulties in surfing maneuvers. Consider them… it might save your life and your surfing days.

And one important thing is always follow the “unwritten rules of surfing”.

Good luck and surf safely!

Sore Throat

We might just call the sore throat a common sore, since it is as common as the common cold. It could happen to anyone, anywhere and anytime. It can be an early sign of many diseases, even some serious diseases. The key is “Pay attention, but don’t panic”.

What are the dangers of sore throat

The most important thing to remember is that the throat is part of your airway. It’s important it keeps open and clear to let the air you breathe go into your lungs. If you have a severe infection, the throat can become very swollen and closes your airway. This condition can be fatal. The early signs of stridor, a coarse sound when you breath because the air flows into a narrow passage, is a sign you need to seek medical attention as soon as possible before the airways closes totaly.

A more common complication is difficulty to swallow. Since it is painful to swallow, patient’s are reluctant to eat, in severe infections, it is even painful to swallow fluid. When this occurs, the patient can develop dehydration. This is also an indication to see a doctor and you might need IV rehydration.

In strep throat – throat infection to due the streptococcus bacteria – when not treated properly, the infection can spread in the blood and cause severe systemic infection. Other complications are heart and kidney problems. You should see a doctor to get antibiotics and most importantly, finish the full course as directed by you physician.

Treatment

The treatment will depend on the cause.

For irritation and virus cause, the treatment is symptomatically.

For bacterial and fungal infection, your doctor will prescribe antibiotics according to the suspected organism. Some doctors will take a throat swab to determine the cause of infection.

What you should do to ease the sore throat?

• You should have enough rest
• Drink plenty of fluids. Even if its painful to swallow, you should encourage yourself to drink about 8 glasses of water a day.
• The sore throat will get worse when you are dehydrated or when you have a dry throat.
• Take pain medications, such as paracetamol and ibuprofen. You can also take over-the-counter throat antiseptic lozenges or gargles. Avoid ones containing alcohol, because it will dry your mouth and tongue, which will worsen the soreness.
• Avoid polluted areas.
• Eat soft food.

You should seek medical attention when you notice:

• High fever.
• Body aching.
• Difficulty in swallowing or breathing.
• Painfull swelling of the neck, ie enlarged lymph nodes.
• You see your throat has white patches.
• You are not getting better after 3-4 days.

There is no sure way to prevent a sore throat. To help reduce your risk:

• Drink enough fluids to prevent dehydration.
• Wash your hands often, especially when you are around people who are sick.
• Identify and avoid irritants, such as smoke, fumes, or yelling, that cause a sore throat.
• Do not smoke or use other tobacco products and avoid exposure to secondhand smoke.
• Avoid contact with people who have strep throat.
• If you have mononucleosis, do not share eating or drinking utensils to prevent spreading the virus to others. A brief kiss on the lips is not likely to spread mono; it is spread when saliva from an infected person enters another person’s mouth.

BIMC HOSPITAL ( ビーアイエムシー ホスピタル ) 。
通称BIMC( ビーアイエムシー ) にご来院になる日本人の患者様には、
日本人スタッフがご対応しています。

当院は、設立当時から24時間年中無休をモットーに、インドネシア人は勿論、
日本やオーストラリアを初めとする世界各国からの旅行者、バリ島在住者の
皆様に対する医療サービス全般をご提供させていいただいております。

BIMC HOSPITAL ( ビーアイエムシー ホスピタル ) 病院施設のご案内

BIMC は日本人スタッフ常駐だからいつでも安心

BIMC は海外旅行保険キャッシュレスメディカルサービス提携病院。だから、お財布も安心

BIMC はクレジットカードの海外旅行保険付帯保険への申請書類も完璧。勿論無料です

BIMC では、国民健康保険や社会保険の申請書類作成も、無料でお手伝いしています

BIMC はバリ島でもきちんとした衛生環境の整った病院だから安心

インドネシア・バリ島の医療事情 Q & A

• ✚ Q) BIMCに来る人の中で、一番多い症状は何ですか？
• ✚ Q) BIMCの日本人スタッフは24時間対応してくれるそうですが？
• ✚ Q) クリニックと病院は違うのですか？
• ✚ Q) 診察を受けたい時はどうすればいいですか？
• ✚ Q) 日本のように、専門医に直接診察してもらうにはどうすればいいですか？

お知らせ　バリ島でアンチエイジング

「日本から持ってきた薬が効かないなぁ・・・」
「せっかく来た旅行だから、具合悪いけどちょっと我慢しちゃおう・・・」
「病院で言葉が通じなかったらどうしよう・・・」
「これぐらいの事で病院に行くなんて、大げさかしら？」

海外でこんな思いをされた方はいっらしゃいませんか？

BIMC は日本人スタッフ常駐だからいつでも安心。

言葉や習慣の違う外国では、病気やケガの症状を的確に伝える事は困難です。
私達BIMCでは、日本人の患者様には日本人スタッフがご対応致しますので、
言葉ができなくても、一切心配いりません。

当BIMCの日本人スタッフは朝9時から夜7時までの院内常駐勤務で、
その他の時間帯は、基本的にお電話で対応しています。

BIMCは、バリでの下痢や腹痛、急な発熱、小さな傷の治療から
緊急医療移送に関わる事まで、24時間年中無休で対応している病院です0。
万が一バリで体調が悪くなってしまったら、
こじらせる前に診察を受けていただくようにお勧めしています。

BIMC は海外旅行保険のキャッシュレスメディカルサービス提携病院だから、
お財布も安心。

現在、日本の保険会社16社の海外旅行傷害保険・キャッシュレスメディカルサービスが使えます。
当BIMCは各種海外旅行傷害保険の正規提携病院なので、面倒な手続きが一切ありません。

海外での医療費は高額になりがち、とよく言われますが、
海外旅行傷害保険のキャッシュレスメディカルサービスがあれば、
旅行中の病気やケガの治療費はサインだけでOK。病院でのお支払いは一切必要ありません。

キャッシュレスメディカルサービスに関する詳細は、日本人スタッフまでお問合せ下さい。

BIMC はクレジットカードの海外旅行保険付帯保険への申請書類も完璧。
勿論無料です。

現在、日本のクレジットカードの種類は多種多様。
更にクレジットカードに付帯している海外旅行傷害保険に関しては、
個人情報などの問題もあり、簡単には分からない事が多いため、
原則的に、現地にて立替払いをしていただき、
ご帰国後に保険金の払い戻し請求手続きをお取りいただいております。
勿論、払い戻しに必要な書類（診断書・領収書など）は、全て無料でお渡ししております

BIMC では、国民健康保険や社会保険の申請書類作成も、無料でお手伝いしています。

海外旅行傷害保険でカバーされない疾病や既往症などについては、
日本でご加入の国民健康保険や社会保険の「海外療養費用」が適応になることがあります。
国民保険や社会保険への申請は、指定された申請書類の作成が必要になります。
BIMCでは、申請書類の作成も無料でお手伝いしています。
申請書類作成が必要な方は、日本人スタッフまでお申し出下さい。
（書類をご用意するまでに、通常1~2週間かかります。予めご了承下さい）

BIMC はバリ島でもきちんとした衛生環境の整った病院だから安心。

当BIMCでは、全ての患者様に安心して治療や施術を受けていただけるように、
病院内の衛生環境にも配慮しています。
特に医療器具の衛生面に関しては、日本の病院と同様に使い捨て器具の使用の徹底と、
使い捨てに出来ない医療用のハサミなどの器具は、専用の加熱滅菌器による殺菌・ 消毒
の処理を、院内の専用施設で専任のスタッフが行っています。
病院施設内の清掃も、先進国に引けをとらない清潔さを保つように毎日努力しています。

このページのトップへ

インドネシア・バリ島の医療事情 Q & A

Q）　BIMCに来る人の中で、一番多い症状は何ですか？

A)　季節にもよりますが、下痢、腹痛、風邪の諸症状とケガ、が
日本人に多い症状と言えると思います。
気温差や疲れなどで体力や免疫力が弱っている時には、
病気にも罹りやすくなっていますから、
とにかく、海外に出たら無理や我慢は出来るだけしないように注意して下さい。

Q）　BIMCの日本人スタッフは24時間対応してくれるそうですが？

A)　BIMCの日本人スタッフは朝9時から夜7時までの院内常駐勤務で、
その他の時間帯は、基本的にお電話での対応になっています。
ただし、緊急の場合は勿論この限りではありません。

日本人スタッフは言葉の通訳だけでなく、
患者様のご様子を拝見して分かる事を医師に伝える必要がありますから、
出来るだけ日本人スタッフの院内勤務時間中にお越しいただきたいのです。
処方されたお薬の作用･副作用なども、直接お話した方が分かりやすいですし。

それから、特に既往症などで日常継続して服用しているお薬のある方は、
特に朝9時から午後7までにお越し頂きたいです。
いつものお薬と、こちらでの処方薬との副作用が出ないように、
お薬の処方を考えなければいけませんからね。

Q)　クリニックと病院は違うのですか？

A)　日本の法律と異なるインドネシアの法律では、
クリニックでは24時間を越えて入院することは出来ません。
24時間を超えてしまう場合は、必ず病院に移って入院することになります。
当BIMCは、インドネシア政府から正式に認可を受けた病院なので、
患者様ご自身が自分で「もう大丈夫」と思えるまで、入院して治療を続ける事ができます。
点滴治療が効果的な症状の場合には、点滴を目的とした数時間の短時間入院も可能ですよ。

Q)　診察を受けたい時はどうすればいいですか？

A)　診察は基本的に予約優先になっていますので、
事前にお電話でご予約されることをお勧めしています。

BIMCでは日本人患者さまには必ず日本人スタッフがお手伝いしていますので、
言葉の心配はいりません。日本語だけで大丈夫ですよ。
また、日本から持ってきているお薬がある場合は、診察時に全てご持参下さい。

インドネシアでは、一般初期医療はGP(ジーピー)と呼ばれる一般医がまず最初に診察します。
（外科、内科、小児科、耳鼻咽頭科、眼科、婦人科 など。　歯科は除きます）
もちろん、GP は初期一般医療を診察できる知識を持っていますので、
あまりご心配なさらないで下さい。
GPが診察して「専門医の診察が必要である」と診断された場合には、
該当する専門医の予約を取り、専門医による診察が行なわれます。
日本のように、初めから直接専門医に診察してもらう、ということはあまり無いですね。

Q) 日本のように、専門医に直接診察してもらうにはどうすればいいですか？

A)　専門医はそれぞれに個人の診療所を開いている場合が多いので、
そちらに行けば直接診察してもらう事が可能です。
ほとんどの個人診療所は夕方6時頃から診察が始まります。

しかし、現在バリに住んでいる現地人専門医の中で、
日本語を完璧に話せる医師はいませんので、
患者さまご自身が英語またはインドネシア語での会話が完全に問題ない場合を除いては、
個人で専門医の診察を受ける事はお勧めできません。

当BIMCで診察をお受けになり、専門医の診察が必要になった場合は、
専門医がBIMCまで来てくれて診察しますので、BIMCの日本人スタッフが
継続してお手伝いすることが出来ます。
専門医の診察でも言葉の心配は一切要りません。

このページのトップへ

BIMC HOSPITAL ( ビーアイエムシー ホスピタル )

病院施設のご案内

✚ 日本人スタッフ常駐、24時間日本語対応

✚各種海外旅行傷害保険、キャッシュレスメディカルサービス取扱い

✚ 往診24時間可能

✚ 救急救命センター

✚ 入院施設完備 （ICUを含む）

✚ 緊急時、事故等対応 手術室

✚ CTスキャン

（※ BIMCでのCTスキャンはシンガポールの専門医からの解読所見が受け取れます）

✚ デジタルレントゲン、超音波、臨床検査施設

✚ 薬局

✚ 医療機器装備の救急車 常時スタンバイ

✚ 緊急医療移送手配可能

※ 当BIMC日本人スタッフの院内常駐は、朝9時から夜7時となっております。

※ 常駐時間外で日本人スタッフを必要とされる方には、
原則的にお電話での対応となりますのでご了承下さい。
また、患者さまが常駐時間内にご来院された場合でも、
日本人スタッフが他の患者様の診察や往診に付き添い中、などといった
やむをえない状況の場合にはお電話での対応となることがございます。

※ 診察は基本的に予約優先となっておりますので、診察をご希望される場合には、
事前にご予約される事をお勧めいたします。（緊急時を除く）

※ ご予約をいただいた場合でも、緊急の患者様がいらっしゃる場合には
ご予約どおりのご診察順序にならない場合がございますので、
何卒ご理解下さいますようお願い申し上げます。

当院に関するご質問やお問合せは
E-mail アドレス : japanmarketing@bimcbali.com までお気軽にご連絡下さい。

尚、バリ島は通信設備が日本のように整っておりませんので、
万が一、メール送信後 48 時間経ってもこちらからのご返信が届かない場合には、
お手数ですがもう一度再送信していただけますようお願い申し上げます。

このページのトップへ

お知らせ　バリ島でアンチエイジング

日本でも一般に浸透してきたアンチエイジング。

実は、BIMC HOSPITALにも、
皮膚科専門医が施術するアンチエイジングがあるのをご存知ですか?

♥ BIMCでの1番人気はなんと言っても「BOTOX （ボトックス）」
♥ BOTOX （ボトックス） は短時間でOK
♥ 日本に比べて料金もお得
♥ 日本人スタッフが通訳のお手伝い
♥ 完全予約制
♥ アンチエイジングに関するお問合せ

♥ BIMCでの1番人気はなんと言っても「BOTOX （ボトックス）」

お顔の表情筋の動きを抑制させることで、
眉間のシワや目尻に出るカラスの足跡、唇の上に出来る縦ジワなど、
表情によって出るシワを出ないようにすることが出来ます。

♥ BOTOX （ボトックス） は短時間でOK

ボトックスの施術に必要なお時間は、皮膚科専門医との診察を併せても約30分程度。
ちょっとした空き時間があれば、どなたにでも簡単にお試しいただけます。

♥ 日本に比べて料金もお得

気になる施術料金ですが、必要になるユニット数には個人差があるものの、
日本での施術に比べるとかなりお安くご提供しています。

♥ 日本人スタッフが通訳のお手伝い

アンチエイジングも日本人スタッフが通訳のお手伝いをしますので、
言葉の心配は一切要りません。

♥ 完全予約制

アンチエイジングは完全予約制です。　必ず事前にご連絡のうえご予約をお取り下さい。
現地でのご予約は月曜日から金曜日の午前9時から午後4時まで受け付けております。

現地ご予約お電話番号： 761 263

♥ アンチエイジングに関するお問合せ

ボトックスをはじめとするアンチエイジングのメニューや料金など、
その他詳細につきましては、日本人スタッフ宛メールにてお気軽にお問い合わせください。
日本語E-mail アドレス : japanmarketing@bimcbali.com

尚、メール送信後 48 時間経ってもこちらからのご返信が届かない場合には、
お手数ですがもう一度再送信していただけますようお願い申し上げます。 ]]> http://www.bimcbali.com/japan/japan.html/feed