• If the mother poos during the birth, which sometimes happens, you should wipe it away, front to back.
• Take the baby and hold it upside-down while supporting its head. This allows the fluid to drain from its mouth.
• When it cries, wrap it in something warm and put it on the mother’s chest. If it is not crying or does not seem to be breathing, you need to begin CPR after two minutes (see CPR for babies).
• About 10 minutes after the baby is born the afterbirth is expelled – your work is not done until that is out. Retain this for later so that the doctor can assess if everything has come out.
• If you are expecting help, do not cut the umbilical cord yourself: wait for the professionals. If not, you need to take your sterile string and tie it tightly around the cord 15 cm from the baby’s tummy. It needs to be tight or the baby will lose blood. Tie another knot 5 cm from the placenta, then use your sharp, sterilized blade to cut between the knots. Put a dressing on the cord until it stops bleeding. Tie another piece of string about 10 cm away from the baby’s tummy.
• Now you need to look after the mother. She will need water, sugar and rest. If the bleeding or pain is severe, you need to treat her for shock (see Shock).
Warning: If you are a pregnant woman travelling somewhere dangerous or remote, make sure you have everything you need to give birth – string to tie the umbilical cord, a fresh blade to cut it, and something warm to wrap the baby in.
If someone in the group you are working with has diabetes, you need to know about it. Not telling you is irresponsible; at the very least, it may explain the person’s occasional grumpy mood and needle marks on their body. They should also brief you on how to treat them if anything goes wrong.
If you are in a war zone or a dangerous place, you might get separated, so they should have the fact that they are diabetic clearly written on their helmet and body armour. They should also be wearing a medical warning bracelet (see Recovery position for adults and children).
Diabetes is all about blood sugar levels, either too much (hyperglycaemia) or too little (hypoglycaemia). You need to know the signs in case they have their first-ever experience of either when you’re together. Because it can be difficult to decide which they have, the safest immediate treatment is sugar. Strangely, it has little effect on a hyperglycaemic person, but will get a hypoglycaemic individual back on the road to recovery. That’s why diabetics often travel with sweets in their pockets. If they have type 2 diabetes (i.e. they have some control over their sugar levels but not much), sweets might be all they carry, so don’t always expect to find an insulin pen.
First signs of hyperglycaemia (high blood sugar): Quickened pulse; no sweating; rapid breathing and thirst. Their breath may smell like nail varnish or pear drops. As it gets worse, they will become sleepy and eventually fall unconscious.
Action: Use an insulin pen – place it against their thigh or into the fat of their stomach and press down on the end like a ballpoint pen. Insulin is the chemical normally produced by the body to regulate blood sugar, so it should help to bring them round. Hurry them to a hospital.
First signs of hypoglycaemia (low blood sugar): Sweating; rapid pulse; short temper; weakness and hunger. They may appear drunk and will get less and less responsive before eventually falling unconscious.
Action: Sit them down and feed them sugar and liquid – orange juice or a fizzy drink is ideal. Once they have recovered they can decide when they should have a dose of insulin, usually when it was next due in any case.
Find their glucose-testing kit and help them to use it so you can check you are not giving them too much sugar.
If they fall unconscious before you can get enough sugar inside them, take them to a hospital as soon as possible.
I don’t know how many times I have gone to a place off the trodden pathway secretly hoping for a touch of diarrhoea. It seems like a good way of getting rid of that last bit of tummy. But try as I might – drinking tap water in Delhi, eating meat on a weeklong boat trip in Vietnam, consuming fish in Ladakh – it never seems to come when you want it.
I have since learnt my lesson. It started with salmonella on a boat holiday in Turkey – the loos flushed only once every night, so I had to fling myself into the water in the dark to avoid embarrassment. On another occasion I had terrible tummy problems on a 16-hour journey from Basra to Amman that could have got me killed. I was supposed to be invisible in case our presence at a petrol station or food stop alerted hijackers further up the road. But I kept having to run out to use the loo at each place we passed. It was usually a fetid, stinking hole in the ground, with no door and a grinning audience. But the most painful couple of days I ever spent was two hours north of Timbuktu, running to and from a tent in the Sahara. I woke up naked on a sand dune after passing out on a dash to a private corner of the desert to find a Tuareg guard smiling down at me, offering me his hand.
Poo stories are brilliant, but I wouldn’t encourage you to go after them.
Action: Find any way you can to make the person comfortable and give plenty of liquid. Avoid all dairy produce, as that will aggravate the stomach. When they can start eating again, try simple foods – pasta, bread, biscuits and potatoes – before moving onto a normal diet. If the condition is very serious, the loss of fluid could lead to shock (see Shock). Seek medical assistance. A doctor will be able to prescribe drugs to help relieve the pain.
Look out for bloody diarrhoea – the chances are that it’s dysentery, which requires antibiotics. Seek urgent medical assistance. In the meantime, keep well hydrated with whatever liquid you can keep down. Water with a tablespoon of sugar and half a teaspoon (non-heaped) of salt per pint (500 ml) will work.
Monique Nagelkerke advises: ‘Do not take the usual anti-diarrhoea remedies to stop bloody diarrhoea as this could result in bowel damage.’
First signs: Obvious deformity, with the bone protruding under the skin where it shouldn’t be. The muscles will spasm and hold it there unless it is put back.
Action: Immobilize the shoulder or finger (see Immobilizing fractures) until you can get proper medical help. It is dangerous mending a dislocation as nerves or muscle can get stuck in the joint. It is also incredibly painful.
If you must tackle the dislocation yourself, this is how you do it. Put your foot in the person’s armpit and pull on the arm until the shoulder clicks back into place. For a hand, pull on the finger until it clicks back into place. Once the dislocated part is back in place, immobilize it (see Immobilizing fractures) and let it rest for some time.
Action: Carry out ABC (see ABC – the first checks) until the casualty’s vital signs are normal again. Put them in the recovery position (see Recovery position for adults and children) and start to warm them up. Even if they appear to be fine, they will need proper medical treatment because any residual liquid in the lungs will cause irritation and lead to the airways becoming narrowed a few hours later.