Saturday 16 December 2017

Rude health: Limping in Lisbon

Our Portuguese neighbours are renowned for their explorers, but Maurice Gueret couldn't navigate their footpaths

Lisbon Coastline
Lisbon Coastline
Maurice Gueret

Physician, heal thyself. I am writing from a sick bed. This place of rest is a large, white-plastic contraption, barely one foot off the ground, with three fixed settings for propping up the patient. My left foot is elevated high up on three towels that sit perilously astride a rucksack. At times like this, one gives thanks for having the wisdom to marry a nurse. Half an hour ago, she fetched a large bag of ice from the nearby bar, and attached it skilfully to my swollen, fast-blackening ankle. The ice has melted already. It's 30 degrees beside this swimming pool near Lisbon.

Excluding a month's geriatric medicine on the isle of Madeira, this is my first time to visit Portugal. The travel agent's description won me over - seaside village, elegant pedestrianised streets, and old fishing boats, bobbing on blue water. The brochure failed to mention the death-trap nature of local footpaths. The traditional Portuguese pavement, known as the calcada, is a jigsaw of small, fat stones. They are arranged in mosaic form, to make pretty patterns or pictures. Dictionaries of the Iberian peninsula must have no words for flat or spirit-level. When stones come loose or go missing, repair men, known as calceteiros, are in short supply. If it rains, the calcadas of Portugal double up as ice rinks.

Pavement sinkhole

My Lisbon-coast holiday had barely begun when my foot descended steeply into a pavement sinkhole. Initial oral treatment came from a bottle of reserva red wine from the Alentejo region, followed by flaming caffeine-laced sambucas for breakthrough pain. This anaesthetised the lower limb for the duration of a fish dinner and got me back to the hotel, where extra pillows were summoned for elevation. The following morning, things looked bleak. The painful ankle had twice the girth of my shapely one. If you think local footpaths are difficult to navigate with good feet, you should try strolling downhill to a chemist when your anterior talo-fibular ligament has been avulsed.


I was impressed by the local pharmacy in Cascais. It had a separate orthopaedic department complete with wheelchairs, crutches and every imaginable form of strapping. Tourist footpaths are quite an industry on this balmy Atlantic coastline. I was seated. A history was taken and the ankle was carefully measured. A perfectly fitting compression bandage was applied with careful instructions about removing it at night. There was no 'companion selling' or 'your pharmacist also recommends' business. The doctor received what the doctor ordered, and the till relieved me of just €12. One likes to tip when the consultation was free.


I shouldn't start on bathrooms or I'll show my true age. But it's a little-known fact that Portugal's last dictator, Antonio Salazar, died from a heavy fall in the bathtub. In 1968 he sustained a nasty head injury that left him paralysed. When he regained consciousness, nobody had the heart to tell him that the regime had changed and that he wasn't in charge any more. Salazar died two years later. From his deathbed, he was still handing out instructions. Salazar liked to order large public monuments, and his country has many architectural wonders. If you find the pavements slippery, wait until you try their baths. All glass and no handrails can make for an adventurous holiday.

Love of cigarettes

Now, don't get me wrong. I loved Portugal. In particular its amazing capital of Lisbon, which is older than both Rome and London. Like our own, Portuguese politicians lost the run of themselves and now have to sell off the family silver and national airline. The people, however, place blame firmly on entry into the eurozone. Early posters for this year's elections feature plenty of hammer-and-sickles. Portugal's prime minister has just been voted the hottest head of state in Europe, which cannot be easy for our flame-headed Enda. I very much liked these Atlantic people. They are a bit like Galwegians, only browner, thinner and with worse coughs. Crisps, biscuits and cakes have much shorter supermarket aisles than at home, but the Portuguese love affair with cigarettes is as torrid as ever.

BCG vaccines

Before I left for holidays, there was a fuss at home about shortage of the BCG vaccine. Babies born in the second half of 2015 have been told they will have to wait until 2016 to have their upper arms indented. Sinn Fein and other health fanatics were up in arms about this shortage, but it gives me the opportunity to raise the fact that most European countries abandoned routine use of this TB vaccine years ago. Other nations, like the USA, have never used it universally at all. To my knowledge, Ireland and Portugal now stand alone in western Europe in advocating this scarring jab for all newborn infants. Other countries reserve it for children from high-risk groups or ethnicities. I personally don't believe any good clinical reason exists for continuing BCG immunisation for all babies. The current shortage provides a real opportunity to copy the rest of our neighbours and conserve a hard-to-get vaccine for those who need it. Ireland is no longer the TB-ridden country it once was, and our rate of infection is akin to many countries that have long abandoned the immunisation of all children. If we don't stop jabbing soon, Irish sunbathers will be even more identifiable by their arms around the swimming pools of Europe than they are already.

Dr Maurice Gueret is editor of the 'Irish Medical Directory'

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