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My mom is 86 yrs old & is diabetic. Her 2 toes on her left foot were infected to the bones in Dec 2015. She had her 2 toes amputated in Dec 2015, then another 3 toes amputated after a week. Her left foot is still full of pus so Dr. in Vanuatu had her operated each week. In total, she had had 5 operations since Dec 2015 till now. With the lack of professional & technical resources and total absence of laboratory for research & testing in Port-Vila hospital, would my mom be better off being amputated continuously OR stop further operations. She's had 5 operations already and suffers greatly. She's been given panadol to minimise her pain daily. Dr. recommends she returns home even though her foot is still full of pus & advises her wound be cleaned twice daily & bandages changed. She can't stand nor walk anymore with her age & does her toilet in bed. She wishes euthanesia but ending one's life is not allowed in Vanuatu.
If she refuses further operations, what will be the consequences to her, in terms of painfulness, life expectancy etc...? Will she be better off with further amputations given her age & condition or live the rest of her life with her current condition? Please note that the public hospital in Vanuatu has very limited facilities. Most doctors are volunteers from overseas. Her Dr. in charge is on holiday overseas so a local doctor did the last 4 amputations.

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Thank u very much for all your advice & support. Vanuatu's local supply of fruits & vegetables all depend on the weather. Last April, nearly 100% of trees & houses were devastated & destroyed following a category 5 cyclone, leaving most people out of water & electricity. Vanuatu has received lots of clothings & food donations from overseas but I'm afraid all donations are not being distributed equally given the location of 80 islands & problems reaching remote areas (local infrastructure totally destroyed) .Hotels have recently been back to business following repairs & renovations. Recent political instability due to corruption plus the current drought don't help much to put the country back to development path. Scarcity of local food only increased the price of imported food. A head of cabbage (imported from Australia)at the supermarket, costed US$7-10 when I visited my family last February, after the cyclone the price doubled. There are only a few supermarkets, 2 chemists, one private hospital owned by expatriates, so u can imagine the exorbitant price they charge for goods & services, more than triple the price in Australia. Minimum wage is approx. US$250 a month with no social welfare at all. Locals depend on their own tribe's herbal medicine when sick & if unlucky ended up being poisoned like my nephew who passed away very young. Expatriates who are seriously ill or need to undergo operation usually go back to their own country (Australia, NZ, France...) to seek medical service. My family members are Ni-Vanuatu so have no choice but to pay the high price.
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All I can say is this is terrible and I am so, so sorry you both are going through this! I wish you all the best.
Peace, strength and love!
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Fion I think the best has been done for your Mom. Once she recovers from the amputation as long as all the diseased tissue was removed she has a chance of recovery.
I am not familiar with IXPRIM but I think it is Tramadol which again is a wise move given the inevitable pain of the amputation. Again I also have no experience with Tramadol, personally or professionally but hear it is effective.
The important thing now is to keep Mom comfortable and prevent secondary infection of her stump. I envision her as a large lady but if possible get her out of bed and exercise her good limbs. If you can also borrow a wheelchair short periods outside or wheeling her to a cafe or stores may improve her depression. Try and keep the diabetes well controlled and feed her a healthy diet. I imagine on a tropical island you have plenty of fresh fruits and veg.
Home is actually the best place for her to be right now even though the family may not be trained caregivers they are the people she loves and trusts.
In our well insulated lives in the US we have no idea of the difficulties people face in remote corners of the world.
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I agree with you ferris1.
Continuing to cut body parts away is not the answer.
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Dr discharged her from public hospital & she's back home. My sister bought IXPRIM from French pharmacy to reduce her daily pain as Panadol not effective. She also managed to borrow a handicapped bed from Red Cross. Now we just pray & wait for her wound to recover after amputation.
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Australia may refuse her based on the infection. Avoid the private hospital unless it has very good accreditation and full staffing. I sincerely hope that she gets assigned to a capable MD right where she is.
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I apologise for my late reply. I live in Taipei with 3 kids to mind by myself & I'm also awaiting news from my family in Vanuatu regarding my mom. She had her latest amputation to the knee & is still in public hospital, with no AC so she has to endure the high heat & humidity up to 35 degrees daily. I had suggested to my Family to transfer her to the only private hospital with AC. However, private hospital has no 24 hrs nurses, lack X-Ray facility, & cost over US$1,000 a day. From what I heard the private Dr is just a general doctor. Evacuation to Australia will be the best solution but cost & visa will be a problem. Mom has no insurance coverage & all insurance agents refused her application when she was 70. If no insurance coverage, Australian consulate will refuse her visa application (I think). Vanuatu is a very beautiful country with over 80 small islands. It is very popular for tourism. Since its independence in 1980, everything changed. It has undergone lots of political instability & corruption. Living there has become very expensive to the locals coz most goods are imported. Communication is also very dear. Internet service cost over US$500 a month. Most monopolised companies charge a fortune for their goods & services. I can't even talk to mom coz there's no wifi at the hospital & phone calls not allowed. I'm also frustrated coz it's hard to reach my family even by phone.
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if all else fails, use maggots to eat the dead and diseased tissue. OMG I am so sorry for her situation! Please write back! Bessings to you and your mom! Lindaz
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Several of us have tried to help Fion but she has not posted again.
I hate to acuse a poster with such a devastating story but are we in troll land again.
This island has been the subject of dispute between Britian and France and now receives most of it 's assistance from Australia. There is a medi vac service from the island to Australia and New Zealand but can cost up to $10K to make the trip
there appear to be specialist Drs on staff at Porta Vila hospital. In addition it would not be surprising to find volunteers from overseas anxious to practice in a remote area to hone their skills The local languages are English and French plus a native language. France and Britain were interested in the area because of manganese deposits. Well that's my ?history/geography lesson for the day. So if you are real Fion please contact again
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As a retired nurse, she is in real trouble. Without proper medical care her suffering will continue. Continuing to cut away body parts is not the answer, and whoever has medical power of attorney needs to consider all options. Pus is really the body's way of clearing infection and does need to be cleaned daily to wipe away the dead tissue. Get some professional help if you can, but you are fighting an uphill battle. I don't know what else to suggest and will pray her suffering is not long.
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I agree with Veronica91, Fion. You need to get her to the mainland so she can get the help she needs. If you are closest to Australia, then try there. I think they have great hospitals there and like Veronica91 said, start with the Red Cross first. They may be able to put you in touch with the right people to help get her to the hospital for treatment. If it were my mother, I would talk with her and see if she would go for the amputation further up the foot. She no longer walks so she needs a motorized chair which you may be able to get donated to your mother with making the right connections. If she continues to have surgery after surgery, she won't live long at her age. She probably doesn't have all that long now anyway with all the infections in her body. The doctors need to get the pus and gangrenous parts off her leg so it doesn't move up and infect the leg. I'm ignorant about the geography as well, who does the island belong to? Is it a British island, French or U.S.? Australian, Chinese ? Whichever country owns it can be a start with phone calls for help. If it isn't owned by another country, start with your country's government offices for help. She also needs either Hydrocodone or Morphine for the pain. At 86, I wouldn't worry about addiction either. Right now, she needs help to make her as comfortable as possible.
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That's a tough call. It all depends on how strong she is to fight off these continuing infections.
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She needs to elevate her legs at a level higher than her heart.
I sleep in a recliner at night, and for a couple of hours several times during the day and evening. No, I don't have diabetes, but a foot specialist at a wound care center encouraged me to do this as I have poor circulation.
Even though the infected areas on my feet have healed now, I continue to elevate, hoping to prevent sores from becoming infected again.
I am 75 years old, living in California.
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Have they tried silver sulfadiazine (thermazene)? It's a topical used on burn victims. How about Tramadol for the pain; it relieves anxiety at the same time.
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Osteomyelitis requires longer term IV antibiotics, and Tylenol would not be sufficient for this pain. They should at least try a little gabapentin and go up on that as she tolerates it - it might limit the need for narcotics. I do suspect the idea of trying to give her good BK amputations instead of painfully diddling with this could be a good one, but they need a better assessment of blood supply and other factors to decide. Being unable to walk does not necessarily make you unable to care for yourself either, if the home is accessible and the arms and the brain work reasonably well.
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I'm afraid no one can tell you how long she will live. Even the Dr's don't always get that right. My dad was supposed to die 4 years ago. He rallied and is living well with diabetes and congestive heart failure at 86. He has his pains and problems, but seems nowhere near death (other then age) now.

Pain management is the problem to tend with now, that and the care she's going to need since she doesn't walk. Are you able to care for her? If not, then you need to tell someone she has nowhere to go and let her be taken into a state facility who has the nurses who can administer her care. I know that's going to be very hard to do, but you also have to think of what's best for you, your family and her care. If you can care for her, don't think of it as a burden...think of it as giving back and paving the way for the time when it's your turn to need help by being a good example to those who might be your care givers in the not too distant future.
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Also being geographically challenged I too had to look at the map. Is there any possibility of Mom being taken to somewhere like Australia where there is good medical care?
Panadol (Tylenol in the US) is totally inadequate to control the pain associated with gangrene. She needs some kind of narcotic. Is it possible to obtain something like morphine?
Cutting another piece of foot or toe cut off is only going to prolong the agony. Mom needs an amputation further up the foot or leg where there is still a good blood supply. If that is done she might stand a chance of recovery. Her desire for euthanasia is very understandable and I will not comment either way.
Stopping all further surgery will give her a prolonged painful death from septicemia. If she was somewhere that had good hospice services it would be possible to keep her comfortable during the dying process. The same thing is likely to happen if the small surgeries continue especially if adequate antibiotics are not available. This kind of infection will also make it impossible to properly control her blood sugars.
So I see there are several options, the best of which is to get her to a modern mainland hospital. If you can not afford to do that contact charities on the country of your choice and see if there is help available. You could start with the Red Cross. The next is do nothing and care for her at home obtaining whatever pain meds you can. Continue with the small surgeries. Amputate up to good healthy tissue. The last one would be to consult local faith healers if you have some and see what they can do to at least ease the pain. This is something hard to comprehend in the West but totally understand and wish there was a way to help more.
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For anyone as geographically ignorant as me - Republic of Vanuatu (French: République de Vanuatu, Bislama: Ripablik blong Vanuatu), is a Pacific island nation located in the South Pacific Ocean.
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