This is three short posts, merged into one.

Yesterday, I removed an ixodid tick from the external auditory canal (fairly deep inside the ear) of a little lad. He had been scratching at it for a few days but mum couldn’t see anything wrong. I reckoned it had crawled in when the boy was sleeping with his pet dog, their normal host.

Auditory canals are tubes of cartilage, lined with skin, leading to the eardrum. They are never straight, and usually form an “S” bend. A nurse saw the tick while using the autoscope, but didn’t know what it was. I recognised it immediately. Thirty five years ago, I was bitten by an ixodid tick, and contracted African tick typhus. This is the “man flu” of typhus diseases. In Thailand, we have mainly scrub typhus, transmitted by tiny mites, and louse-borne typhus which…you guessed it.

The problem was how to remove the tick. It was attached by its mouthpiece to the skin, deep in the ear. If it had been just wandering about, we could have floated it out, by flooding the canal with oil. This technique is good for maggots and larvae as the oil blocks their spiracles (breathing pores).

I got the finest pair of tweezers in the surgical armoury and three of us held him down, and distorted the ear canal so I could see with a powerful torch. I nipped it off as close to the skin as I dared and pulled it out. Mum was most impressed. It was bleeding a bit, so we put in a wick soaked in chloramphenicol eye ointment. The trick is to get as much of the mouthpiece out as possible, to prevent infection. I think I did.



Now “Tacky”. This is a bouncy castle play area for children set up in a market shed in Maesot. Strangely, no children are playing on it. It looks grim, never mind tacky. Quite scary faces, in fact.

And finally Toe. Here is a photograph of impetiginised eczema. Dirty feet, itching, scratching, not wearing footwear, looks a real mess. Cleaning, antibiotics, anti-itch/ histamines, and some moisturising cream will sort it out promptly.

PS one for the road, another ‘toe’ showing gross clubbing in a man with advanced pulmonary tuberculosis. You can see it best on the man’s right great toe. On the left, he has an advanced fungal nail infection.



6 Replies to “Tick-tacky-toes”

      1. That’s interesting, isn’t it. I have no problem with the medical conditions, but maybe you could also expand some of these into a wider social/economic context – changes in diet and life-style for instance or whatever occasions particular conditions – just a thought. And what about traditional medical practices – effects etc I’m not really trying to turn you into a social scientist, but then again…

      2. The Karen have been in conflict with the Burmese army government since 1985. Many are living in refugee camps, but I deal with displaced persons. There has been no development of their region for the past 30 years, no functioning clinics, hospitals without drugs and equipment. The people come to Thailand to work for little money. It used to be $1 a day for 7am to 7pm. They are mostly poor and living from hand to mouth. Their diet is low in vitamin B1 (polished rice and dried fish). Even though their leaders are at peace with the generals at the moment, their state is not being developed. They rely on traditional beliefs which for the most part are harmless but ineffective. They live for the present as they have little control of what happens in the future. I’m just scratching at the surface. Helping a few. The solution is political. But I’m sure your husband felt the same way working in Africa.

      3. Yes, Graham did feel very frustrated in Kenya. As you say, political solutions are what is usually called for in these situations. Good on you, though, for doing what you can. My history is very patchy, but this whole situation between Burma and the Karen goes way back, doesn’t it – around the time the British were mucking around in Burma before WW2??? We did some wretched things, whose unresolved ill-doing goes on resonating down the decades. Anyway, keep up the good work. You are surely appreciated by those you do manage to help.

  1. I always read your posts IBC. My hubby Ross says, I quote “fix the little bastard up with a drop of kero or diesel fuel before trying to remove it – they die and relax their grip” – hahaha. 🙂

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