Acute abdominal pain and traveller's diarrhea

Acute abdominal pain

On my second trip to Nepal, I was finally sitting down to dinner late one evening, when there was a knock at the door. One of the participants of the course was there on his scooter, asking if I would come to help someone who was acutely ill. I quickly finished my dinner and jumped on the back of the scooter with my repertory and a kit of remedies. It was dark quite early and after a trip through alleys and bumpy paths, we came to one of the kind of houses that are so familiar there – half finished. The first storey is finished, above, however, the corners of the second storey are in place but the storey itself is not there.

A young woman was lying on the second floor, on a bed under a tarpaulin. She looked very sick and it was clear that something was very wrong with her. She had terrible pain in her belly and could not keep any food or drink. On examining her, I found that she had a painful swelling in the middle of her belly and no peristalsis. I assumed that it was an invagination or torsion of the intestines, and said that she would have to go to a surgeon. After much talking with the course participant, it became clear that hospitalisation was not an option. In those parts of the world, people are of the opinion that one simply dies in hospital, if one can afford to go there at all. All eyes were looking hopefully at me. I was clearly seen as her doctor, the only one treating her, and I had permission to treat her homeopathically.

In such an acute situation, I assume that a good remedy should produce a reaction within a quarter of an hour. Using the rubric “Intussussception”, I gave Arsenicum. Nothing happened and I sat quietly beside the bed, becoming uncomfortable and unconfident. Of course, I tried to understand what had happened with her, via the translator, and gave her Bryonia, since she was lying there so very still. Again, there was no change. Then Opium, but alas, no reaction – except for the fact that she sat up and bent over, drawing her knees up, offering a clear picture for the next remedy: Colocynthis. Around that time, the story finally became clear: something had happened in her family that had made her extremely angry. Within fifteen minutes, the pain was gone and she asked for something to eat. I dared to get back on the scooter and go bed, knowing that she would live. The next day, she came to visit the clinic and there was no palpable mass at all in her belly.

Needless to say that I would never have dared to do this in Holland; crisis and necessity break the rules!

Traveller’s diarrhea

After a personal experience, I always ask patients with chronic diarrhea after a trip to the tropics, if they have experienced any severe frights on their journey. Twenty five years ago, I travelled through Nepal. One evening in a lodge, we felt very threatened by a group of young men who were partying and we fled, with the idea that we were being chased for a long time (which, luckily, was not the case). Thank goodness, some people put us up for the night. This was the last day of a three week trek; we were going back to Kathmandu by bus the next day. It was only when we were actually on the bus that I started to feel safe. As soon as we departed, I felt the first signs of diarrhea. I will always remember that trip: having diarrhea while travelling on a bus from the fifties, driving over mountain paths next to ravines is not such a fun thing to do, and in my case it was charged with feelings of shame. Unfortunately, in that time, I didn’t have a homeopathic traveller’s kit with me, so I just sat it out. A few weeks later, my complaints were over. About ten years later, I did a proving together with several colleagues. On the second night of the proving, I had a dream: I was being chased by 3 giants. I could just escape but I felt terribly anxious. The next day, I went to work but I could hardly sit at my desk as I often had to run to the toilet with diarrhea. The remedy that we were proving turned out to be Opium: diarrhea after fright, ailments from shame. Later, I saw a patient who had come back from a trip to the tropics with intestinal complaints after he having been mugged. Opium relieved his symptoms.

Photos: Wikimedia Commons
Rainer Haessner; construction of a new house nearby the street between Kathmandu and Bhaktapur
Kogo; market day at Namche Bazar (Khumbu, Nepal)