Bo Dòkter · Curaçao
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41 weeks pregnantAt 41 weeks of pregnancy, your baby is not automatically in danger, but some risks increase gradually. Discuss monitoring and the offer of induction with your maternity team without delay. Call immediately for reduced movements, bleeding, green or brown amniotic fluid or broken waters.A blow to the eyeA blow to the eye can cause bruising, but also damage to the cornea, the eye chamber, the eye socket or the retina. Do not press on the eye or try to examine it yourself by pushing. Blood in front of the iris, reduced vision, double vision, flashes of light, new black spots, severe pain or nausea after an eye injury need prompt medical assessment. If the injury involves chemical exposure rather than a blunt impact, rinse immediately and seek prompt help afterwards too.A child briefly stops breathingA child briefly stopping breathing, turning blue or becoming floppy must always be taken seriously. In babies, this may involve a BRUE, choking, respiratory infection, reflux, a seizure or another problem. Every episode resembling an actual breathing arrest needs medical assessment. Call 912 for a threat to life. Never shake a baby.A child going to hospitalGood preparation matters when a child needs hospital care. Child-friendly explanations, a calm parent and clear arrangements help reduce stress. Watch for deterioration on the journey and after discharge. For a threat to life, call 912; for urgent assessment outside office hours, call HAP 9252.A child with feverFever in a child is often caused by a virus and usually clears up on its own. However, it can also indicate a more serious infection, especially in very young children, unusually drowsy children or those drinking little. Bo Dòkter advises a low threshold for medical assessment in children under 3 years; babies and children with warning signs need prompt assessment.A child with low weightA child with low weight or poor growth needs careful assessment. Some children are naturally small, but inadequate intake, feeding problems, illness, psychosocial stress or neglect may be involved. Children under 3 years particularly need prompt medical assessment.A child with mouth blisters caused by herpesA first herpes infection can cause painful blisters and ulcers in a child's mouth. Children often drink poorly, drool more and may have a fever. Dehydration is the main immediate risk. Avoid contact with the eyes. Herpes needs particular attention in young babies and children with reduced immunity. Call a doctor for poor drinking, little urine, unusual drowsiness, eye symptoms or possible exposure in a young baby.A child with mouth painMouth pain in a child often comes from ulcers, blisters, inflamed gums, thrush, teething or a small wound. The main risk is that the child stops drinking adequately. Warning signs include drooling with swallowing problems, difficulty breathing, refusing drinks, dehydration and becoming more ill quickly. Children under 3 years should again have a low threshold for medical assessment.A child with overweightA child can have excess weight without this reflecting willpower or parenting. Growth, inherited traits, sleep, food, stress, medicines and environment all contribute. Assess growth charts and behaviour rather than blame. Young children and those gaining weight quickly need a low threshold for medical assessment.A dislocated kneecapWhen the kneecap dislocates, it usually moves to the outside of the knee. This often happens after a twist, misstep or sports injury and is particularly common in young people. The knee immediately becomes very painful, may look visibly deformed and can swell quickly. Do not try to push the kneecap back yourself. Assessment must also check for nerve and blood vessel problems and damage to bone and cartilage, such as an osteochondral injury.A fall or blow to the headA fall or blow to the head may cause only a bump, but can also cause concussion, a skull fracture or bleeding. Symptoms may become noticeable only hours later, and concussion does not require loss of consciousness. Repeated vomiting, increasing drowsiness, a seizure, loss of neurological function or unequal pupils requires immediate emergency care.A paralysed arm or leg, facial droop or problems speaking, swallowing or seeingSudden facial droop, a weak or paralysed arm or leg, or difficulty speaking, understanding, swallowing or seeing may be a stroke or TIA. Do not wait, even if symptoms disappear: note when the person was last without symptoms, give nothing to eat, drink or swallow, and call Ambulance 912 immediately.A spot on your foreskinA foreskin lesion may be caused by irritation, inflammation, fungal infection, an STI or, rarely, cancer. Have a painful, hard, bleeding or non-healing lesion assessed. A retracted foreskin that cannot return and constricts the penis is an immediate emergency.A spot on your skinA skin lesion can be harmless, inflamed, infectious or malignant. Have it assessed if it grows, changes, bleeds, does not heal or looks clearly different from your other lesions. A skin biopsy may be needed if skin cancer is suspected.A sprained or torn knee ligamentA knee ligament can stretch or tear after a twist, fall, sporting collision or hard blow. The anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL) or lateral collateral ligament (LCL) may be affected. Symptoms include pain, swelling, instability, the knee giving way and sometimes a pop or an immediate sense that something went wrong. Not every injury is immediately life-threatening, but a locked knee, major swelling after trauma, a cold or pale lower leg, tingling or being unable to bear weight need prompt assessment.Abdominal aortic aneurysmAn abdominal aortic aneurysm is a localised widening of the body's main artery in the abdomen. Most cause no symptoms and are monitored with ultrasound, but growth increases the risk of rupture. Sudden severe abdominal or back pain with pallor, sweating, fainting or collapse is immediately life-threatening.Abdominal cutaneous nerve entrapmentWith nerve entrapment in the abdominal wall, often called ACNES, a trapped small sensory nerve causes a sharp, very localised painful spot. The diagnosis can only safely be considered after dangerous causes in the abdomen, chest and pelvis have been assessed; never label new severe abdominal pain as ACNES yourself.AbortionAn abortion ends a pregnancy using medicines or a medical procedure. The most suitable method depends on how many weeks pregnant you are, your health and the care available locally.Absent periodsAbsent periods are called amenorrhoea. If pregnancy is possible, a pregnancy test is always the first step. The doctor then considers factors such as nutrition, stress, exercise, hormones and how the ovaries are working.Abuse by someone you knowAbuse by a partner, family member, carer, acquaintance or colleague can be physical, sexual, psychological, digital or financial. It is never your fault. You do not have to wait for visible injuries before asking for help. Think about safety first: choose a time and device on which you can safely look for information, speak to someone you trust or a care professional, and make a plan that fits your situation. Call Ambulance 912 for immediate danger to life.Achilles tendon injuryThe Achilles tendon connects the calf muscles to the heel. Overloading it can cause tendon problems; a forceful movement can tear it.AcneAcne develops when hair follicles become blocked with skin oil (sebum) and dead skin cells. It is common, but can cause scarring and affect how you feel.Actinic keratosisActinic keratosis is a rough or scaly patch of skin caused by accumulated UV damage. Some patches can become skin cancer, so assessment is important.ADHDADHD is a developmental disorder involving a persistent pattern of inattention and/or hyperactivity and impulsivity that interferes with everyday functioning.ADHD in adultsIn adults, ADHD may involve persistent difficulties with attention, planning, organisation, restlessness and impulsivity that affect several areas of life.ADHD in childrenChildren with ADHD have a persistent pattern of inattention, hyperactivity and/or impulsivity that causes difficulties at school, at home or with friends.After an accidentAfter an accident, injuries may be visible immediately, but symptoms sometimes develop later. First check consciousness, breathing and severe bleeding, and have warning signs assessed promptly.After COVID: recovering in the first weeksAfter COVID, many people still have fatigue, reduced fitness, a cough or brain fog for a few weeks. Rest, a gentle pace and attention to warning signs help support safe recovery.AgoraphobiaAgoraphobia causes strong fear in situations where escape or getting help seems difficult, such as transport, shops, queues or open spaces. Avoidance restricts life. Cognitive behavioural therapy with gradual exposure often helps considerably.AlcoholAlcohol use becomes a problem when you lose control or it harms your health, work or relationships. Treatment and support are available.AllergyAn allergy is a reaction to something that is usually harmless, such as food, pollen, house dust, animals, an insect sting or a medicine.ALSALS is a progressive disease of the nerve cells that control movement. It can affect walking, speaking, swallowing and breathing.AnaemiaIn anaemia, the blood has too few healthy red blood cells or too little haemoglobin to carry enough oxygen. This may cause tiredness, weakness and breathlessness; treatment depends on the cause.Anaesthesia for eye surgeryFor many eye operations, you remain awake while drops or an injection around the eye numb it; sometimes sedation or general anaesthesia is more appropriate. Discuss blood thinners, difficulty lying flat, breathlessness and anxiety beforehand, and immediately report pain, nausea, breathlessness or a strong urge to move during the procedure.AnginaAngina, also called angina pectoris, is chest pain or pressure caused by the heart muscle temporarily receiving too little oxygen, usually because of narrowed coronary arteries. Stable angina occurs predictably with exercise or stress and settles with rest. New pain at rest, symptoms that are worsening more quickly or an episode that feels different may mean unstable angina or a heart attack and need urgent help.Anorexia nervosaAnorexia nervosa is a serious eating disorder involving food restriction, an intense fear of gaining weight and often a distorted body image.Antibiotic-resistant bacteriaAntibiotic resistance means bacteria have changed so that one or more antibiotics no longer kill them. The bacteria, not the person, are resistant, which may make an infection harder to treat.AntibioticsAntibiotics kill certain bacteria or slow their growth. They do not work against viruses such as those causing colds and flu, and should be used only when needed.AnxietyEveryone worries sometimes. In an anxiety disorder, fear or worry persists, is hard to control and interferes with daily life.Anxiety in childrenSome fear and worry are part of growing up. Anxiety becomes a problem when it is intense, persists or interferes with school, home life, friendships and daily activities.Aortic stenosisIn aortic stenosis, the heart's main outlet valve does not open properly, making the left ventricle pump harder. Regular echocardiograms are important because symptoms may be absent for a long time; new breathlessness, chest pain, dizziness or fainting on exertion may indicate severe narrowing and need prompt cardiology assessment.Aphthous mouth ulcersAphthous ulcers are small, painful sores inside the mouth. Most heal on their own within one to two weeks and are not contagious.AppendicitisAppendicitis is inflammation of the appendix that needs urgent care. Pain often starts around the belly button and moves to the lower right side. Symptoms may worsen quickly and hospital treatment is usually needed.ARFIDARFID is an eating disorder in which someone avoids or restricts food so much that nutrition, growth or daily life suffers, without fear of weight gain being the main reason.Assessment by a geriatrician in hospitalA hospital doctor for older people looks beyond a single illness. They also assess medicines, memory, mood, movement, nutrition, independence and the home situation. A coordinated treatment plan follows.Asthma in adultsAsthma in adults causes episodes of coughing, wheezing, chest tightness and breathlessness. With the right treatment, most people can control their symptoms well.Asthma in childrenIn asthma, the airways become inflamed and narrower. A child may develop coughing, wheezing, a feeling of tightness or difficulty breathing, especially at night, during exercise or with infections.Athlete's footAthlete's foot is a superficial dermatophyte infection, usually between the toes or on the sole and edges of the foot. Scaling, cracks and itching often respond to a topical antifungal and keeping the skin dry, but eczema and bacterial infections can look similar. A warm foot with rapidly spreading redness, pus, fever or a wound in someone with diabetes needs prompt assessment.Atopic eczemaEczema linked to an inherited tendency is called atopic eczema or atopic dermatitis. The skin barrier and immune system are more sensitive, causing periods of dry, itchy inflammation. It is not contagious. Consistent basic care and timely anti-inflammatory treatment can greatly reduce flare-ups.Atrial fibrillationAtrial fibrillation is an irregular and often fast heart rhythm originating in the upper chambers of the heart. It may cause palpitations and tiredness and increases the chance of clots and stroke.Attacks of dizziness during or after migraineVestibular migraine can cause attacks of dizziness, a spinning sensation or loss of balance. Headache may occur before, during or after the attack, or not at all.AutismAutism is a difference in brain development that can affect communication, social interaction, sensory processing and the need for predictability. Every autistic person has their own strengths and support needs.Babies and cryingCrying is a baby's main way of communicating. Hunger, a wet nappy, tiredness, wind, heat, cold or needing comfort are common causes, but unusual crying or an unwell baby needs assessment.Back pain: exercise videosStaying gently active and doing suitable exercises helps many people with ordinary lower back pain. A video is not a diagnosis or a personal treatment plan. Stop for increasing radiating pain, loss of sensation, weakness or bladder, bowel and saddle-area symptoms.Bacterial joint infection (septic arthritis)A bacterial joint infection, also called septic arthritis, is a serious infection that can quickly damage a joint. Sudden severe pain and swelling in a joint need urgent assessment.Bacterial vaginosisIn bacterial vaginosis, the natural balance of bacteria in the vagina has changed. Thin grey-white discharge and a fishy smell are typical, but itching or pain may have another cause. It is not a classic STI, although sexual factors play a role and testing is sometimes needed.Bad breathBad breath usually comes from the mouth or teeth, for example from a coated tongue, gum problems or a dry mouth. Thorough cleaning often helps, but persistent odour needs dental assessment. Swelling and swallowing or breathing problems are warning signs.Bald patchesBald patches are a pattern, not a diagnosis. Causes include alopecia areata, scalp fungal infection, hair pulling, scarring or other skin disease. Distinguishing them matters: fungal infection may spread to others and scarring may cause permanent damage.Basal cell carcinomaBasal cell carcinoma is a common skin cancer that usually grows slowly and almost never spreads to other parts of the body. Without treatment, however, it can grow further and damage surrounding tissue.BedbugsBedbugs are small insects that hide in mattresses, furniture and cracks and feed on blood at night. They are not known to spread disease, but bites may cause itching, lost sleep and, rarely, an allergic reaction.Bedwetting in adultsUnintentional urination during sleep in adulthood is called nocturnal enuresis. Investigation is needed, especially when it starts for the first time, because several treatable causes are possible.Bedwetting in childrenBedwetting is common in children, especially under 5, and is not their fault. Most children grow out of it, but support, routines and treatment when needed can help.Bell's palsyIn Bell's palsy, the facial nerve on one side suddenly works less well. This can make the corner of the mouth droop and prevent the eye from closing. Because a drooping face can also result from a stroke or another condition, assessment the same day is necessary.Benign breast changes (mastopathy)Mastopathy is a broad, not always clearly defined term for benign breast pain, tightness, lumps and cysts. Symptoms often vary with menstruation. A new firm lump, skin dimpling, bloody nipple discharge or a change in one breast needs investigation.Benign paroxysmal positional vertigo (BPPV)BPPV causes brief attacks of spinning dizziness when turning over in bed, looking up or bending down. Loose calcium crystals stimulate a balance canal. A targeted repositioning manoeuvre often helps. New loss of neurological function or inability to walk is not ordinary BPPV.Binge-eating disorderBinge-eating disorder involves recurring episodes of binge eating with loss of control and considerable distress or shame, without regular compensatory behaviour as in bulimia. It is a treatable mental health condition, not a lack of willpower. Seek help from your family doctor, especially for physical symptoms or severe low mood.Bipolar disorderBipolar disorder is a mental health condition involving periods of elevated mood, such as mania or hypomania, and periods of depression. It is more than an ordinary mood swing and can be treated with medicines, therapy and regular support.Bird fluBird flu is infection with an influenza A virus that mainly circulates among birds and rarely infects people, usually after intensive unprotected contact with sick or dead animals or a contaminated environment. Symptoms range from a red eye and mild flu to severe pneumonia. Report symptoms after relevant exposure immediately before entering a waiting room, so testing, isolation and early antiviral treatment can be arranged safely.Bite woundsA human or animal bite that breaks the skin can become infected, even if the wound looks small. Rinse it immediately and have it assessed to see whether antibiotics, a tetanus vaccination or protection against rabies are needed.Bladder cancerBladder cancer starts in the cells of the bladder. Blood in the urine is the most common sign and may come and go without pain; always have blood in the urine investigated, even the first time or if there is only a small amount.Bladder infectionA bladder infection, or cystitis, is usually a bacterial infection of the bladder. It may cause burning when passing urine, frequent urges and lower abdominal pain; without treatment, an infection may spread up to the kidneys.Bladder infection in childrenA bladder infection in children is usually bacterial. Babies and young children may only have fever, irritability or poor feeding; older children may have burning and frequent urination. Prompt assessment helps prevent a kidney infection.Bladder infection in menBladder infection symptoms in men need a doctor's assessment, because a urinary tract infection (UTI) is less common and may be linked to the prostate, urinary retention, stones or another problem. A urine sample helps guide treatment.Bladder infection in older adultsIn older adults, a urinary tract infection (UTI) may cause usual symptoms such as burning and frequent urination, but frail people or those with dementia may show new behavioural changes. Sudden confusion has many possible causes and needs urgent assessment, rather than an assumption that it is a UTI.Bladder infection in womenBladder infections are common in women because the urethra is shorter. Burning, frequent urges and pressure in the lower abdomen are typical; pregnancy, fever, back pain or blood needs earlier assessment.BlistersA blister is a fluid-filled pocket beneath the top layer of skin. Friction, a burn, an allergy or a skin condition may cause it; most blisters heal on their own if protected.Blocked earA blocked feeling in the ear is often caused by earwax, a cold, pressure changes or fluid, but may also mask sudden hearing loss. Put nothing into the ear. Hearing that suddenly becomes clearly worse over hours or a few days, especially on one side, needs urgent assessment the same day.Blocked fallopian tubesHere, the Dutch term ‘dichte zaadleiders’ refers to blocked fallopian tubes: the tubes that bring egg and sperm together. One or both tubes may be blocked by a previous infection, endometriosis, surgery or sterilisation. This usually causes no symptoms, but may make getting pregnant harder and increase the risk of an ectopic pregnancy.Blocked tear ductWith a blocked tear duct, tears cannot drain properly from the eye to the nose. This causes a persistently watery or sticky eye and sometimes infection of the tear sac. In babies, congenital narrowing often opens on its own; in adults, the cause needs investigation. Painful redness beside the nose, fever or reduced vision needs prompt assessment.Blood in the urineBlood in the urine may make it pink, red or brown. Always have this assessed, even if it happens only once, there is only a small amount or it is painless.Blood thinnersBlood thinners reduce clot formation and help prevent thrombosis, pulmonary embolism and stroke. They slow clotting, so unusual bleeding or a hard knock needs extra attention.Blood vessel blockage in the eyeThrombosis in the eye may refer to blockage of a retinal artery or vein. An arterial blockage often causes sudden painless loss of vision and is considered an eye stroke with an immediate risk of a brain stroke. A vein blockage also requires prompt ophthalmic assessment.BoilsA boil is a deep infection around a hair follicle with a painful red lump and pus. Do not squeeze it; warm compresses may help. Spreading infection, fever or a boil on the face needs assessment.Bow legs and knock knees in childrenBow legs and knock knees are often part of normal growth. Bow legs usually become less marked during the toddler years. Knock knees are often most noticeable around 3 to 5 years and gradually improve afterwards.Bowel cancerBowel cancer is a cancerous tumour in the colon or rectum. If you have blood in your stool, a persistent change in bowel habits, unexplained weight loss or anaemia, this needs investigation, but may also have another cause.Bowel endoscopyAn examination inside your bowel is usually called a colonoscopy. A doctor uses a flexible camera to examine the large bowel and sometimes the last part of the small bowel. Preparation varies between hospitals and is essential for a good examination. After sedation, you usually must not drive yourself. Call a doctor for severe abdominal pain, increasing bleeding, fever or feeling clearly worse after the examination.Bowel polypsBowel polyps are growths in the lining of the colon or rectum. Most are benign, but some types can develop into bowel cancer over years and are therefore removed and examined.Bowen's diseaseBowen's disease is squamous cell carcinoma in situ: a very superficial form of skin cancer in which abnormal cells are still confined to the top layer of skin. It often causes a slowly growing, scaly reddish-brown patch that can resemble eczema or psoriasis. A biopsy usually confirms the diagnosis. Treatment is important because some patches can progress to invasive squamous cell carcinoma.Brain aneurysmA brain aneurysm is a bulge in an artery in or around the brain. Many aneurysms cause no symptoms, but rupture often causes a sudden, unprecedentedly severe headache and can become life-threatening within minutes. Call Ambulance 912 immediately and do not drive yourself.Brain injury and workAfter a brain injury, work may feel different from before the injury. Fatigue, slower thinking, difficulty keeping track of things, sensitivity to stimulation, problems finding words or emotional fluctuations are often invisible, but greatly affect work. A gentle, gradual return usually works better than quickly resuming full duties. This page provides general medical and practical information, not specific employment law.Brain metastasesBrain metastases are cancer cells from another organ growing in the brain. Symptoms result from the location of the metastasis, swelling, pressure or bleeding and may include headache, a seizure, weakness or behavioural change. New neurological symptoms with cancer require prompt assessment; sudden loss of function or failure to recover after a seizure is an immediate emergency.Breast cancerBreast cancer starts when abnormal cells in the breast grow uncontrollably. Early recognition and treatment are important. Have a new lump or other change assessed, even without pain.Breast changesA new lump, change in shape or skin, inverted nipple or unexpected nipple discharge is often benign, but may indicate infection or breast cancer and needs assessment. Pay particular attention to changes that are new and persistent; redness with fever needs prompt care, and severe illness with rapidly spreading redness may be an emergency.Breathing too fastBreathing too fast or too deeply can lower carbon dioxide in the blood and cause tingling, cramps and dizziness, but rapid breathing can also result from asthma, pulmonary embolism, heart problems, infection or a metabolic disturbance. Do not automatically assume stress, especially during a first or unusual episode.Bringing up milk in babiesMany babies bring up small amounts of milk after feeds and grow normally. Forceful, green or bloody vomiting, drowsiness, dehydration, a swollen abdomen or poor growth are warning signs.Broken footA broken foot means one of the bones in the foot is cracked or broken. Pain, swelling, bruising and difficulty putting weight on it are common, but you can still walk with some fractures. Protect the foot, never straighten a foot that is out of position yourself, and have a suspected fracture medically assessed.Broken hipA broken hip usually means a fracture of the upper thigh bone close to the hip joint. Older people are particularly at risk after a fall, but a major accident can affect anyone. Groin or hip pain, inability to stand and a shortened leg turned outwards raise suspicion. Keep the person lying down, do not try to straighten the hip, and arrange immediate medical assessment and safe transport.Broken vertebraA broken vertebra, one of the bones of the spine, may result from a serious accident, but also from osteoporosis after a small movement or fall. Some fractures are stable; others may threaten the spinal cord or nerves. Keep someone as still as possible after major trauma, and have new weakness, loss of sensation, breathing problems or loss of bladder or bowel control assessed immediately.Broken wristA broken wrist usually involves the end of the radius, the forearm bone on the thumb side, sometimes together with other bones or ligaments. Pain, swelling, bruising and difficulty moving often follow a fall onto an outstretched hand. A wrist can be broken without an obvious change in shape. Remove rings, support the arm, do not straighten the wrist yourself and have the injury assessed the same day.Bruised nailA nail may turn blue, dark red or black when blood is trapped beneath it after a blow, pressure or tight shoes. A small bruise usually grows out with the nail, but severe pain, major damage or discolouration without injury needs assessment.Bruised or broken ribA bruised rib and a broken rib often cause the same sharp pain with deep breathing, coughing, laughing and movement. Most isolated rib injuries heal without surgery, but breathing deeply remains important to prevent mucus build-up and pneumonia. Increasing breathlessness, paleness, drowsiness, coughing up blood or severe abdominal pain after a blow may indicate internal injury and needs immediate help.BruisesA bruise forms when a blow or pressure damages small blood vessels beneath the skin. During healing, the colour may change from red or purple to green and yellow, and usually disappears within a few weeks.Bulging eyesWith bulging eyes, one or both eyes project further forwards. Thyroid eye disease is a common cause in adults, but a suddenly painful, red, bulging eye may also result from bleeding or infection in the eye socket. Loss of vision, colour vision or eye movement requires immediate ophthalmic assessment.Bunion (hallux valgus)Hallux valgus is a change in alignment in which the big toe points towards the other toes and a bump develops on the inside of the foot. This may cause pain, pressure areas, calluses and difficulty with shoes. Not every bump is hallux valgus: a warm, red, painful bump may also indicate gout or infection. Suitable shoes and reducing pressure often help, but further treatment is sometimes needed.Caesarean birthA caesarean is an operation in which a baby is born through cuts in the abdomen and womb. It may be planned or performed as an emergency. Good preparation, getting moving early, wound care and watching for warning signs are important. Call a doctor for heavy bleeding, fever, increasing wound pain, difficulty breathing, chest pain, a swollen red leg or feeling rapidly more unwell.Calf cramps at nightNight-time calf cramps are sudden, painful contractions of the calf muscle during rest or sleep. They often last seconds to minutes and may leave the muscle tender for a while. They are often harmless, but not all lower-leg pain is ordinary cramp. A swollen warm leg may indicate thrombosis, a cold pale leg may indicate a blood supply problem, and tingling, weakness or radiating back pain may suggest a nerve problem. Discuss recurring cramps, especially if you take medicines or have another illness. Do not start supplements yourself assuming they always help; the cause needs to be clear first.Calf muscle tearA calf strain is a sudden stretch or tear of a calf muscle, often during push-off, sprinting or jumping. Deep vein thrombosis, Achilles tendon rupture, a ruptured Baker's cyst and serious vascular or muscle problems can look similar. A newly swollen warm calf or pain without a clear sporting movement needs same-day assessment.Calf painCalf pain is often caused by muscle cramp or injury, but a painful, swollen, warm calf may indicate deep vein thrombosis. New breathlessness, chest pain or fainting may indicate a pulmonary embolism and requires immediate help.Cancer and planning a pregnancyCancer and cancer treatment can affect fertility, pregnancy and when to try for a baby. The most important time to discuss this is before treatment starts. During and shortly after treatment, contraception, pregnancy safety and cooperation between your oncologist, GP, fertility specialist and, if needed, a gynaecologist or urologist are important.Cancer and workMany people can work with cancer, but rarely exactly as before. Fatigue, concentration problems, infection risk, pain, appointments and emotions can have a major impact. A flexible approach is usually best: what is possible, necessary and safe, and what support is available locally on Curaçao through your treating team, GP and work support services?Cancer painPain in cancer can come from the tumour, metastases, treatment or another condition. A personal pain plan combining medicines and non-drug treatment can often greatly reduce pain, so that no one has to suffer unnecessarily.Cannabis for medical conditionsCannabis or a medicine containing cannabis components may sometimes reduce symptoms in a small number of conditions. It usually does not cure the underlying illness, evidence varies greatly by symptom, and use may cause side effects, dependence and interactions.Cardiac rehabilitationCardiac rehabilitation is a supervised programme following, for example, a heart attack, angioplasty, heart surgery, heart failure or another heart condition. It combines a safe, gradual increase in activity with information, lifestyle guidance, emotional support and help returning to daily life. Exercises must always be tailored to you. Stop immediately if you develop chest pain, severe breathlessness, dizziness or feel unwell, and get in touch with a healthcare professional.Care and treatment preferencesThinking about future care preferences helps record what matters to you if you later cannot speak or decide for yourself. Discuss values, treatment limits and a representative with your doctor and loved ones, record agreements clearly and have them checked against the rules and care practices of Curaçao.Caring for someone (informal care)Informal care is unpaid help for someone close to you who is ill, disabled or dependent. Good care requires attention not only to them but also to your own limits, health, rest and safety. Seek help early for overload, and call the appropriate care service if the person's medical condition worsens.Carotid artery stenosisIn carotid artery stenosis, atherosclerotic plaque narrows the passage for blood to the eye and brain. The narrowing itself often causes no sensation in the neck, but material that breaks away may cause a TIA or stroke. New loss of facial, arm, speech or visual function is therefore an immediate emergency, even if it disappears within minutes.Carpal tunnel syndromeIn carpal tunnel syndrome, the median nerve is compressed at the wrist. This mainly causes tingling, numbness or pain in the thumb, index finger, middle finger and part of the ring finger, often at night.CataractsA cataract is clouding of the eye's lens, causing gradually blurred vision and increased glare. Surgery can replace the cloudy lens when symptoms interfere sufficiently with daily life.Central serous chorioretinopathyA 'fluid blister in the retina' often means central serous chorioretinopathy: fluid leaks from the vascular layer beneath the central retina and lifts the macula locally. It often resolves by itself, but recurrence or prolonged fluid can cause permanent loss of contrast and detail; many sudden flashes, floaters or a curtain over vision are not a reason to wait and see.Cervical cancerCervical cancer develops in the lower part of the womb that opens into the vagina. Persistent infection with certain types of HPV is the main cause; screening can detect abnormal cells before they become cancer.Cervical disc herniationWith cervical disc herniation, a bulging disc or bony growth presses on a nerve in the neck. This can cause pain, tingling, reduced sensation or weakness in an arm.Cervical screening and HPV self-samplingA cervical smear and a validated self-sampling kit can detect high-risk HPV before cervical cancer causes symptoms. A positive self-test always requires an agreed medical follow-up step; in the Dutch programme, a cervical smear follows to assess cervical cells. Screening is for people without symptoms and never replaces assessment of bleeding, unusual discharge or pelvic pain.Checking your breastsKnowing how your breasts or chest normally look and feel helps you notice changes. Look at and feel each breast, armpit and the area up to the collarbone regularly, about monthly.Chemical in the eyeA chemical in the eye can damage its surface very quickly. Start rinsing immediately and continuously with plenty of clean lukewarm water; do not first try to identify the substance. Remove contact lenses only if this is easy, do not rub and do not try to neutralise the chemical. Have the eye professionally assessed after rinsing, especially with pain, redness, blurred vision or exposure to a corrosive substance.Chest painChest pain often comes from muscles, acid reflux or stress, but can also indicate a heart attack, pulmonary embolism, collapsed lung or tear in the aorta. New pressure-like pain with breathlessness or feeling ill needs immediate assessment.ChickenpoxChickenpox is a highly contagious infection caused by the varicella-zoster virus, with fever and itchy blisters at different stages. A healthy child usually recovers without specific treatment, but a young baby, pregnant person, adult or someone with weakened immunity can become seriously ill and needs early assessment by telephone.ChikungunyaChikungunya is a viral infection spread by Aedes mosquitoes. Sudden fever and often severe pain in several joints are characteristic. Most people recover, but joint symptoms may last months or longer.ChilblainsChilblains are itchy, burning or painful swellings after exposure to cold and damp. They are unusual in Curaçao but may occur after travel or marked cold exposure; warm up slowly and have ulcers, infection, diabetes, poor circulation or persistent symptoms assessed.Child abuseChild abuse may be physical, emotional or sexual, or involve neglect. Children do not always show clear signs. Safety comes first when there are concerns. Listen calmly, avoid leading questions and do not initiate a dangerous confrontation. Call 912 for a threat to life. For urgent medical assessment outside office hours, call HAP 9252. In other situations, a GP can help identify a safe next step the same day.Child growthA child's growth is assessed through repeated measurements of weight, standing height or length while lying down, and head circumference in young children. One measurement tells little: the pattern on a suitable growth chart, the parents' build, gestational age, nutrition, development and health together give it meaning. Sudden weight loss, growth that has stopped, dehydration or an unwell child needs timely assessment.ChildbirthChildbirth is the process in which contractions open the cervix, the baby is born and the placenta then comes out. Every labour is different; contact your maternity team as soon as the signs you have agreed to watch for begin.Childhood illnesses with rashesRashes in children are often caused by a virus and usually clear up on their own, but not every rash is harmless. Pay particular attention to purple or red spots that do not fade under pressure, unusual drowsiness, difficulty breathing, a stiff neck or rapidly worsening illness: these may indicate meningococcal disease or sepsis and need immediate emergency help. Measles and rubella are especially important during pregnancy and in people with a weakened immune system. Have your child assessed if you are unsure, especially with a high fever, dehydration or if they look ill.ChlamydiaChlamydia is a common sexually transmitted infection caused by the bacterium Chlamydia trachomatis. It often causes no symptoms. Testing provides clarity and treatment reduces the chance of complications and further spread.Cholestasis in pregnancyCholestasis in pregnancy is a liver condition in which bile acid levels in the blood rise. Severe itching without a clear rash, often on the palms and soles and worse at night, is typical. The condition usually resolves after birth, but may increase risks for the baby. New severe itching or a reduction in the baby's movements therefore needs prompt assessment.CholesteatomaA cholesteatoma is a build-up of skin cells in the middle ear or the bone behind the ear. It is not an ordinary plug of skin and is usually not cancer, but may keep growing, damage bone and cause serious infections.CholesterolCholesterol is a fatty substance the body needs. Too much cholesterol, particularly LDL cholesterol, may contribute to narrowing of the arteries over many years and increase the risk of heart attack, stroke and other vascular disease.Chronic painChronic pain lasts longer than the usual healing time, often more than three months. The pain is real, even when tests show no clear damage to explain it. Treatment focuses on safety, functioning and quality of life.Cleft lip and palateA cleft is a gap in the upper lip, jaw and/or palate present at birth because tissues do not fully join together early in pregnancy. It can affect feeding, hearing, speech and teeth. Treatment takes place in stages through a specialist team from birth, sometimes into adulthood.Clubfoot in babiesClubfoot is a condition present at birth in which the foot points inwards and downwards. Parents are not to blame. Early treatment is important, usually using the Ponseti method: a series of casts, sometimes a small tendon procedure, and then a brace to prevent recurrence. Consistent brace use is an important part of successful treatment.Cluster headacheCluster headache causes extremely severe attacks of pain on one side, around or behind one eye. Attacks often come in series at set times, with watering, a blocked nose or a drooping eyelid on the same side. A doctor must confirm the diagnosis and make a plan for rapid attack treatment and prevention.Coeliac diseaseCoeliac disease is a lasting immune reaction to gluten in wheat, barley and rye. It damages the small intestine and may cause digestive symptoms, anaemia, tiredness, growth problems or few noticeable symptoms. Have tests while you are still eating gluten; do not start a gluten-free diet yourself before testing.Cold soresA cold sore is usually an infection with herpes simplex virus type 1. It often starts with tingling, burning or itching on the lip, followed by blisters and crusts. The virus then stays in the body and may reactivate because of stress, sunlight, illness or tiredness. A cold sore is infectious, particularly when blisters or wet sores are present. Take extra care around the eyes, newborns and people with a weakened immune system. Cold sores are very common and nothing to be ashamed of.Combined lifestyle programme (GLI)A lifestyle programme, or GLI, is not a strict short-term diet. It provides support with eating, physical activity, sleep, stress and maintaining changes. The aim is lasting change and lower health risks. Access, availability and cover may vary locally, so check with your GP or healthcare professional on Curaçao. Call a doctor if activity causes symptoms beyond normal exertion, or if an existing condition becomes unstable.Common coldA common cold is a contagious viral infection of the nose and throat that usually improves on its own within one to two weeks, although a cough may last longer. Rest, fluids and saline nose drops may ease symptoms; antibiotics do not help, and breathlessness, drowsiness, dehydration or illness in a very young baby needs prompt assessment.Communication, hearing problems and intellectual disabilitiesGood care starts with communication the person can hear, see, understand and use. A hearing problem or intellectual disability does not mean someone cannot make their own choices. Ask for suitable support, extra time and understandable information, and involve someone close to them only with consent or when legally necessary.Complex regional pain syndrome (CRPS)CRPS is persistent, often burning pain, usually in one arm or leg, that is much more severe or longer-lasting than expected after the original injury. Temperature, colour, swelling, sensation and movement may change. Early recognition and active rehabilitation with a team offer the best chance of recovery.CondomsWhen used correctly, condoms reduce the likelihood of pregnancy and many sexually transmitted infections. Use a new condom for every sexual act, from the first genital contact. If it tears or slips off, prompt assessment may be needed for emergency contraception, STI tests or HIV PEP.Congenital adrenal hyperplasia (CAH/AGS)Adrenogenital syndrome is an inherited condition affecting the adrenal glands. The body makes too little cortisol and, in some forms, too little aldosterone.ConstipationWith constipation, poo is hard, passed less often or takes considerable effort to pass. Lifestyle measures often help, but warning signs need investigation.Constipation in childrenConstipation in children often develops because a child holds in painful poo. Early, calm treatment prevents a cycle of pain, fear and withholding.Contact dermatitisContact dermatitis is skin inflammation caused by direct irritation or a delayed allergic reaction to a substance. The skin may itch, burn, become red or darker, and develop blisters, cracks and scaling. The main step is to identify the cause and limit contact, while restoring the skin barrier and using treatment if needed.Contact lens problemsA red, painful or watery eye associated with contact lenses can range from irritation to a serious corneal infection. Remove your lenses immediately if symptoms develop and do not wear them again until a doctor or optometrist considers it safe. Pain, sensitivity to light, blurred vision or a white spot on the eye may indicate keratitis or a corneal ulcer and need prompt assessment. Do not use old drops or old lenses, and keep the lens and case if the doctor wants to examine them.Contraceptive implantThe contraceptive implant is a small rod under the skin of the upper arm that helps prevent pregnancy for a long time. It is very reliable and you do not have to remember it every day. However, irregular bleeding is common, so it is important to discuss beforehand whether this method suits you. Always have the implant inserted and removed by a trained healthcare provider. Mention medicines that may affect how it works, and have pain, signs of infection or possible pregnancy assessed promptly.Contraceptive injectionThe contraceptive injection contains a progestogen that prevents pregnancy for several months. This method is reliable when injections are repeated on time, but can change bleeding patterns, temporarily reduce bone density and delay the return of fertility.Contraceptive patchThe contraceptive patch is a form of combined contraception that releases hormones through the skin. When used correctly, it reduces the chance of pregnancy, but it does not protect against sexually transmitted infections (STIs). Not everyone can or wants to use this method. Factors such as the risk of blood clots, migraine with aura, certain heart or blood vessel problems and smoking can matter. Always discuss whether it is suitable for you with a doctor or contraception provider in Curaçao.Contraceptive vaginal ringThe contraceptive vaginal ring is a flexible contraceptive device inserted into the vagina, where it gradually releases hormones. When used correctly, it reliably prevents pregnancy, but it does not protect against sexually transmitted infections (STIs). Not everyone can use a ring safely. An increased risk of blood clots, migraine with neurological symptoms, certain medicines and forgetting or being late to replace the ring need particular attention.COPDCOPD is a lasting lung disease in which air has difficulty flowing out of the lungs. Coughing, phlegm, wheezing, tiredness and increasing breathlessness are common. Stopping smoking, good inhaler technique, activity, vaccinations and a personal action plan may reduce symptoms and flare-ups.Coping with hot weatherHot and humid weather can cause dehydration, heat cramps, heat exhaustion and life-threatening heatstroke. Drink appropriately, find somewhere cool, limit strenuous activity and take extra care of vulnerable people.Corneal injuryA corneal injury is often a scratch or graze on the clear surface of the eye. It can cause severe pain, watering, redness and light sensitivity. Most small injuries heal well, but contact lens use, dirt or metal in the eye, pus, worsening vision or increasing pain may indicate infection or deeper damage. Never use anaesthetic eye drops at home to suppress the pain.CornsA corn is a hard, pressure-sensitive core of thickened skin caused by friction and pressure, usually on toes or soles. It may look small but be very painful when walking or wearing shoes. Treatment focuses on reducing pressure and safely removing excess hard skin. If you have diabetes, poor circulation or reduced feeling in your feet, do not cut the skin or use acids yourself; have the area assessed.Coronavirus in hospitalHospital admission for COVID-19 is needed when monitoring or treatment at home is not safe enough, for example because of low oxygen, dehydration, severe weakness or destabilisation of another illness. The team treats the virus and lungs and also monitors clots, the heart, kidneys, delirium, nutrition, mobility and recovery.Coronavirus vaccinationCoronavirus vaccination trains the immune system against SARS-CoV-2 and mainly aims to prevent severe COVID-19, hospital admission and death. Which vaccine and booster are suitable depends on age, health, previous doses and current availability in Curaçao.CoughCoughing is a common reflex that helps keep the airways clear. It is usually caused by a virus and gets better on its own, but the duration, age, underlying conditions and accompanying signs determine whether tests are needed. Breathlessness, coughing up blood, drowsiness or a vulnerable baby or older person are reasons to seek assessment more readily.Coughing up bloodBlood in coughed-up mucus needs assessment. A few small streaks or spots need urgent medical advice; more blood, or blood with chest pain or breathlessness, is an emergency.COVID-19 (coronavirus)Coronavirus illness, officially COVID-19, is an infection caused by SARS-CoV-2. Symptoms range from none or mild cold symptoms to serious lung and other organ problems. Most people recover at home, but prompt assessment matters for breathlessness, deterioration or increased risk of severe illness.Cracked corners of the mouthCracked corners of the mouth often result from a combination of moisture, irritation and infection. Saliva that repeatedly collects in the corners softens the skin, allowing fungi or bacteria to grow more easily. Poorly fitting dentures, lip licking, nutritional deficiencies or diabetes sometimes contribute.Cradle capCradle cap is a harmless, common skin condition in babies that causes greasy white or yellow flakes, mainly on the scalp. It is not contagious and usually clears on its own within a few months.Crohn’s diseaseCrohn’s disease is chronic immune-mediated inflammation that can affect any part from the mouth to the anus, often causing abdominal pain, diarrhoea, tiredness and weight loss. Treatment suppresses inflammation and prevents damage; severe pain with a swollen abdomen, heavy bleeding, sepsis or a painful lump around the anus requires urgent care.CroupCroup is usually a viral infection that causes swelling around the voice box in young children. A barking cough and hoarseness are typical; stridor at rest, chest retractions, blue lips, drooling or exhaustion need immediate medical assessment.CT scanA CT scan uses X-rays and computer calculations to create detailed cross-sectional images of the body. Contrast medium is sometimes needed to show organs and blood vessels more clearly. Report pregnancy, kidney problems, allergic reactions, diabetes medicines and all other medicines beforehand.Cystic fibrosisCystic fibrosis is an inherited condition in which mucus becomes too thick in organs including the lungs and pancreas. Early specialist treatment, daily airway care, good nutrition and targeted medicines limit damage, but suddenly worsening breathlessness or coughing up blood needs prompt assessment.DandruffDandruff causes white or yellowish flakes and sometimes an itchy scalp. It is often a mild form of seborrhoeic dermatitis, is not contagious and is not caused by poor hygiene. Bald patches, broken hairs, pus or pain are not typical of ordinary dandruff.De Quervain's tenosynovitisIn de Quervain's tenosynovitis, tendons and their sheath on the thumb side of the wrist are irritated. Adjusting activities, a splint and sometimes an injection often help; surgery is rarely needed.Dealing with problemsProblems with money, housing, relationships, health, loss or other circumstances can cause stress and physical or mental health symptoms. Sorting out your problems, seeking support and choosing one manageable step can help; an unsafe situation or crisis needs prompt help.Deep vein thrombosis in the legDeep vein thrombosis, or DVT, is a blood clot in a deep vein of the leg. One leg may become swollen, painful, warm or discoloured. Part of the clot can travel to the lungs and cause a life-threatening pulmonary embolism.DehydrationDehydration means the body loses more fluid than it takes in, often along with salts. Babies, older people and people who are ill can deteriorate particularly quickly. Small sips and correctly prepared oral rehydration solution (ORS) can help with mild fluid loss, but drowsiness, collapse or no longer passing urine requires urgent care.Delaying your periodA period can sometimes be delayed safely with hormonal contraception or a short course of hormone medicine. The suitable method depends on what you already use, your health, pregnancy and the risk of blood clots.DeliriumDelirium is a sudden, fluctuating disturbance of attention and thinking caused by a physical problem, medicine or intoxication. It is not normal ageing and needs medical assessment the same day; sometimes immediate lifesaving help is needed.Delirium in childrenDelirium in a child is an acute, fluctuating change in attention, consciousness and behaviour caused by illness, treatment, medicine or intoxication. A child may become quiet or agitated, and the underlying cause always needs prompt medical assessment.DementiaDementia is a syndrome in which thinking, memory or other cognitive functions decline enough to interfere with daily life. It is not a normal part of ageing; assessment looks at the pattern, cause and treatable factors.DengueDengue is a viral infection spread by Aedes mosquitoes and is well known in Curaçao. Symptoms often include high fever, a severe headache, pain behind the eyes, muscle and joint pain, nausea and sometimes a rash. Severe dengue often develops around the time the fever falls. Warning signs may then appear, such as abdominal pain, persistent vomiting, bleeding, drowsiness, increasing weakness and dehydration. Do not use ibuprofen, naproxen, diclofenac or aspirin until dengue has been ruled out, because these medicines can increase the risk of bleeding.DepressionDepression is more than a few days of feeling low. Low mood or loss of interest is present almost every day and affects sleep, energy, thinking, relationships and functioning. Good assessment and treatment help; thoughts of suicide require help the same day.Developmental coordination disorder (DCD)DCD is a neurodevelopmental condition in which learning and performing motor skills is significantly harder than expected and interferes with everyday life. It is not laziness; careful assessment and practical support at home and school can make a big difference.Diabetes and pregnancyDiabetes before or during pregnancy requires extra support to monitor glucose (blood sugar), blood pressure, kidneys, eyes and the baby's growth. Ideally, start a shared plan before conception. Never stop or change medicines or insulin yourself.DiarrhoeaWith diarrhoea, stools are more frequent and looser than usual. A gut infection is usually the cause and often gets better on its own, but dehydration can quickly become dangerous, especially for babies, older people, pregnant people and those with vulnerable health. Drinking enough and recognising warning signs in time matter most.Difficulty getting pregnantGetting pregnant may take longer because of factors involving eggs, ovulation, fallopian tubes, the womb or sperm, and sometimes the cause remains unknown. Assessing both partners at the same time and providing support based on age, duration and medical history prevents unnecessary delay.DiphtheriaDiphtheria is a rare but serious infectious disease caused by toxin-producing bacteria. Diphtheria in the throat in particular can block the airway and damage the heart or nerves. Suspected diphtheria needs immediate medical assessment, isolation measures and treatment; do not wait for it to improve on its own.Dislocated elbowIn a dislocated elbow, the bones forming the joint are no longer in their normal positions. This is painful and can damage blood vessels, nerves, ligaments or bone. Keep the arm still, never try to put the elbow back yourself and have the injury assessed urgently the same day.Dissociative disorderIn dissociation, the connection between thoughts, feelings, memories, the body, identity or surroundings feels temporarily disrupted. This can be a human response to being overwhelmed, but recurring severe difficulties may indicate a dissociative disorder. Professional assessment matters because physical, neurological, sleep-related and substance-related causes can produce similar symptoms.Distressing birth experienceGiving birth can feel physically or emotionally traumatic, even if others say everything went well. Recovery needs acknowledgement, checks for physical problems and trauma-focused help if needed.Distressing sexual experienceA distressing sexual experience may involve pain, pressure, violated boundaries or sexual violence. What happened is not your fault. Seek medical and emotional help immediately; also ask which reporting and forensic options are available under Curaçao's procedures.DiverticulitisDiverticulitis is inflammation of one or more pouches in the large bowel. It often causes pain in the lower left abdomen, fever and changes in bowel movements. A mild, uncomplicated episode can sometimes be treated at home, but a perforation, abscess, blockage or sepsis needs prompt hospital care.DizzinessDizziness can mean spinning, unsteadiness, light-headedness or nearly fainting. Causes range from dehydration, a drop in blood pressure and medicines to an ear, heart or neurological problem. The exact sensation, onset, duration, position and accompanying symptoms determine urgency. New stroke signs, chest pain or unconsciousness are emergencies.DNA testing for medicinesDNA testing for medicines, also called pharmacogenetics, examines variants that can influence how certain medicines are processed or work. For some well-studied combinations, the result can help guide the choice of medicine or dose, but does not predict with certainty whether a medicine will work or cause side effects.Down syndromeDown syndrome is a chromosomal variation present from birth, involving extra genetic material from chromosome 21. Development and health vary widely from person to person. With appropriate health checks, early support, inclusive education, a say in decisions and good access to care, people with Down syndrome can lead meaningful lives.Drooping eyelids or eyebrowsA drooping eyelid or low eyebrow can develop gradually because of ageing, excess skin, muscle weakness or previous surgery. Sometimes the problem mainly affects appearance or everyday activities, for example by limiting the upper part of your vision or making your eyes feel heavy. But an eyelid that suddenly droops, especially with a large or small pupil, double vision, headache or weakness, can be a sign of a stroke, aneurysm or nerve problem and needs emergency attention.Dry eyesDry eyes occur when there is too little tear film, it evaporates too quickly or its quality is poor. Burning, stinging, grittiness, fluctuating blurred vision and, surprisingly, watery eyes are common. Sun, wind, air conditioning, screen use and contact lenses can worsen symptoms in Curaçao. A painful red eye or sudden loss of vision is not ordinary dryness.Dry skinDry skin has too little water and fat in its outer layer. It may feel tight, rough, flaky or itchy, or develop cracks. Sun, heat, sweating, air conditioning, frequent washing and irritating products often contribute in Curaçao. Good skincare helps; inflammation, infection or an underlying illness may sometimes need medical assessment.Duchenne muscular dystrophyDuchenne muscular dystrophy is an inherited, progressive muscle disease caused by a lack of dystrophin. Early diagnosis, corticosteroids, heart and lung monitoring, rehabilitation and specialist support improve functioning and life expectancy.Dupuytren’s diseaseIn Dupuytren’s disease, connective tissue in the palm thickens, forming nodules and cords that can slowly pull fingers into a bent position, especially the ring and little fingers. Waiting is possible while the hand functions well; treatment is discussed when straightening and daily tasks become difficult, with recurrence possible after every technique.Dyshidrotic eczemaDyshidrotic eczema, or pompholyx, causes small, intensely itchy blisters on the fingers, palms, toes or soles. It may clear and return; treatment helps control inflammation and dry skin.Ear dischargeEar discharge means fluid, pus, blood or clear fluid is coming from the ear. Possible causes include a middle-ear infection with a hole in the eardrum, ear canal inflammation, a perforated eardrum, a foreign body or injury. Rarely, very clear watery fluid after head trauma may indicate leaking cerebrospinal fluid. Keep the ear dry, avoid cotton buds and do not start ear drops without knowing what is wrong.Ear infection (ear canal)In an ear canal infection, the skin between the outer ear and eardrum is red and swollen. Pain when pulling the ear, itching, fluid and a blocked feeling are typical. Keep the ear dry and only use prescribed ear drops.Ear infection (middle ear)In a middle ear infection, inflammatory fluid is present behind the eardrum. Children in particular develop sudden ear pain and fever after a cold. Most infections recover on their own, but young babies, seriously ill children and complications need prompt assessment.EaracheEarache can come from the ear itself or be referred from the throat, teeth, jaw or neck. A middle ear infection is common in children; in adults, several causes must be considered. Fever, swelling behind the ear, neurological symptoms or sudden hearing loss need prompt care.Eating disordersAn eating disorder is a serious mental health condition in which eating, body image or behaviour around food disrupt health and daily life. You can be seriously ill at any weight. Early treatment improves the chance of recovery; have physical warning signs and safety concerns assessed immediately.Eating problemsAn eating problem means that eating, appetite or food choices are difficult, without the reason yet being clear. Physical illness, swallowing problems, pain, stress, sensory sensitivity, food shortages or an emerging eating disorder may contribute. Have persistent symptoms, growth or weight changes and warning signs assessed.EbolaEbola is a rare but serious viral disease. Infection mainly occurs through direct contact with body fluids from an infected person who is ill or has died. Symptoms after relevant travel or exposure require immediate telephone advice: call ahead and do not arrive at a waiting room unannounced.Ectopic pregnancyIn an ectopic pregnancy, the pregnancy usually implants in a fallopian tube and cannot safely continue to grow. A positive test with one-sided abdominal pain, shoulder-tip pain, dizziness or fainting needs prompt assessment, with or without vaginal bleeding; call Ambulance 912 for severe pain, collapse or shock.EczemaEczema is a collective term for skin inflammation with itching, redness, scales, bumps, cracks or weeping patches. The right approach depends on the type and cause. Daily moisturising often helps; pain, pus, fever or rapid spread need medical assessment.Elbow bursitisElbow bursitis causes a soft or tense swelling over the tip of the elbow. Pressure and knocks are common causes, but a red, warm, painful swelling with fever may be infected and needs assessment the same day.Elder abuseElder abuse is physical, psychological, sexual or financial harm, neglect or restriction of freedom within a relationship of trust. The older person is never to blame; safety and voluntary, respectful help come first.Emollient ointments and other moisturising treatmentsAn emollient is a cream, lotion or ointment that forms a protective layer on the skin and holds in moisture. It helps dry, itchy or scaly skin, for example with eczema.End of lifeEnd of life care focuses on comfort, calm, dignity and clear arrangements. Advance care planning helps you discuss treatment wishes, where care will be provided and contact people in good time. Palliative care does not mean giving up: it focuses on quality of life and symptom relief. Check local laws and procedures on Curaçao separately; do not automatically assume Dutch rules on euthanasia or end of life decisions apply. When dying is expected, follow the existing care plan and treating team's guidance; 912 is only for unexpected, immediate threats to life.EndometriosisEndometriosis is a chronic condition in which tissue similar to the lining of the uterus grows outside it and may cause inflammation. Symptoms vary greatly and cannot be predicted from the amount of visible disease. Careful assessment and shared choices about pain treatment, hormone treatment, fertility care and sometimes surgery matter.Endometritis after childbirthInflammation of the womb lining after childbirth is a bacterial infection in the womb. Fever, increasing lower abdominal pain, feeling unwell or unpleasant-smelling postnatal discharge needs medical assessment the same day, because prompt treatment prevents complications.Enlarged breasts in menEnlarged breasts in men may consist of extra fat, growth of breast gland tissue or both. Glandular growth is called gynaecomastia and is common during puberty and in older age. It is usually benign, but a hard lump on one side, a nipple change or an armpit lymph node needs investigation.Enlarged kidneys in babiesEnlarged kidneys in a baby usually means that ultrasound shows widening of the renal pelvis or other parts of the urinary tract because urine is collecting there. Many mild dilations resolve on their own, but blockage or backward urine flow can cause infection and kidney damage; planned scans and prompt assessment of fever, poor feeding or little urine are therefore important.Enlarged lymph nodeAn enlarged lymph node is usually a reaction to a nearby infection, such as a cold, throat infection or skin wound. The node often becomes tender and then gets smaller again. A hard, growing, fixed or persistently enlarged node, especially with fever, night sweats or weight loss, needs investigation.EpididymitisEpididymitis is inflammation of the tube behind the testicle that stores and carries sperm. An infection, including a sexually transmitted infection (STI), may cause it; sudden severe pain may be a twisted testicle and is an emergency.EpilepsyEpilepsy is a brain condition with an enduring tendency to have unprovoked epileptic seizures. Seizures may involve jerking and unconsciousness, but also staring, unusual sensations or brief loss of contact. Diagnosis needs specialist assessment; treatment and safety arrangements are tailored to the individual.EpiscleritisEpiscleritis is usually mild inflammation of the thin tissue between the conjunctiva and the white of the eye. It often causes a sudden local red patch, irritation and mild tenderness without reduced vision. A red eye with severe deep pain, light sensitivity, blurred vision, contact-lens use or injury needs prompt assessment because a more serious cause may be present.Erection problemsDifficulty getting or keeping a firm erection is common. Physical and psychological factors can play a part at the same time; discussing this with your GP can also identify early vascular disease or a medicine side effect.ErysipelasErysipelas is an acute bacterial infection of the skin and superficial lymphatic vessels, causing a rapidly enlarging, warm, swollen and painful red or darkened area, often with fever. Have it assessed the same day because antibiotics are needed, and call 912 for sepsis, collapse or rapidly worsening, very painful skin.ErythrasmaErythrasma is a superficial bacterial skin infection, usually in warm, moist skin folds such as the groin, armpits and between the toes. The patch is often reddish-brown, clearly defined and finely scaly. It resembles a fungal infection but needs different treatment; examination with a Wood's lamp may reveal a coral-red glow.Essential tremorEssential tremor is a neurological movement disorder that mainly causes rhythmic shaking of both hands when holding a position or moving. The head and voice may also shake. Caffeine, stress, lack of sleep and some medicines can make it worse, but new or sudden shaking must first be investigated for other causes.EuthanasiaEuthanasia means a doctor deliberately ending a patient's life at that patient's explicit request. Curaçao has no statutory euthanasia procedure comparable to that in the Netherlands: ending life on request and assisting suicide are criminal offences under the published Curaçao Criminal Code. Always discuss a wish to die carefully with your GP (family doctor) and ask about palliative care.Excessive hair growthIncreased hair growth may be normal variation, but coarse dark hairs in a male pattern in women are called hirsutism and may result from increased androgen activity. Rapid change with a deepening voice needs prompt assessment.Exercises for dizzinessSpecific exercises can help certain forms of dizziness, especially positional vertigo and recovery of the balance system. The right exercise depends on the diagnosis and affected side; warning signs require urgent assessment first.Eye damage from diabetesDiabetes can damage blood vessels and nerve tissue in the eye. Diabetic retinopathy and macular oedema can cause no symptoms for a long time and later lead to permanent loss of vision. Regular eye checks and good treatment of glucose, blood pressure and other risk factors reduce the risk.Eye problems (ROP) in your premature babyRetinopathy of prematurity is abnormal growth of blood vessels in the retina of babies born very early or very small. The baby usually does not notice or show this. Timely screening and treatment when needed prevent severe retinal detachment and blindness in many children.Eye strokeIn an eye stroke, an artery of the retina becomes blocked. Vision in one eye is usually lost partly or completely, suddenly and without pain. This requires immediate medical care: the chance of recovery is limited, and the risk of a stroke must also be investigated the same day.Facial painFacial pain is pain in the forehead, around the eye, or in the cheek, jaw, mouth or chin. The cause may involve a tooth, jaw joint, nerve, headache disorder, eye, skin, sinus, blood vessel or previous injury. The precise pain pattern and accompanying symptoms determine which tests and treatment are needed.FaintingWhen you faint, you briefly lose consciousness because the brain temporarily receives less blood. The cause is often harmless, such as standing for a long time, heat, pain or fright, but sometimes an abnormal heart rhythm or another serious condition is involved. Lay the person safely flat, check their breathing and recovery, and have warning signs assessed immediately.FatigueFatigue often results from lack of sleep, demands on you or recovery after illness. Persistent or unexplained fatigue can also be associated with a physical or mental health problem.Fatigue with cancer that cannot be curedFatigue with incurable cancer is a severe lack of energy that does not always go away with sleep. Cancer, anaemia, symptoms, treatment, medicines and emotions can contribute together. Palliative care focuses on comfort and what matters most to the patient.Fatty liver diseaseFatty liver disease means that too much fat is stored in liver cells. Metabolic dysfunction often contributes, but alcohol, medicines and other diseases can also play a part. Most people notice little at first; assessing scarring and managing diabetes, weight, blood pressure and cholesterol are central to determining health risks.Febrile seizureA febrile seizure is a seizure during a fever, usually in young children. The child may jerk, stare, become floppy or briefly stop responding. It looks frightening, but a short simple febrile seizure often stops on its own and usually causes no lasting harm. Calm first aid is important: check the time, place your child on their side, loosen tight clothing, put nothing in their mouth and do not cool them in a bath or with water during the seizure. A first febrile seizure, one lasting longer than 5 minutes, repeated seizures, an asymmetric or one-sided seizure, or signs of meningitis need prompt medical assessment.Female genital mutilation (FGM)Female genital mutilation, or FGM, means cutting away or damaging external female genital organs without a medical reason. It is internationally recognised as a human rights violation, can cause lasting symptoms and requires safe, confidential, trauma-sensitive care without judgement.Female sterilisationFemale sterilisation closes or removes the fallopian tubes to prevent pregnancy permanently. It is highly reliable but can still fail, usually requires surgery and should be considered permanent.FeverFever signals that your body is reacting to something, often an infection. Usually a virus is responsible and you recover with rest, fluids and time. However, fever can also indicate more serious problems such as dengue in Curaçao, dehydration, pneumonia, sepsis or meningitis. Look beyond the temperature: consider how ill someone looks, whether they remain clear-headed, drink, pass urine and breathe normally. Vulnerable people, including babies, older people, pregnant people and those with a weakened immune system, should contact a doctor sooner.FibromyalgiaFibromyalgia is a real, long-term condition involving widespread pain, fatigue, unrefreshing sleep and often difficulty concentrating. The symptoms are not caused by inflammation or damage throughout the muscles or joints. The nervous system probably processes and regulates pain signals differently. Diagnosis is based on a conversation and physical examination; targeted tests are sometimes needed to find another or coexisting illness.Fifth diseaseFifth disease is a usually mild infection caused by parvovirus B19. Children often develop bright red cheeks followed by a lacy rash; adults more often have joint pain. The infection needs extra attention during pregnancy, with a chronic condition involving red blood cell breakdown, or with a severely weakened immune system.Filarial worms (filariasis)This article uses the Dutch term ‘draadwormen’ to mean filarial worms: various tropical roundworms transmitted by biting mosquitoes or flies. Depending on the species, larvae and worms may occur under the skin, in lymph vessels or around the eye. Travel region, symptoms and species determine investigation and treatment. These are different from pinworms or Strongyloides.Floaters (mouches volantes)Floaters are moving dots, threads or clouds in your vision. They are often harmless, but a sudden increase in spots, flashes of light or a curtain across your vision may indicate a retinal tear.FluFlu is a contagious respiratory infection caused by an influenza virus. It often starts suddenly with fever or chills, muscle pain, headache, tiredness and a dry cough. Most healthy people recover at home, but flu can be severe in young children, older people, pregnant people and those with chronic conditions. In Curaçao, dengue and COVID-19 can cause similar symptoms; warning signs and people at higher risk need timely assessment.Food allergyIn food allergy, the immune system reacts to a food that is harmless to most people. Symptoms may develop quickly, with hives, swelling, vomiting, breathlessness or circulatory problems, but slower forms also exist. Anaphylaxis is unpredictable: for airway, breathing or circulation symptoms, use the prescribed adrenaline auto-injector immediately and call Ambulance 912.Food stuck in a child's throat or food pipeWhen food or an object becomes stuck in a child, first establish whether the child can still cough effectively, speak and breathe. Choking needs immediate first aid and Ambulance 912. A child who is breathing but cannot swallow, keeps drooling or has pain may have a blockage in the food pipe (oesophagus) and needs urgent assessment.Foodborne illnessIllness caused by something in food may be due to a virus, bacterium, parasite, toxin or chemical contamination. Diarrhoea and vomiting often resolve on their own with enough fluids, but blood, dehydration, pregnancy, vulnerability, neurological symptoms or illness after fish or home-preserved food require prompt assessment.Foreign body in the eyeA loose speck of dust can often be removed by blinking and plenty of clean water, but a splinter can scratch the cornea, become embedded or penetrate the eyeball at high speed. Do not rub, use tweezers or press on the eye. Reduced vision, severe pain, sensitivity to light, a distorted pupil, a visibly embedded object or a metal-on-metal injury requires immediate ophthalmic assessment.ForgetfulnessForgetting things easily can relate to stress, lack of sleep, mood, medicines or physical illness, but sometimes to a memory disorder. Sudden confusion is different and needs prompt assessment.Functional neurological disorder (FND)In functional neurological disorder, certain brain networks do not work together properly for a short or longer period, causing real neurological symptoms such as weakness, tremor, walking problems or seizures. The symptoms are neither deliberately produced nor imagined. Diagnosis should preferably be based on recognisable positive clinical signs identified by an experienced professional, rather than only on normal scans or blood tests.Fungal nail infectionsA fungal nail infection affects a toenail or fingernail and is caused by dermatophytes, yeasts or other fungi. The nail often becomes thick, discoloured and crumbly. Many other nail changes look similar; confirming the diagnosis is particularly important before a long course of tablets.Fungal skin infectionA fungal skin infection is a superficial infection affecting the skin, hair or sometimes skin folds. Symptoms vary by location: round scaly patches on the body, cracks between the toes, an itchy groin or other patches with red, scaly edges. Treatment depends on the site and severity. Do not use only a corticosteroid cream on a suspected fungal patch without advice, because this can hide and worsen the infection.GallstonesGallstones are hard particles in the gallbladder or bile ducts. Many people have no symptoms. If a stone temporarily blocks a drainage duct, it can cause severe pain in the upper right or upper middle of the abdomen. Persistent pain, fever, jaundice, drowsiness or becoming increasingly unwell may indicate inflammation or a blockage and need prompt medical assessment.Ganglion cystA ganglion cyst is a benign swelling filled with jelly-like fluid near a joint or tendon sheath. It often occurs on the hand or wrist and may grow or shrink. Many ganglion cysts disappear on their own. Have a new or changing lump assessed if the diagnosis is uncertain, especially with pain, redness, rapid growth, tingling or loss of strength.Gastro-oesophageal reflux diseaseIn gastro-oesophageal reflux disease, stomach contents regularly flow back into the oesophagus, causing troublesome symptoms or damage. Heartburn and acid regurgitation are typical, but swallowing problems, bleeding, weight loss or chest pressure are warning signs and must not be attributed to reflux alone.GenderGender concerns roles, expectations, identity and expression associated with femininity, masculinity or other experiences of gender. Gender identity is different from sexual orientation. Gender diversity is not an illness. Some people do experience distress or suffering and may need respectful social, psychological or medical support.Generalised anxiety disorderWith generalised anxiety disorder, you worry excessively about different areas of life on many days and find it hard to stop worrying. Anxiety often comes with restlessness, muscle tension, fatigue and problems concentrating and sleeping. It is not a weakness of character: treatment, including cognitive behavioural therapy and sometimes medicines, can help considerably.Genital herpesGenital herpes is a common infection caused by the herpes simplex virus. The first outbreak may be painful, with blisters, sores or burning, but many people have mild symptoms or none at all. You can pass on the virus without visible blisters too. Herpes needs extra attention during pregnancy because a newborn baby can become seriously unwell.Genital wartsWarts on the penis, vulva, vagina or anus are usually genital warts caused by low-risk HPV types. They can appear months after infection and do not prove recent infidelity; have the diagnosis confirmed, do not use ordinary wart treatments on the genitals, and discuss STI testing, treatment, pregnancy and HPV vaccination.Gestational diabetesGestational diabetes is high blood sugar diagnosed during pregnancy and usually causes no obvious symptoms. Nutrition, safe exercise, glucose monitoring and medicines if needed reduce risks for parent and baby. Monitoring remains necessary after birth because of an increased risk of type 2 diabetes.Giant cell arteritisGiant cell arteritis is inflammation of medium and large arteries, almost always in people aged 50 or over. A new headache, jaw pain when chewing or vision symptoms must be assessed the same day to prevent blindness and stroke.Glandular feverGlandular fever is usually an Epstein-Barr virus infection and often causes a sore throat, fever, swollen lymph nodes and prolonged tiredness. Most people recover on their own, but breathlessness from throat swelling, severe dehydration or sudden pain in the upper left abdomen may require immediate help.GlaucomaGlaucoma is a group of eye diseases that damage the optic nerve. The most common form develops slowly and causes no symptoms for a long time; lost areas of vision do not return. Early detection and treatment can often slow further damage. Sudden severe eye pain with a red eye, blurred vision, coloured rings around lights, headache or nausea may be acute angle-closure glaucoma and needs immediate specialist eye assessment.Glue earGlue ear means fluid behind the eardrum without an acute ear infection. It mainly occurs in children and can cause temporary hearing loss. It often clears on its own, but persistent hearing loss can affect language, learning and behaviour.Golfer's elbowGolfer's elbow is pain around the tendon attachment on the inside of the elbow. It often develops when gripping, bending the wrist or rotating the forearm temporarily puts more strain on the tendon than it can tolerate. You do not have to play golf to get it. Temporarily adjusting activities and gradually building up exercises usually helps; prolonged complete rest does not automatically make the arm stronger. Tingling, loss of strength, injury, redness or joint swelling needs assessment.GonorrhoeaGonorrhoea is a sexually transmitted infection caused by the bacterium Neisseria gonorrhoeae. It can affect the urethra, vagina or cervix, anus, throat and sometimes the eyes. Many people have no symptoms but can still pass on the bacteria. Get tested at the relevant sites, have sexual partners seek advice and use only treatment prescribed by a doctor, because resistance is a worldwide problem.GoutGout is joint inflammation caused by deposited uric acid crystals. It often produces a suddenly very painful, red, hot, swollen joint, classically the big toe but also the ankle, knee, midfoot, wrist, fingers or elbow. An attack can closely resemble infection. Septic arthritis is a dangerous mimic requiring prompt exclusion, sometimes by joint aspiration. Have a professional choose attack treatment and do not independently stop a prescribed urate-lowering medicine such as allopurinol. Kidney function, kidney stones, tophi, lifestyle, dehydration and monitoring the urate target matter for long-term care.GriefGrief is a personal response to loss, with no required stages or fixed end date. Sadness, anger, guilt, relief and physical symptoms may come and go. Severe difficulty coping, psychosis, substance misuse or suicidal thoughts calls for professional help.Grommets (ear tubes)Grommets are small tubes that ventilate the middle ear through an opening in the eardrum. They are mainly used in children with persistent middle-ear fluid causing hearing problems or certain recurrent ear infections. Grommets usually fall out on their own.Group A strep bacteriaGroup A streptococcus, often shortened to GAS or strep A, is a bacterium that can cause throat infections, scarlet fever and skin infections. Most infections can be treated well, but sometimes the bacteria enter deeper parts of the body and cause severe illness such as necrotising fasciitis, streptococcal shock or sepsis. Watch for rapidly increasing pain, rapid deterioration, confusion, breathing difficulty and someone who looks very ill.Had sex and do not want to become pregnantAfter sex without reliable contraception, emergency contraception can reduce the chance of pregnancy. The sooner you seek advice, the more options are usually available. Emergency contraception does not end an existing pregnancy and does not protect against STIs.Hair lossHair loss is common and has many possible causes. Inherited hair loss is the most common, but stress, illness, childbirth, deficiencies, thyroid problems, autoimmune disease, pulling on the hair and scalp inflammation may also contribute. Not every form is harmless: rapid or scarring hair loss, bald patches with redness or scaling, and hair loss with other physical symptoms need timely assessment. Do not expect miracles from supplements or oils.Hair loss in menHair loss in men is often hereditary and hormone-sensitive, usually causing a gradually receding hairline and thinning crown. Rapid shedding, scarring, scales, pain or whole-body hair loss are less consistent with ordinary male-pattern loss and need assessment.Hair loss in womenHair loss in women often causes a gradually widening parting and less volume on top rather than a bald crown like men. Not all loss is hereditary: diffuse shedding, scarring, severe itching, deficiencies, thyroid or hormonal problems and loss after pregnancy or illness need different approaches.Hairy tongueHairy tongue is a harmless change to the tongue's surface. The small projections, called papillae, become longer than usual and trap pigments, bacteria, yeasts and food debris. This can make the tongue look black, brown, yellow or green and sometimes cause an unpleasant taste or bad breath. It often looks worse than it is, but persistent discolouration, pain or other mouth symptoms should be assessed.Hand, foot and mouth diseaseHand, foot and mouth disease is a viral infection that mainly affects young children. It often starts with a fever, sore throat or loss of appetite, followed by painful mouth ulcers and blisters or spots on the hands and feet. The illness usually clears up on its own, but a sore mouth can make drinking difficult. Watch closely for dehydration, unusual drowsiness and difficulty breathing.Hard, painless lump in the eyelid (chalazion)A hard lump in the eyelid that does not hurt is often a chalazion. A small gland in the eyelid becomes blocked, forming a firm lump. A chalazion is different from an acutely painful stye and often goes away slowly. Do not squeeze it. Have lumps assessed if they keep coming back, persist or look unusual.Having coronavirusIf you have COVID-19 or symptoms that fit, you can usually recover at home. Protect people around you, drink enough and watch your breathing and any deterioration. Make contact early if you are at high risk of severe illness, because any treatment needs assessment soon after symptoms begin.Hay feverHay fever is an allergic reaction to pollen from trees, grasses or weeds. Typical symptoms are sneezing fits, a watery runny nose, an itchy nose or eyes and watering eyes. Symptoms are unpleasant but usually not dangerous. However, it matters to distinguish hay fever from breathlessness caused by asthma: wheezing, coughing, chest tightness or shortness of breath need extra attention and sometimes prompt assessment.Head and neck paragangliomaA paraganglioma in the head or neck is a rare tumour arising from nerve tissue near blood vessels and nerves. It often grows slowly, but can affect swallowing, hearing, voice and nerve function, and may be hereditary.Head liceHead lice are unpleasant but do not indicate poor hygiene. They live on hair and scalp and usually spread through direct hair contact. Itching is common, but not everyone notices symptoms immediately. Wet combing is an important way to find and remove lice. Additional treatment may follow local or professional guidance. Do not use pesticides on your own initiative, kerosene or other dangerous home remedies. Treatment failure may involve resistance. Check household members and close contacts too, because reinfestation often occurs among nearby contacts.HeadacheHeadaches are common and usually harmless, for example from tension, migraine, too little sleep or a viral infection. However, a headache can sometimes indicate a serious cause. A headache that suddenly reaches maximum intensity, or occurs with paralysis, speech problems, fever with a stiff neck, pregnancy-related warning signs or a red painful eye needs immediate medical assessment. Look at the pattern and accompanying symptoms as well as how severe the pain is.Health checks and testsA health test may detect a risk or disease before symptoms appear, but not every test is useful for everyone. A result may be a false positive or false negative and lead to unnecessary further tests or false reassurance. Age, personal risks, symptoms and whether early treatment really helps should determine which screening is worthwhile.Healthcare changes when you turn 18Around your eighteenth birthday, consent, privacy, appointments, prescriptions, digital access, insurance and the transition from paediatric to adult care may change. Ideally, start months beforehand with a single written transition plan and check which rules and coverage actually apply in Curaçao or the European Netherlands, so that medicines, equipment and support do not stop unexpectedly.Healthy eatingHealthy eating is not a perfect diet but a lasting pattern with a wide variety of plant foods, enough protein, fibre-rich carbohydrates, suitable fats and mainly water to drink. Having highly processed foods, sugary drinks and very salty foods less often helps reduce the risk of conditions such as cardiovascular disease and diabetes. Make gradual choices that are affordable, fit your culture and can be maintained. Illness, pregnancy, being underweight, swallowing problems or medicines may mean you need individual advice.Healthy livingHealthy living is not about perfect eating, intense exercise or an ideal weight. It consists of habits that reduce your chance of illness and support daily life: a varied diet, regular movement, enough sleep, not smoking, as little alcohol as possible, managing stress and protection from sun and heat. Choose one manageable step suited to your health and circumstances.Hearing lossHearing loss can develop gradually or suddenly and affect one or both ears. Earwax, middle ear problems, noise damage, age and diseases of the inner ear or hearing nerve are possible causes. Sudden hearing loss needs medical assessment the same day.Hearing voicesHearing voices can occur with psychosis, trauma, mood problems, lack of sleep, substances, neurological or physical illness. The experience feels real to the person. Threatening commands, confusion or immediate danger require urgent help.Heart attackA heart attack usually occurs when a coronary artery suddenly becomes blocked, leaving part of the heart muscle short of oxygen. It often causes chest pressure or pain, breathlessness, sweating, nausea or pain spreading to other areas, but symptoms can also be less typical. If you suspect a heart attack, do not wait: call Ambulance 912 immediately and do not drive yourself.Heart failureHeart failure means the heart does not pump blood around the body well enough to meet the body's needs. This can make you tired, breathless and less able to manage activity, and cause fluid to build up in your legs, abdomen or lungs. Suddenly worsening breathlessness, especially at rest or when lying down, pink frothy phlegm, confusion or rapid deterioration may indicate acute heart failure or pulmonary oedema and requires immediate emergency attention.Heavy bleeding during or after childbirthHeavy bleeding during or after childbirth is called postpartum haemorrhage. The uterus often fails to contract adequately, but a tear, retained placental tissue or a clotting problem may also be the cause. It can quickly become life-threatening; continued heavy bleeding, dizziness, palpitations, breathlessness or collapse requires immediate action.Heavy periodsHeavy menstrual bleeding means losing enough blood during your period to interfere with daily life. There is often no serious cause, but assessment is advisable for anaemia, pain, bleeding between periods or a clear change.Heel pain and heel spursPeople often use 'heel spur' to mean pain under the heel caused by irritation of the plantar fascia, the band of tissue along the sole, even when no actual bony spur is visible on an X-ray. Pain is often worst with the first steps after resting. Recovery usually involves managing activity more carefully, suitable footwear and patience, rather than complete rest or pushing too hard too soon.Help from an occupational physicianHelp from an occupational physician or another occupational health professional focuses on the relationship between health, safety and work. They can advise on your capacity for work, returning to work, workplace adjustments, occupational risks and how medical symptoms relate to your duties. Access, roles and rules differ between employers, insurers and countries. Do not automatically expect the same system as in the Netherlands: ask what is arranged locally on Curaçao or in your contract.HepatitisInflammation of the liver is also called hepatitis. It can be caused by a virus, an autoimmune reaction, alcohol, toxins, herbal products or medicines. Symptoms may start mildly with tiredness, nausea or jaundice, but sometimes progress rapidly to severe liver failure. Confusion, drowsiness, rapidly worsening jaundice, a tendency to bleed and being seriously unwell are warning signs. Do not drink alcohol or start courses of supplements on your own initiative.Hepatitis AHepatitis A is a viral infection of the liver, usually passed on through contaminated food, drink or hand-to-mouth contact. Many people recover fully, but you may feel very unwell for weeks to months, with tiredness, nausea, abdominal pain and sometimes jaundice. Becoming seriously unwell, drowsiness, inability to drink or rapidly turning yellow needs prompt medical assessment.Hepatitis BHepatitis B is a viral infection of the liver that can spread through blood, sexual contact and from mother to baby around birth. The infection can be acute, but can also become chronic and silently damage the liver for years. Vaccination, testing contacts who may have been exposed and good medical guidance are important; alcohol and unproven supplements do not help.Hepatitis CHepatitis C is a viral infection of the liver. Many people notice nothing at first, but without a test you cannot know whether you are infected. Nowadays, the infection can usually be cured effectively with medicines prescribed by a doctor. There is still no vaccine. Infection mainly spreads through blood-to-blood contact, and testing matters after a possible risk, including during or around pregnancy.HeroinHeroin is a powerful opioid drug that affects the reward system and breathing. Use can quickly lead to dependence, overdose and serious harm, especially when combined with alcohol, benzodiazepines or other depressant substances. Help is available and treatment works. Call 912 immediately for signs of overdose. Only use naloxone if it is available, is intended for you or you know how to give it safely.Herpes eye infectionHerpes viruses can inflame the cornea and other parts of the eye. A red painful eye, light sensitivity or blurred vision needs prompt assessment by an ophthalmologist. Early antiviral treatment helps limit damage; ordinary antibiotics do not work against herpes viruses.HiccupsHiccups are usually a harmless reflex caused by sudden contractions of the diaphragm and often stop on their own. A short bout after eating quickly, fizzy drinks or laughter is usually not dangerous. Hiccups lasting more than 48 hours, returning often or occurring with neurological, chest or abdominal symptoms do need assessment.Hidradenitis suppurativaHidradenitis suppurativa is a long-term inflammatory skin condition that causes painful lumps, abscesses and sometimes tunnels beneath the skin, often in the armpits, groin, buttocks or under the breasts. It is not caused by poor hygiene and is not contagious. Early recognition, good wound care and suitable treatment can help limit pain, scarring and flare-ups.High blood pressureHigh blood pressure usually causes no clear symptoms, but over time it can damage the heart, brain, kidneys and eyes. The focus is therefore on reliable repeated measurements and overall risk, rather than panic over a single reading. Measuring correctly at home, supporting healthy habits and not changing medicines yourself are important parts of safe care.Hip dysplasiaHip dysplasia means that the ball and socket of the hip do not fit together properly, or that the socket is still too shallow. It is often a developmental hip condition that is present at birth or develops early in life. Early recognition matters because treatment is often simpler at a young age. Signs vary with age: a baby's hip may be unstable without causing pain, while an older child may limp or have difficulty spreading their legs.Hip inflammation in childrenA child with hip pain or a limp may have temporary hip inflammation, also called irritable hip or transient synovitis. This is usually harmless and often gets better on its own. However, a bacterial joint infection, called septic arthritis, must also be considered: this is a medical emergency. Fever, being unwell and refusing to stand on the leg make prompt assessment especially important.Hip replacementA hip replacement is a prosthesis fitted when pain and restriction from hip damage do not improve enough with other treatments. Surgery can greatly improve walking, sleeping and daily function, but requires preparation and substantial rehabilitation. Important risks include infection, thrombosis, hip dislocation, nerve problems, a feeling of unequal leg length and, longer term, wear or loosening. After hip replacement, tell every doctor and dentist that you have a prosthesis. Antibiotics for dental procedures are not routine for everyone; if unsure, discuss this with your orthopaedic specialist and dentist, especially with previous prosthetic infection or high risk.HIVHIV is a virus that damages the immune system if left untreated. With effective treatment, the virus can often remain suppressed over time, allowing people to stay healthy and preventing sexual transmission while the viral load remains undetectable. Prompt testing advice after exposure, PEP within 72 hours and PrEP before exposure are important forms of prevention.HivesHives are sudden, itchy raised patches that can change location within hours. Swollen lips or eyelids may occur too; breathlessness or swelling of the tongue and throat can indicate anaphylaxis.HoarsenessHoarseness means that your voice sounds different, becomes weaker or cuts out. It is often caused by a virus, voice strain or irritation from smoke or stomach acid, but it can also indicate a vocal cord problem, paralysis or, more rarely, a tumour. Hoarseness with stridor, a high-pitched sound when breathing in, difficulty breathing or swallowing, or persistent hoarseness in someone who smokes needs prompt assessment.HookwormsHookworms are small intestinal worms that feed on blood from the bowel wall. Larvae usually enter through bare skin from soil contaminated with faeces. A long-lasting infection can cause anaemia and growth problems.HPV vaccinationHPV vaccines protect against important types of human papillomavirus. They work best before someone encounters these virus types. They are intended to help prevent infections and, later, some cancers and warts. They do not treat an existing HPV infection or an abnormal cervical screening result. Eligibility and the number of doses depend on the local vaccination programme, age and any relevant medical circumstances.Hypersensitivity to contrast mediumA hypersensitivity reaction to contrast medium may occur during or shortly after a scan, usually with itching or hives and rarely with serious breathing or blood pressure problems. Always describe exactly what previous reaction you had; an iodine or shellfish allergy is not the same thing.Illness anxiety disorderWith illness anxiety disorder, fear of a serious illness continues to dominate your life, even after careful assessment and explanation. The symptoms are not pretend: treatment addresses the anxiety cycle and a safe, agreed pathway for new physical warning signs. Call Ambulance 912 if suicide or severe self-neglect poses an immediate danger.Illness while travellingIllness during or after travel needs assessment based on the destination, dates, mosquito and animal contact, food, fresh water, sex and activities. Seek immediate local help for severe symptoms; fever during or after time in a malaria area, possible rabies exposure, severe dengue signs and diving problems must not wait.ImpetigoImpetigo is an infectious bacterial skin infection. It often causes red areas, blisters or sores with yellow or honey-coloured crusts, frequently around the nose and mouth but also elsewhere. Good hygiene helps limit spread: wash hands, do not scratch crusts open, do not share towels and keep nails short. It is more common in children, but adults can get it too. Call a doctor if areas spread rapidly, are near the eyes, are very painful or recur, if someone has a weakened immune system, or if fever or feeling ill develops.In hospitalA hospital admission may be planned, for tests or surgery, or unexpected through emergency care. Good preparation helps: bring an up-to-date medication list, report allergies, have important documents and contact details readily available, and ask questions until you understand what is happening. During admission, staff focus on identification, medicines, infection prevention, movement and discharge planning. Practical rules on Curaçao vary by hospital and sometimes by ward, so always follow the instructions of the hospital you are attending.Inflamed bursa in the kneeAn inflamed bursa in front of the kneecap causes a soft or tense swelling at the front of the knee. This often results from frequent kneeling or a knock. Warmth, redness, fever or a wound may suggest a bacterial infection.Inflamed eyelid marginsIn blepharitis, the edges of the eyelids are inflamed over a long period or repeatedly. You may have burning, itchy eyes, crusts at the eyelashes and dry eyes. Daily warm compresses and gentle cleaning usually form the basis of treatment.Inflamed head of the penisIn balanitis, the head of the penis is red, tender, itchy or swollen. The foreskin is often inflamed too. Irritation, fungus, bacteria, a skin disease, diabetes or a sexually transmitted infection may be the cause. Treatment depends on assessment.Inflamed nail foldWith an inflamed nail fold, the skin beside a fingernail or toenail is red, swollen and painful. A small wound can cause an acute bacterial infection; prolonged moisture and irritation more often cause chronic inflammation. Pus or spreading inflammation needs assessment.Inflammation in the joints of the back and pelvis (axial spondyloarthritis)Axial spondyloarthritis is a long-term rheumatic inflammation mainly affecting the joints between the pelvis and spine and the back. Movement, targeted exercise therapy and medicines can reduce pain and stiffness and limit damage.Inflammation of the hair folliclesIn folliculitis, one or more hair follicles are inflamed. You see small red or pus-filled bumps around hairs. Friction, shaving, bacteria, yeast and warm hot-tub water may play a role. Most mild cases recover with gentle skin care.Inflammation of the inner lining of the heartInflammation of the inner lining of the heart is usually a serious infection of a heart valve. Prompt hospital treatment with targeted antibiotics and sometimes surgery is needed to prevent heart failure, stroke and spread of the infection.Inflammation of the rectumWith inflammation of the rectum, the last part of the large bowel is irritated and inflamed. Possible symptoms include an urge to pass stool, pain, mucus, diarrhoea and bleeding. Assessment is needed because infections, bowel diseases and radiotherapy each require different treatment.Inflammation of the skin around the mouth (perioral dermatitis)Perioral dermatitis causes small red bumps and burning, flaky skin around the mouth, nose or eyes. Corticosteroid cream on the face can trigger or worsen it. Stopping the cream and simple skin care are important, sometimes alongside medicines.Inflammation of your oesophagus caused by stomach acidIn reflux oesophagitis, stomach acid flowing back up damages the lining of the oesophagus. This can cause burning behind the breastbone, acid regurgitation and swallowing problems. Lifestyle changes and acid-suppressing medicines often help, but warning signs need investigation.Ingrown toenailAn ingrown toenail develops when the nail edge presses or grows into the skin beside it. This often causes pain, redness and swelling, usually in the big toe. Early on, reducing pressure, drying carefully and trimming correctly may help, but picking, digging or cutting a V shape often makes things worse. Seek assessment sooner with diabetes, poor circulation, neuropathy, reduced immunity, pus, spreading redness, cellulitis or fever.Inguinal herniaAn inguinal hernia is a bulge of abdominal contents through a weak area in the abdominal wall in the groin. You often see or feel a lump that enlarges with coughing, straining or lifting and becomes smaller at rest or when lying down. Most inguinal hernias are not immediately life-threatening, but a trapped or strangulated hernia is an emergency. Do not force a painful, hard or stuck lump back in.Inherited conditionAn inherited condition is caused wholly or partly by a change in genetic material that can be passed on within a family. Inheritance is not an all-or-nothing prediction: the pattern of inheritance, likelihood, severity and age of onset vary. Discussing your family history, a medical assessment, informed consent and genetic counselling help establish whether testing is useful and what a result can and cannot tell you.Intensive care (ICU)Intensive care is for people so seriously ill or injured that important body functions need very close monitoring or temporary support. Breathing, blood pressure, the heart, kidneys or brain can be monitored intensively and supported with equipment or medicines when needed. An ICU admission is often distressing for both patient and family, and recovery can continue long after discharge with physical, cognitive or psychological symptoms.IntertrigoIntertrigo causes red, irritated patches where skin touches skin and stays warm or moist. Keeping the area dry and aired helps, but a fungal or bacterial infection may need treatment.Intrauterine contraceptionAn intrauterine device is a highly reliable, long-acting contraceptive placed in the womb. There are hormonal and copper devices. Choice, fitting, duration of protection and side effects differ by type.Involuntary eye movements (nystagmus)Shaking eyes often refers to nystagmus: repeated involuntary eye movements. This may be present from infancy or develop later. New nystagmus with dizziness, double vision, difficulty walking or loss of neurological function may indicate an acute neurological problem.Iron overloadIron overload means too much iron is stored in the body. It may be hereditary, as in HFE haemochromatosis, or secondary to repeated blood transfusions, certain blood disorders or liver disease. Early symptoms are often vague, such as tiredness, joint problems or abdominal pain. High ferritin alone does not prove iron overload; transferrin saturation, medical history and sometimes genetic testing or imaging help identify the cause. Treatment is medical, usually involving professionally performed venesection when appropriate.Irritable bowel syndrome (IBS)IBS causes recurrent abdominal pain related to bowel movements and changes in how often you pass stools or how hard they are. There is no visible bowel damage, but the symptoms are real. Bleeding, weight loss, fever or symptoms at night require investigation for another cause.ItchingItching is an irritating sensation that makes you want to scratch or rub. It may affect one area or the whole body. Dry skin or a skin condition is often responsible, but itching can sometimes signal allergy, infection, parasites, a medicine reaction or liver, kidney or blood disease. Take extra care during pregnancy, or with breathlessness, swelling or rapidly worsening illness.Itching in the buttock cleftItching between the buttocks or around the anus is often called pruritus ani. Stool residue, moisture, sweat, excessive cleaning, perfumed products, haemorrhoids, a fissure, eczema, psoriasis, fungal infection, threadworms and other causes can irritate the skin. Gentle cleaning, thorough drying and loose cotton clothing often help, but scratching usually worsens itching. Avoid prolonged self-treatment with steroid creams or antifungals. Bleeding, a palpable swelling, pus, fever, diabetes, reduced immunity or significant pain need medical assessment.Jet lagJet lag occurs when your body clock runs behind or ahead of local time after rapid travel across several time zones. You may feel tired, sleepy, nauseous, irritable and less alert. Symptoms are usually temporary but can become risky if you need to drive or operate machinery, are pregnant, take medicines or are particularly sensitive to disrupted sleep.Joint problemsJoint problems include pain, stiffness, swelling or reduced movement in one or more joints. Possible causes include overuse, injury, osteoarthritis, gout, an inflammatory disease and infection. Location, duration, morning stiffness, swelling and other symptoms help distinguish them. A suddenly red, hot, swollen and very painful joint, especially with fever or feeling unwell, needs urgent assessment the same day.Jumper’s kneeJumper’s knee is an overuse condition of the patellar tendon below the kneecap. Targeted, gradually increased tendon loading usually helps more than complete rest or pain relief alone.KeratoacanthomaA keratoacanthoma is a rapidly growing skin lesion that often resembles squamous cell skin cancer. Do not treat it yourself or decide to wait based on its appearance alone. A doctor needs to assess whether referral, a biopsy or removal is needed. Rapid growth, bleeding, crusting or a lesion on sun-damaged skin particularly need medical assessment.Kidney cancerKidney cancer usually develops from cells in the kidney tubules. A kidney tumour is often found by chance on a scan; blood in the urine, persistent flank pain or unexplained weight loss needs investigation.Kidney damageChronic kidney damage means that kidney function and/or the amount of albumin in the urine has been abnormal for at least three months. The eGFR and urine albumin level together determine risk and follow-up.Kidney infectionA kidney infection is a bacterial infection of the kidney and renal pelvis. Fever, chills and pain in the side or back need medical assessment the same day; pregnancy or signs of sepsis make this especially urgent.Kidney stonesA kidney stone is a hard crystal in the kidney or ureter. Colicky pain often comes in waves; fever or chills with a stone may indicate an infected blockage and needs immediate emergency care.Knee arthroscopyKeyhole surgery of the knee is called knee arthroscopy. The doctor looks inside the joint with a camera and may provide treatment immediately. It has useful applications, but does not help every type of knee pain. Benefits are often limited for wear-related changes or general osteoarthritis. After surgery, watch for infection, blood clots, increasing swelling and pain that does not gradually improve.Knee osteoarthritisKnee osteoarthritis can cause pain, stiffness, swelling and difficulty walking, standing up or using stairs. Adapted activity is a central part of treatment.Knee problemsKnee problems can result from overuse, a twist, wear and tear, irritation around the kneecap or a meniscus or ligament injury, but sometimes from an infection, thrombosis or fracture. The location of pain, how swelling develops and whether you can still bear weight give important clues. A warm red knee with fever, a painful swollen calf, obvious deformity after trauma or inability to bear weight need prompt assessment. Not every knee problem is an emergency, but recurring or unexplained symptoms deserve a clear explanation and examination.Knee replacementA knee replacement is a prosthesis fitted when pain, stiffness and loss of function from severe knee damage do not improve enough with other treatments. Surgery can improve walking, stair use and sleep, but requires active rehabilitation and patience. Possible complications include infection, thrombosis, wound problems, persistent stiffness, loosening and sometimes lasting pain despite technically successful surgery. Tell your dentist and other doctors that you have a knee prosthesis. Antibiotics for dental procedures are not automatically needed for everyone; if unsure, discuss this with your orthopaedic specialist and dentist, especially with previous prosthetic infection or high risk.Kneecap pain with movementPain around or behind the kneecap when using stairs, squatting, running or sitting for a long time is often called patellofemoral pain. The knee is usually not damaged; targeted exercise therapy and a gradual increase in activity often help.LaparoscopyKeyhole surgery in the abdomen is called laparoscopy. The doctor examines or operates through small cuts in the abdominal wall. It may be used for gallbladder problems, appendicitis, endometriosis or investigating abdominal symptoms. Although the wounds are small, it remains surgery with risks such as bleeding, infection and organ damage. Afterwards, watch for fever, increasing abdominal pain, difficulty breathing and wound problems.Lazy eyeA lazy eye, also called amblyopia, means vision in one eye does not develop properly, even though the eye itself may look almost normal. This mainly happens during childhood, while the brain is still learning to process images. Early recognition and consistent treatment matter because recovery is more likely while vision is developing. Causes may include a squint, different focusing strengths between the eyes or blocked vision. Call immediately for a new white pupil, sudden new squint, drooping eyelid, sudden vision loss or a child suddenly looking at things differently.Leg amputationAfter part of a leg is amputated, wound care, rehabilitation and protecting the other leg are important for recovery.Leg ulcerA leg ulcer is a wound on the lower leg that does not heal well, usually because of problems with the veins. The circulation must be assessed before a compression bandage or stocking can be used safely.Lichen planusLichen planus is an inflammatory condition of the skin or mucous membranes. It can affect the skin, mouth, genitals, scalp or nails. Symptoms are often not dangerous, but can last a long time and sometimes cause scarring or permanent damage. Oral and genital forms need monitoring, and follow-up matters in some forms because of a small risk of cancerous change.Lichen sclerosusLichen sclerosus is a chronic inflammatory condition mainly affecting genital skin. It often affects the vulva, the area around the anus, or the penis and foreskin, and can also occur in children. Without appropriate treatment, skin can become thin, white, painful or scarred. Professional treatment with a strong anti-inflammatory cream and monitoring are important. There is a small risk of cancer in skin affected for a long time.LightheadednessLightheadedness differs from spinning dizziness. It often feels as though you may faint, become hazy or lose consciousness, especially on standing or during exertion. Causes range from harmless to serious: insufficient fluids, a drop in blood pressure, blood loss, low blood sugar, medicines, an abnormal heart rhythm or a neurological problem. Describe exactly how it feels and watch for warning signs such as chest pain, loss of neurological function, fainting or black stools.LipomaA lipoma is usually a benign, slowly growing lump of fat cells under the skin. It often feels soft, rubbery and movable and does not need removal if it causes no problems. A new lump still needs assessment; rapid growth, a deep or fixed position, pain, neurological loss of function or recurrence after removal does not necessarily fit an ordinary lipoma.Liver damageLiver damage can result from MASLD, alcohol, viruses, autoimmune diseases or other long-term strain on the liver. You may notice little at first, but scarring can develop over time: fibrosis and later cirrhosis. Advanced liver damage can cause fluid in the abdomen, bleeding, jaundice and confusion. Stop alcohol completely if liver damage is suspected and have warning signs assessed promptly.Living with several chronic conditionsWith several chronic conditions at once, advice, appointments and medicines can conflict. Person-centred care first identifies what matters most to the patient and creates one coordinated plan.LonelinessLoneliness is the painful feeling that you have less contact, or less meaningful contact, than you need. It can affect anyone, including people with family or many contacts. Small, achievable steps and a conversation with your family doctor may help; seek help immediately if you feel despair or become unsafe.Long COVIDLong COVID, also called post-COVID, means symptoms persist after a coronavirus infection or continue to have a clear impact later. Fatigue, breathlessness, palpitations, brain fog, loss of smell and worsening after exertion are common. Good care involves both acknowledging symptoms and ruling out other treatable causes. Overexertion can delay recovery, especially when symptoms worsen after activity.Low blood pressureLow blood pressure is not always an illness. Some people naturally have lower blood pressure without symptoms. It becomes a problem when the brain or other organs receive too little blood. Causes range from a drop on standing and dehydration to bleeding, sepsis, heart problems or medicines. Associated falls, fainting, fever, blood loss or breathlessness determine urgency.Low moodLow mood sometimes accompanies setbacks or loss, but persistent low mood that affects functioning may indicate depression or a physical condition. Suicidal thoughts always need immediate, serious attention.Lower abdominal and pelvic painLower abdominal or pelvic pain can arise from the bowel, bladder, muscles or reproductive organs. Pregnancy, ectopic pregnancy, a twisted ovary or testicle, appendicitis and serious infection sometimes need to be ruled out quickly.Lower back painLower back pain is usually not dangerous and often improves by keeping active and gradually building up daily activities. Problems with urination or bowel movements, numbness around the perineum or anus, or rapidly increasing leg weakness require immediate emergency assessment.Lower leg pain during sport or workLower leg pain during sport or heavy work often results from overloading muscles and the tissue covering bone. Localised bone pain may be a stress fracture; rapidly increasing severe pain with a tense lower leg may be acute compartment syndrome.Lumbar disc herniationIn a lumbar disc herniation, material from an intervertebral disc can irritate a nerve root, causing pain radiating down the leg, tingling, loss of sensation or weakness. Recovery usually occurs without surgery. New bladder, bowel or saddle-area symptoms are time-critical.Lung cancerLung cancer starts in the lungs or airways. Symptoms may remain vague for a long time, but a persistent cough, coughing up blood, breathlessness, hoarseness, chest pain and unintentional weight loss are important signs. Not everyone with lung cancer smokes, and nobody deserves stigma or blame. Suspected cancer is usually investigated with scans, tissue testing and staging to establish how far the disease has spread. Treatment may include surgery, radiotherapy, chemotherapy, targeted therapy, immunotherapy or palliative care.Lung damage in a premature babyLung damage in a premature baby is often called bronchopulmonary dysplasia, or BPD. It mainly develops in very premature babies whose lungs are immature and who have needed extra breathing support or oxygen. Symptoms vary but may include fast breathing, wheezing, extra oxygen needs, feeding difficulties, slow growth and vulnerability to respiratory infections such as RSV. Good follow-up matters, alongside a smoke-free environment, attention to nutrition and development, and timely help for breathing difficulties or poor growth.Lyme diseaseLyme disease is a bacterial infection transmitted by an infected tick, usually after time in an area where Lyme occurs. An expanding red or bluish-red skin patch is often diagnosed clinically; early blood tests may be negative, and heart, nerve or joint symptoms require targeted treatment.Macular degenerationMacular degeneration damages the macula, the central part of the retina that provides sharp vision. Straight lines may look bent and a patch may appear in the centre of your vision. New distortion or rapid loss of central vision needs same-day assessment by an eye specialist.MalariaMalaria is a serious infection caused by Plasmodium parasites after a bite from an infected mosquito. Fever during or after a stay in a malaria area must be treated as malaria until tests rule it out. Falciparum malaria in particular can quickly become life-threatening.Mallet fingerIn mallet finger, the tendon that straightens the finger's end joint is torn or pulled away with a piece of bone. The fingertip droops and you cannot straighten it actively. Prompt, correct, continuous splinting often gives good recovery.Managing pain during labourPain during labour comes from contractions, pressure and the stretching of tissues. Preparation, support, positions and medical pain relief can help. Discuss your wishes and the available options with your midwife or doctor beforehand.Mastitis during breastfeedingMastitis is inflammation of the breast that often starts when milk does not drain well. The breast may become warm, painful and swollen and you may feel flu-like. Continuing to feed normally is usually safe and helps.MastocytosisMastocytosis is a rare condition with too many abnormal mast cells in the skin or organs. Substances from these cells can cause itching, redness, abdominal symptoms, fainting and anaphylaxis. Diagnosis and treatment planning should be handled by an experienced specialist.MasturbationMasturbation is a normal form of sexuality. It is usually safe and does not cause blindness, infertility or physical weakness. Help may be appropriate for pain, injury, loss of control or problems in daily life.ME/CFSME/CFS is a long-term illness in which exertion can markedly worsen symptoms. This setback is called post-exertional malaise, or PEM, and requires careful management of available energy.MeaslesMeasles is a highly contagious viral infection with high fever, cough, red eyes and then a rash. It can cause pneumonia, brain inflammation and death. Call before entering a healthcare facility so that others are not exposed.Medicines and safe drivingMedicines can affect reaction time, attention and vision without you fully noticing. Check official driving advice for each medicine and do not drive if drowsy, dizzy, confused or experiencing blurred vision.Medicines for anxiety: antidepressantsAntidepressants can reduce anxiety and avoidance in an anxiety disorder, even without depression. Benefits develop gradually; side effects may start earlier, and reduction should be step by step with the prescriber.Medicines for psychosisAntipsychotics can reduce delusions, hallucinations and severe agitation. The choice is individual and requires monitoring of benefits and side effects; never stop suddenly without advice.Medicines that calm you or make you sleepyVarious medicines can make you calm, drowsy or slower to react. This may be intended, but also increases the risk of falls, accidents and breathing problems, especially with combinations; do not stop suddenly without advice.Medicines that suppress immunity and vaccinationsMany non-live vaccines can be given while taking medicines that suppress immunity, but protection may be lower. Live vaccines can sometimes be dangerous; plan every vaccination with your treating clinician and never stop the immunosuppressant yourself.MelanomaMelanoma is skin cancer arising from pigment cells and can spread. A new or changing patch should be assessed promptly; early complete removal offers the best chance of cure.MelasmaMelasma causes harmless but sometimes bothersome brown or grey-brown patches, usually on the face. Sunlight and visible light often maintain it; treatment takes months and recurrence is common.Ménière’s diseaseMénière’s disease is an inner ear condition with attacks of vertigo, fluctuating hearing loss, tinnitus and a feeling of fullness in one or both ears. New loss of neurological function, sudden deafness in one ear or dizziness clearly different from previous attacks requires prompt assessment.MeningitisMeningitis is serious inflammation of the membranes around the brain and spinal cord. Symptoms can worsen quickly. Severe headache, fever, neck stiffness, drowsiness, sensitivity to light, confusion or an unwell child must be taken seriously immediately. Do not wait for a rash: there may be none. Suspected meningitis or meningococcal disease needs prompt emergency care.Mental health problems and workMental health problems can be caused by work, worsened by work or start outside work and affect functioning. Early discussion, appropriate temporary adjustments and treatment help recovery; safety and capacity come before a rapid return to full duties.Mental health problems in adultsMental health problems can affect mood, anxiety, thinking, sleep, the body, relationships and functioning. A comprehensive assessment considers severity, duration, safety, substance use, physical causes and circumstances; treatment is chosen together.Mental health problems in young peopleMental health problems in children and young people may show as anxiety, low mood, anger, physical symptoms, withdrawal or problems at school. Early support helps; thoughts of self-harm, suicide or being unsafe require professional assessment the same day.Meralgia paraestheticaMeralgia paraesthetica is irritation or compression of a sensory nerve supplying the outer thigh. It causes burning, tingling or a numb area, but should not cause muscle weakness.Mesothelioma: asbestos-related cancer of the lung or abdominal liningMesothelioma is a rare cancer of the lining around the lungs or inside the abdomen. The most common cause is inhaling asbestos fibres many years earlier.MigraineMigraine is a brain disorder with attacks of usually throbbing headache, nausea and sensitivity to light or sound. A temporary aura sometimes comes first. New loss of neurological function must never automatically be considered migraine, because a stroke can look similar.MiscarriageA miscarriage is the loss of a pregnancy before the baby can live outside the womb. Bleeding and cramps are common, but an ultrasound is needed for certainty. One-sided abdominal pain, shoulder pain or fainting can indicate an ectopic pregnancy.Missed contraceptive pillsWhat to do after a missed contraceptive pill depends on the exact type, how many active pills were missed, the point in the schedule, sex without a condom, vomiting, diarrhoea and other medicines. Check the packaging and seek professional advice promptly.MolesMoles are usually harmless spots containing pigment cells. A new or changing spot may need assessment to rule out skin cancer.Molluscum contagiosumMolluscum contagiosum causes small, smooth skin bumps with a central dimple, due to the molluscum contagiosum virus. They mainly affect children and usually disappear on their own, but eczema, inflammation, spots around the eye, extensive lesions with weakened immunity or genital spots in an adult need a focused assessment.Morton's neuromaMorton's neuroma is thickening around an irritated nerve between the metatarsal bones. It causes burning forefoot pain and tingling towards the toes.Motion sicknessMotion sickness occurs when the eyes, balance organs and body-position senses send conflicting information about movement. Looking ahead, fresh air and a position with less movement often help. Medicines work best when taken beforehand, but can cause drowsiness and unsafe driving.Mouth careGood mouth care protects teeth, gums and the lining of the mouth. Daily cleaning and regular check-ups help prevent cavities, inflammation and bad breath.Mouth inflammation from cancer treatmentChemotherapy, stem cell transplantation and head or neck radiotherapy can damage the lining of the mouth. Early reporting and daily mouth care limit pain, infection and nutritional problems.Mouth problemsMouth problems can arise from teeth, gums, the mouth lining, saliva or dentures. The cause determines what care is needed.Mouth problems at the end of lifeAt the end of life, mouth care focuses on comfort: a moist, clean mouth, less pain and care that fits the person's wishes and capacity.Mpox (monkeypox)Mpox is a viral infection often causing changes to the skin or mucous membranes, fever and pain. It spreads mainly through direct and prolonged close contact.MRI scanMRI uses a strong magnet and radio waves to make detailed images without X-rays. A complete safety check for metal, implants, gas cylinders and pregnancy is essential.Multiple sclerosis (MS)Multiple sclerosis is an inflammatory disease of the brain and spinal cord. Symptoms vary between people; early assessment of new loss of neurological function and appropriate disease-modifying treatment are important.MumpsMumps is a contagious viral infection that may swell the salivary glands in front of and below the ears. Most people recover, but serious complications are possible. The MMR vaccine gives the best protection.Mycoplasma genitaliumMycoplasma genitalium is a bacterial STI that can cause urethral and cervical inflammation. Targeted testing and treatment matter because antibiotic resistance is increasing.Nappy rashNappy rash is redness and irritation in the skin covered by a nappy. Moisture, friction, stools and urine usually cause it. Sometimes a fungus such as candida contributes, or more rarely a bacterial infection. Gentle care, more frequent changes, time without a nappy and a protective barrier product often help. Do not use talc, improvised home remedies or strong corticosteroid creams without a doctor. Call a doctor for broken skin, spreading rash, fever, pus, considerable pain or uncertainty about a fungal or bacterial infection.NarcolepsyNarcolepsy is a lasting sleep-wake disorder with marked daytime sleepiness. Some people briefly lose muscle strength with emotions; proper diagnosis and treatment make daily life safer.Narrowing or blockage of a leg artery (intermittent claudication)In intermittent claudication, atherosclerosis reduces blood flow to working leg muscles, causing pain or cramp after roughly the same walking distance that eases with rest. The condition also indicates increased heart and stroke risk. Pain at rest, a non-healing wound or a suddenly cold, pale, numb or weak leg needs urgent assessment.Natural methods of contraceptionNatural contraception uses signs of fertility to avoid unprotected sex on fertile days. It requires daily accuracy, is less reliable in typical use than an IUD or implant, and does not protect against sexually transmitted infections (STIs).Nausea and vomiting in pregnancyNausea and vomiting are common in early pregnancy and can occur at any time of day. Inability to drink, dehydration, weight loss or unusual pain and fever may indicate hyperemesis or another condition and need same-day assessment. Timely anti-sickness medicine is usually safer than severe untreated symptoms.Neck painNeck pain usually comes from muscles, joints and temporary overloading, and often improves with continued movement. Prompt assessment is needed after an accident, with fever and serious illness, or with new loss of arm or leg function.Neuralgic amyotrophyShoulder nerve inflammation, usually called neuralgic amyotrophy, often starts with sudden, very severe shoulder or arm pain, followed days to weeks later by weakness and muscle wasting. Early assessment is needed to rule out other emergency causes and safely support pain control, breathing and recovery.Neuropathic painNeuropathic pain is pain caused by damage to or disease of sensory nerves. It often feels burning, shooting or electric, with tingling, numbness or pain from light touch. Investigating the cause is important because treatment and urgency depend on whether it involves, for example, diabetes, shingles, pressure on a nerve, medicine-related damage or an acute neurological condition.Night shifts and healthNight shifts disrupt your body clock and make good sleep harder. This can lead to fatigue, mistakes and additional health risks in the long term.Nitrous oxideNitrous oxide may seem harmless because its effects are brief, but it can immediately cause oxygen deprivation, burns from extreme cold, falls and loss of consciousness. Repeated use can inactivate vitamin B12 and cause serious nerve damage. Thrombosis, mental health disturbances and pregnancy risks also make prompt assessment important.Noise-induced hearing lossLoud noise can temporarily or permanently damage hair cells in the inner ear. Muffled hearing or tinnitus after noise is a warning sign. Sudden major hearing loss, severe dizziness or ear injury after a loud bang needs assessment the same day.NosebleedMost nosebleeds are not dangerous and stop with proper pressure. Sit down, lean slightly forward and pinch the soft part of the nose continuously for 10 to 15 minutes.Oak processionary caterpillarThe oak processionary caterpillar lives on certain oak trees in Europe and releases microscopic irritating hairs that can affect the skin, eyes and airways. This oak-related exposure is not typical of Curaçao. Symptoms after travel, imported materials or contact with other caterpillars need assessment based on the actual species and severity.Obesity and pregnancyA BMI of 30 or above before or early in pregnancy increases the chance of gestational diabetes, high blood pressure, thrombosis and birth-related problems, among other things, but most pregnancies proceed without serious complications. Respectful care, extra checks and an individual plan for nutrition, movement, medicines, birth and the postnatal period help reduce risks; losing weight on your own during pregnancy is usually not the goal.Obesity in adultsObesity is a chronic condition in which excess body fat can harm health. It usually develops through a combination of genetic predisposition, environment, health, medicines, sleep and lifestyle. It is not a lack of willpower.Obsessive-compulsive disorder (OCD)Obsessive-compulsive disorder involves unwanted recurring thoughts, images or urges and/or compulsions that temporarily reduce anxiety but keep the cycle going. It goes beyond a preference for order or perfectionism. Cognitive behavioural therapy with exposure and response prevention is an important treatment; a doctor may add medicines.Oesophageal cancerOesophageal cancer is a malignant tumour of the oesophagus. Increasing swallowing problems and unintentional weight loss are important warning signs. Early referral offers the best chance of treatment.Optic atrophyIn optic atrophy, fibres of the optic nerve are permanently damaged. Vision, colour vision or the visual field may deteriorate; investigations mainly aim to find and treat the cause to prevent further damage.Oral thrushOral thrush is a Candida infection of the mouth or throat with painful white or red patches. It is more common in babies and with dentures, inhaled corticosteroids, antibiotics, diabetes or weakened immunity.Osgood-Schlatter diseaseIn Osgood-Schlatter disease, the growth plate at the bump below the kneecap hurts because of repeated pulling by the patellar tendon. It mainly affects sporty children during a growth spurt and usually improves with adjusted activity levels.OsteoarthritisOsteoarthritis is a long-term joint condition that can cause pain, stiffness and reduced movement. Knees, hips and fingers are often affected.Outer hip painPain on the outside of the hip is often caused by irritation of the gluteal tendons around the bony prominence at the hip. Adjusting activities and targeted exercise therapy usually help more than prolonged rest.Ovarian cancerOvarian cancer often causes vague but persistent symptoms, such as bloating, feeling full quickly, abdominal or pelvic pain and needing to urinate more often. These symptoms usually have another cause, but new symptoms that recur frequently deserve investigation. Diagnosis and treatment belong with a specialist team.Ovarian cystAn ovarian cyst is a cavity filled with fluid or other material in or on an ovary. Many cysts before menopause are related to ovulation and disappear on their own. Size, appearance, symptoms, age, pregnancy and menopause determine whether monitoring or treatment is needed.Overactive bladderAn overactive bladder causes sudden strong urgency, frequent urination and sometimes urine leakage, without an infection or another clear cause fully explaining this. Bladder training and pelvic floor support are often the first treatment.Overactive thyroidWith an overactive thyroid, there is too much thyroid hormone in the body. Palpitations, weight loss, trembling and heat intolerance are common, but the cause must be established through blood tests; high fever, severe agitation and a very fast heart rate can indicate a rare thyroid storm.Overweight in adultsOverweight means having more body fat than may be desirable for health. Weight alone does not tell the whole story: waist circumference, blood pressure, blood tests, fitness, sleep, medicines and personal goals together determine suitable lifestyle support.Pain and painkillersPainkillers can support recovery and functioning, but every medicine has limits and risks. Choose the mildest suitable option, use the lowest effective dose for as short a time as possible, and check combinations with a doctor or pharmacist.Pain at the vaginal openingPain at the vaginal opening can be caused by irritation, infection, skin disease, tense pelvic floor muscles, hormonal dryness or long-term pain sensitivity. Careful examination with consent helps choose appropriate treatment.Painful red lump in the eyelidA painful red eyelid lump is usually a stye: an inflamed oil gland near an eyelash. Warm compresses often help. Rapidly spreading redness, fever, pain on moving the eye or reduced vision needs prompt assessment.Painkillers such as ibuprofen, naproxen and diclofenac (NSAIDs)NSAIDs such as ibuprofen, naproxen and diclofenac reduce pain, fever and inflammation but can cause stomach bleeding, kidney problems, fluid retention and cardiovascular problems. They are not safe for everyone, especially during pregnancy, with blood thinners or with kidney disease.PalpitationsPalpitations mean noticing your heartbeat as pounding, skipping beats, fluttering or suddenly speeding up. They are often harmless, for example because of stress, caffeine or an extra heartbeat, but sometimes a heart rhythm problem or another physical condition is responsible. Palpitations with fainting, chest pain, severe shortness of breath, becoming pale or weak, or an episode that does not settle need prompt assessment.Pancreatic cancerPancreatic cancer sometimes causes no clear symptoms in its early stages. Yellow skin or eyes, weight loss and upper abdominal or back pain need investigation.Panic attackA panic attack is a sudden wave of intense fear with physical symptoms such as palpitations, breathlessness and dizziness. An attack is usually not dangerous, but a first or unusual attack may need medical assessment.Panic disorderIn panic disorder, unexpected panic attacks recur and the person remains afraid of further attacks or their consequences. Treatment with cognitive behavioural therapy and sometimes medicines often helps.Parasitic wormsWorms is a collective term for various parasites of the intestine, skin or organs. The species is identified from appearance, symptoms, travel and residence history, and targeted tests; do not take a general deworming treatment on your own initiative, because treatment and risks differ greatly.Parents with mental health or addiction problemsGrowing up with a parent who has mental health or addiction problems can bring uncertainty, stress and extra responsibility. The child is not to blame and does not have to cure the parent; support from reliable adults can be protective.Parkinson’s diseaseParkinson’s disease is a gradually progressive brain condition that can affect movement, sleep, thinking, mood, blood pressure, the bowel and other body functions. Sudden loss of function is not part of the usual course; never stop levodopa or other Parkinson’s medication abruptly, and have swallowing problems, falls or acute confusion assessed promptly.PEG feeding tubeA PEG tube passes through the abdominal wall directly into the stomach and is used for nutrition, fluids and sometimes medicines. Good daily care and prompt action for dislodgement, leakage or peritonitis are important.Pelvic inflammatory diseaseInflammation of the womb, fallopian tube or ovary is an infection in the pelvis. Prompt antibiotic treatment reduces the risk of an abscess, long-term pain, an ectopic pregnancy and difficulty becoming pregnant.Pelvic organ prolapseIn pelvic organ prolapse, the uterus, bladder, bowel or top of the vagina moves down into or towards the vagina because supporting tissue and the pelvic floor have weakened. A heavy or bulging sensation, urinary or bowel problems and discomfort during sex may occur. Treatment is needed only if it causes problems and may include pelvic floor therapy, a pessary or surgery.Penile dischargeMucus or pus from the penis often indicates inflammation of the urethra, frequently due to an STI such as gonorrhoea or chlamydia. Get tested promptly and receive targeted treatment. Avoid sex until a healthcare professional says treatment for you and your partners is complete.Perforated eardrumA perforated eardrum is an opening in the thin membrane between the ear canal and middle ear. It may result from an ear infection, a pressure difference, a loud bang or an object in the ear. Many small tears heal by themselves, but the ear must stay dry, and sudden hearing loss, severe dizziness, head injury or persistent discharge needs prompt assessment.Persistent or recurring nasal symptomsPersistent or repeatedly recurring nasal symptoms have several possible causes. Allergic and non-allergic rhinitis are common, but nasal polyps, prolonged irritation, rebound from decongestant nasal sprays or structural problems may also contribute. One-sided blockage, nosebleeds, a visible mass or loss of smell with breathlessness deserve extra attention.Personality disorderIn a personality disorder, long-standing patterns of feeling, thinking and relating to others are so strong that they cause considerable distress or problems. The person is not their diagnosis; appropriate psychotherapy and support can bring change.Peyronie’s diseaseIn Peyronie’s disease, firm scar tissue forms in the wall of the penis, which can make an erection painful, shorter, narrower or noticeably curved. A sudden snap with swelling and bruising during sex may be a penile fracture; a painful erection that does not go away is also an immediate emergency.PhobiaA phobia is a strong, lasting fear of a particular object or situation, even though the actual danger is usually much smaller than the fear suggests. Avoidance brings temporary relief but often keeps the fear going. Cognitive behavioural therapy with safe, gradual exposure helps many people.Piles (haemorrhoids)Piles are enlarged cushions of blood vessels in or near the anus. They can cause bright red bleeding, itching, mucus, a feeling of pressure, pain or a lump that protrudes. Do not automatically assume that bleeding from the anus is caused by piles.Pilonidal diseaseInflammation in the cleft between the buttocks usually develops when hairs and skin debris irritate and infect a small tract beneath the skin. A painful abscess often needs opening and draining. Recurrent symptoms may need planned surgery.Pitted keratolysisPitted keratolysis causes small crater-like pits in the outer horny layer of the soles, due to bacteria that thrive in sweat and enclosed footwear. The condition is usually superficial and treatable by keeping feet dry and using targeted topical treatment.Pityriasis roseaPityriasis rosea is a temporary rash that often starts with one larger oval patch, followed by many smaller scaly patches on the trunk and upper arms. It usually clears by itself within a few weeks and is generally not contagious.Pityriasis versicolorPityriasis versicolor is a superficial overgrowth of the normal skin yeast Malassezia, causing finely scaly pale, dark or pink patches mainly on the chest, back, neck and upper arms. It is not contagious. Antifungal treatment stops the active yeast, but the colour difference may remain visible for weeks to months.Planning pregnancy and inherited conditionsIf you are planning pregnancy and you, your partner or family have an inherited condition, genetic counselling before pregnancy can clarify individual risks and options. Carrier screening, prenatal screening, diagnostic testing and PGT answer different questions, and no test guarantees a child without a condition.Pneumococcal vaccinationPneumococcal vaccines protect against serious disease caused by pneumococci, such as pneumonia, sepsis and meningitis. The appropriate vaccine and repeat doses depend on age, previous vaccinations, immune function and local vaccination policy in Curaçao.PneumoniaPneumonia is an infection of lung tissue. It can be caused by viruses, bacteria or sometimes material going down the wrong way into the airways, known as aspiration. Common symptoms include coughing, fever, shortness of breath, pain on breathing, tiring easily and feeling unwell. Older people, young children and those with chronic illness can become seriously unwell more quickly. Pneumonia does not always need the same treatment. Appropriate antibiotic use therefore matters: use them only when suited to the likely cause and severity.Pneumothorax (collapsed lung)A pneumothorax is air between the lung and chest wall, causing part of the lung to collapse. It often causes sudden chest pain and breathlessness, but severity can vary greatly. A tension pneumothorax is life-threatening and can cause rapid deterioration with severe breathlessness, a fast heartbeat and agitation. After a pneumothorax, do not fly or dive until a doctor has confirmed it is safe again.Polycystic ovary syndrome (PCOS)PCOS is a hormonal condition involving irregular or absent ovulation and often increased effects of male hormones. It can affect periods, skin, hair, fertility and metabolism. Treatment is tailored to symptoms and whether you want to become pregnant.Polymyalgia rheumaticaPolymyalgia rheumatica causes pain and prolonged morning stiffness around the shoulders and hips, mainly in people over 50. It often responds quickly to corticosteroids, but follow-up checks are needed.PolyneuropathyPolyneuropathy means that several nerves outside the brain and spinal cord are damaged, often first in the feet and later in the hands. Diabetes, alcohol, vitamin deficiency, medicines and inherited diseases are possible causes. Rapidly ascending weakness or breathing problems require emergency care.Posterior vitreous detachmentIn vitreous detachment, the gel inside the eye pulls away from the retina as part of ageing. This is often a normal process, but a retinal tear may occur as it separates. New flashes of light, a sudden increase in moving spots or a dark curtain therefore need assessment by an ophthalmologist or urgent eye service the same day. Only an eye examination with dilated pupils can reliably rule out a retinal tear.Postnatal depressionDepression after giving birth causes persistent low mood, anxiety, emptiness or loss of enjoyment and can make caring for yourself and your baby difficult. It is treatable and does not mean you are a bad parent. Confusion, delusions, mania or danger to the parent or baby is an immediate emergency.PregnancyDuring pregnancy, your body changes and a baby grows in the uterus. Register early with a maternity team for check-ups, discuss all medicines, take folic acid, avoid alcohol and drugs, and seek immediate help for heavy bleeding, severe abdominal pain, breathlessness, a seizure or reduced consciousness.Pregnancy and contrast agentsContrast agents can make organs and blood vessels clearer on CT, MRI or fluoroscopy. Iodinated contrast, and especially gadolinium, are used during pregnancy only when expected medical benefit outweighs possible risks. A necessary scan for a serious condition must not be delayed dangerously.Pregnancy and COVIDCOVID-19 is often mild, but pregnancy increases the risk of severe illness, hospital admission and premature birth. Test if you have symptoms, seek early advice about treatment, continue antenatal check-ups and get immediate help for breathlessness, chest pain, drowsiness, blue-grey discolouration or clearly reduced baby movements.Pregnancy and group B strepGroup B streptococci can temporarily be present in the bowel or vagina without symptoms and are not a sexually transmitted infection. GBS can rarely pass to the baby during birth and cause serious infection. Screening and intravenous antibiotics during labour are planned according to local policy and individual risk factors.Pregnancy and high blood pressureHigh blood pressure during or after pregnancy may cause no symptoms and can sometimes quickly progress to pre-eclampsia with organ damage. Have raised readings assessed, follow check-ups and medication carefully, and seek immediate help for a systolic pressure of 160 or a diastolic pressure of 110 or higher, severe headache, visual symptoms, upper abdominal pain, breathlessness or a seizure.Pregnancy and itchingItching during pregnancy is often caused by dry or stretched skin. However, severe itching without an obvious rash, especially on the palms and soles and at night, may be obstetric cholestasis. Have this assessed the same day with bile acid and liver tests, and call immediately for reduced baby movements.Pregnancy and surgeryMedically necessary surgery must not be delayed unsafely during pregnancy. The surgeon, anaesthetist and maternity team jointly assess urgency, stage of pregnancy, anaesthesia, medicines, blood clots and monitoring of the baby. Non-essential procedures are usually postponed until after pregnancy.Pregnant with tripletsA triplet pregnancy involves three babies growing at the same time and needs specialist monitoring because of the high risk of premature birth, growth differences, high blood pressure, gestational diabetes and complications when babies share a placenta. Follow your maternity team's direct emergency plan and call Ambulance 912 for collapse, heavy bleeding, a seizure or severe breathlessness.Pregnant with twinsA twin pregnancy involves two babies growing at the same time. Early identification of placentas and amniotic sacs is essential, because a shared placenta adds risks of unequal blood distribution and growth differences. All twins also have a higher risk of premature birth and pregnancy complications.Premature ejaculationPremature ejaculation means ejaculation happens earlier than wanted and is difficult to control, causing tension or distress. It can often be treated with explanation, exercises, sex therapy or medicines.Premenstrual syndromeIn premenstrual syndrome, physical and psychological symptoms recur in the days before a period and lessen shortly afterwards. A daily symptom diary over at least two cycles helps with diagnosis. Severe low mood or suicidal thoughts require immediate help.Pressure soreA pressure sore develops when skin and underlying tissue are exposed to pressure or shearing forces for too long, often over a bony area or beneath a device. Early discolouration that does not fade may indicate deeper damage. Relieving pressure immediately, checking daily and professional wound assessment help prevent worsening; do not massage the area.Preterm prelabour rupture of membranesIn preterm prelabour rupture of membranes, amniotic fluid leaks before 37 weeks and before labour begins. This always needs immediate assessment by the midwife or hospital because of infection, premature birth and umbilical cord problems; do not use a tampon or wait at home for contractions.Preventing coronavirusNo single measure prevents every coronavirus infection. The best protection comes from combining several measures: up-to-date vaccination, staying home when ill, fresh air, distance from vulnerable people, a well-fitting mask in higher-risk situations and good hand and cough hygiene.Preventing fallsFalls often result from a combination of reduced strength or balance, dizziness, vision, foot problems, medicines and obstacles. Individual assessment and strength and balance training work better than simply being careful. Prompt help is needed after a fall involving head impact, blood thinners, severe hip or back pain or loss of neurological function.Preventing pregnancyContraception helps prevent pregnancy, but methods differ in reliability, use, side effects and medical suitability. Choose a method that fits your health and wishes with a knowledgeable professional, also use condoms against STIs and seek emergency contraception promptly after unprotected sex or an error with your method.Problems at homeProblems at home may involve arguments, control, threats, violence, neglect, addiction or being overwhelmed. Responsibility for violence never lies with the person experiencing it; safety, support accepted freely and an up-to-date local help plan come first.Problems with veins in the pelvisEnlarged or poorly functioning veins in the pelvis can cause chronic lower abdominal pain, often worse after prolonged standing, around menstruation or after sex. Other causes of pelvic pain must be carefully ruled out before treatment of the veins is considered.Prostate cancerProstate cancer develops from cells in the prostate and often grows slowly, but some forms are aggressive. PSA can help with detection and monitoring, but is not specific to cancer; diagnosis usually requires MRI and tissue examination.ProstatitisProstatitis may develop suddenly due to bacteria, with fever, pain and difficulty passing urine, or cause long-term pelvic symptoms without a detectable infection. Acute bacterial prostatitis can cause urinary retention and sepsis and must be treated promptly.PsoriasisPsoriasis is a chronic inflammatory disease with sharply defined red or dark patches and scales. It is not contagious and can also affect the nails and joints; treatment depends on the location, extent and impact on life.Psoriatic arthritisPsoriatic arthritis is long-term joint inflammation that can occur with psoriasis. Joint symptoms sometimes start before clear skin patches appear.PsychosisDuring psychosis, the ability to judge reality is temporarily severely disrupted, for example by delusions, hallucinations or confused thinking. Early, calm help often improves recovery; danger, severe self-neglect, intoxication or physical instability require urgent assessment.PterygiumA pterygium is a benign triangular growth of conjunctiva over the cornea. Sunlight, wind, dust and dryness play a part, making it more common in tropical climates. Artificial tears and protection can reduce irritation; growth towards the pupil, changes in vision or persistent discomfort require assessment by an ophthalmologist.PTSD (post-traumatic stress disorder)PTSD can develop after a distressing or threatening event and causes reliving of events, avoidance, negative mood and constant vigilance. The event is never the victim's fault; effective trauma-focused treatments are available.Pubic licePubic lice are an infestation of small lice that mainly live in coarse hair around the genitals. They usually spread through close physical or sexual contact. The lice do not transmit infectious diseases, but itching and scratching can damage the skin.Pulmonary embolismA pulmonary embolism is a blood clot lodged in a lung blood vessel. It can cause sudden breathlessness, chest pain, coughing or a fast heartbeat. Signs of a leg thrombosis, such as pain or swelling in one leg, may also be present. A severe pulmonary embolism can be life-threatening. If suspected while you are stable, call your GP the same day or HAP 9252 outside office hours. For severe breathlessness, chest pain with collapse or fainting, call Ambulance 912 immediately.Q feverQ fever is an infection caused by the bacterium Coxiella burnetii. Infection usually occurs by inhaling contaminated dust or small droplets around animals, especially goats, sheep or cattle. Many people have no symptoms, but pneumonia, liver inflammation and persistent or localised infection are possible.RabiesRabies is a viral infection that is almost always fatal once symptoms begin. You can acquire it through a bite, scratch or saliva from an infected animal entering a wound, graze or mucous membrane. Time therefore matters: immediately wash the area thoroughly with water and soap for a prolonged period and arrange medical assessment that same day for possible post-exposure treatment. Do not wait for symptoms; treatment needs to begin before they appear.Raised intracranial pressureRaised intracranial pressure means the pressure inside the skull is too high. Causes can include bleeding, swelling, infection, a build-up of fluid or idiopathic intracranial hypertension. A headache with visual symptoms, double vision, vomiting or papilloedema needs prompt assessment. Sudden loss of neurological function or reduced consciousness is an acute emergency.Raised TSH with normal thyroid hormoneRaised TSH with normal free T4 is often called subclinical hypothyroidism. It does not always mean the thyroid is permanently underactive: the result may be temporary and many people have no symptoms. Repeat testing and assessment in the individual's context prevent unnecessary treatment.Ramadan and healthDuring Ramadan, many Muslims fast from dawn to sunset. Healthy adults can usually tolerate this, but fasting can pose serious risks with diabetes, pregnancy, kidney or heart disease, frailty or certain medicines. Discuss a personal, respectful plan beforehand.Raynaud's phenomenonIn Raynaud's phenomenon, small blood vessels in the fingers or toes temporarily become very narrow. A finger or toe may become pale, blue or red and feel cold, numb or painful. Cold, air conditioning and stress are common triggers. Raynaud's is usually harmless, but a first attack later in life, sores or lasting discolouration may point to another condition and need assessment.Reactive arthritisReactive arthritis is an inflammatory reaction in joints that usually develops one to several weeks after an infection of the bowel, urinary tract or genitals. The bacterium is usually not in the joint, but a warm, swollen joint with fever must first be assessed for an actual joint infection.Recovery after childbirthAfter birth, your body and emotions need time to recover, and the baby needs regular care and checks. Bleeding, cramps, tiredness and mood changes may be normal, but some signs need prompt help.Recreational drugsDrugs affect the brain and body. Effects, risks and duration are unpredictable because of the substance, strength, combinations, health and contamination. This article covers prevention, recognising problems and first aid without instructions for use. Call Ambulance 912 for inability to wake someone, slow breathing, a seizure, chest pain, extreme overheating or other life-threatening signs after drug use.Rectal bleedingBright red blood on toilet paper or stool may come from haemorrhoids or a small fissure, but dark blood, black stool, a lot of blood or accompanying symptoms need urgent assessment.Red eyeA red eye is a symptom with many causes. Itching or discharge is often harmless, but pain, sensitivity to light, worsening vision, contact lens use, an abnormal pupil, a newborn baby or an eye injury requires prompt assessment.Red patch on the white of the eye from a broken blood vesselA clearly defined red patch on the white of the eye is often a subconjunctival haemorrhage. It is usually painless, does not affect vision and clears up on its own. Pain, sensitivity to light, reduced vision, injury or bleeding elsewhere are not typical of a harmless patch.Reduced sexual desireReduced sexual desire is common and is only a medical problem if it bothers the person. Physical health, mood, relationships, life stage and medicines can all play a part. Good help starts without judgement and with attention to consent and safety.Reduced vision from brain injury around birthIn cerebral visual impairment, the brain processes images less well because of injury or a developmental problem around birth. The eyes may look normal. Vision often varies with busy surroundings, fatigue and the task.Reduced vision in adultsReduced vision in adults can result from a focusing error, cataract or eye disease, but sometimes from a retinal problem or stroke. Gradually blurred vision needs investigation; sudden sight loss, flashes with a curtain or sight loss with neurological deficits is urgent.Reduced vision in childrenA child may see less well because of a focusing error, a lazy eye, a squint or an eye disease. Early checks matter because young brains are still learning to see. A white pupil, sudden sight loss, a painful red eye or serious eye injury is a warning sign.Reducing your risk of cardiovascular diseaseYour risk of a heart attack and stroke falls if you do not smoke, eat healthily, exercise and have blood pressure, cholesterol, diabetes and kidney disease treated properly. A risk score is an estimate and must take account of your background and medical situation.Reflecting on your lifeThinking about values, choices and meaning is part of life and is not an illness. It becomes important to seek help when low mood, anxiety or despair takes over everyday functioning.Removal of the womb (hysterectomy)A hysterectomy is an operation to remove the womb. It may be needed for severe bleeding, fibroids, pain, prolapse or cancer when other treatments do not help enough or are unsuitable.Removing cells or tissue for testingDuring a biopsy, a healthcare professional removes cells or a small piece of tissue. A pathologist examines this material to identify the change, for example inflammation, infection, a benign abnormality or cancer.Respiratory syncytial virus (RSV)RSV usually causes a cold, but can cause severe bronchiolitis or pneumonia in young babies, vulnerable children, older people and people with heart, lung or immune problems. Pauses in breathing, blue lips or being unable to wake someone is an immediate emergency.Restless legs syndromeRestless legs syndrome causes a strong urge to move the legs, mainly at rest and in the evening, with temporary relief from movement. Assessment focuses on the pattern, iron levels, medicines, pregnancy and kidney disease. A warm, swollen leg on one side is not ordinary RLS.Retinal detachmentIn retinal detachment, the light-sensitive retina separates from the layer beneath it. New flashes, many floaters or a dark curtain need emergency eye care the same day.Retinitis pigmentosaRetinitis pigmentosa is a group of inherited retinal conditions in which night vision and the peripheral visual field gradually decline. The rate varies greatly. Sudden flashes, many new floaters, a dark curtain or rapid loss of vision are not part of ordinary gradual RP and are eye emergencies.Rheumatic conditionsRheumatic conditions are a broad group of disorders affecting joints, muscles, tendons, bones and connective tissue. Causes and treatments vary greatly. Persistent swelling, prolonged morning stiffness or a hot joint with fever require medical assessment.Rheumatoid arthritisRheumatoid arthritis is a chronic autoimmune disease with inflammation of the joints, often symmetrically in the hands, wrists and feet. Early referral and treatment with disease-modifying medicines reduce the chance of permanent damage.Rheumatology medicines and pregnancyDiscuss plans for children and pregnancy early with your rheumatologist and maternity team. Not all rheumatology medicines are unsafe, but some can cause serious harm. Uncontrolled disease and suddenly stopping everything are also risky; do not make changes on your own.RosaceaRosacea is a long-term inflammatory condition of the face, causing redness, flushing, visible blood vessels, bumps or eye symptoms. Sun and heat in Curaçao can trigger it. Eye pain, sensitivity to light or blurred vision needs prompt eye assessment.RoseolaRoseola is a common viral infection in babies and toddlers, with a sudden high fever lasting several days, often followed by a pink rash as the fever falls. Most children recover on their own, but age, drinking, breathing, how easily they wake and warning signs matter more than the name of the rash.Roundworm infectionRoundworms are intestinal parasites acquired by swallowing eggs from contaminated soil, food or hands. Symptoms range from none to abdominal pain, cough or, rarely, blockage of the bowel or bile ducts.RubellaRubella is a contagious viral infection that is often mild, but can seriously harm a baby during pregnancy. A rash alone is not reliable for diagnosis: if you suspect rubella, call before entering a practice, and call the same day if you are pregnant or have been exposed.Runner's kneeRunner's knee often means pain on the outside of the knee from irritation around the iliotibial band. The term is also used for other overuse problems, such as patellofemoral pain at the front. Identifying the pain's location and cause therefore matters. Reducing load, temporarily adjusting sport and building back gradually often help. Not all knee pain with running is harmless: a fall, fever, a warm swollen knee, a swollen lower leg or inability to bear weight needs prompt assessment.Ruptured brain aneurysmA ruptured weak spot in a blood vessel in the head is usually a ruptured brain aneurysm. This causes sudden bleeding around the brain. The classic symptom is an extremely severe headache that starts very suddenly and reaches maximum intensity within seconds to minutes. This is an emergency: call Ambulance 912 immediately.Salivary gland stonesA salivary stone blocks drainage from a salivary gland, often under the jaw. Pain and swelling typically increase around meals. Fever, pus or swallowing and breathing problems need prompt care.SarcoidosisSarcoidosis is an inflammatory disease in which groups of immune cells, called granulomas, form in one or more organs. The lungs and lymph nodes are often involved, but the eyes, skin, heart or nervous system can also be affected. The course varies greatly and treatment is not always needed.ScabiesScabies is a contagious skin infestation caused by the human scabies mite. It often causes intense itching at night and bumps or burrows. All close contacts usually need treatment at the same time, even without symptoms, to stop a cycle of reinfestation.Scalp ringwormScalp ringworm, also called tinea capitis, is a fungal infection of the scalp and hair. Common signs include itching, scaling, broken hairs or bald patches. Cream on the skin alone is usually not enough: because the hair is also affected, treatment with a medicine taken by mouth is often needed under medical guidance. A painful swollen area of inflammation with pus, called a kerion, needs prompt assessment to help prevent permanent hair loss.Scarlet feverScarlet fever is a contagious infection caused by group A streptococci, with fever, a sore throat and a fine, rough-feeling rash. A doctor assesses whether tests and antibiotics are needed. Breathlessness, drooling, drowsiness or a rash that does not fade under pressure are warning signs.Scheuermann’s diseaseScheuermann’s disease is a growth disorder in which several vertebrae become wedge-shaped, causing a stiff, rounded upper or middle back, usually during puberty. Exercise therapy, monitoring and sometimes a brace help; new weakness, numbness or problems with urination or bowel movements require immediate assessment.Schmallenberg virusSchmallenberg virus mainly causes disease in cattle, sheep and goats and is spread by biting midges. Research in highly exposed people has found no evidence that the virus causes disease in humans. Symptoms after contact with sick livestock still need normal medical assessment because birth materials can transmit other infections.Scrotal painScrotal pain can result from bruising, inflammation, an inguinal hernia or another cause. Sudden severe pain in one testicle may be testicular torsion and must be assessed in hospital immediately to save the testicle.Seasonal affective disorderSeasonal affective disorder is recurrent depression that starts in a particular season and then lifts, usually during months with less daylight. In Curaçao, this pattern is less clear-cut; have low mood, excessive sleep, loss of enjoyment or suicidal thoughts assessed and other causes ruled out.Seborrhoeic dermatitis: flaky skin on the scalp, face or earsGreasy or dry flakes on the scalp, eyebrows, creases beside the nose and around the ears often suggest seborrhoeic dermatitis. It is not contagious and can return. Gentle care and a suitable shampoo or medicated treatment help; pain, pus, fever or patchy hair loss need assessment.Seborrhoeic keratosisA seborrhoeic keratosis is a common, benign skin growth that looks stuck onto the skin. Treatment is usually unnecessary, but a new, bleeding or changing lesion must be assessed.Sensitive to certain vegetables, fruit or nutsItching, tingling or mild swelling in the mouth and throat soon after raw fruit, raw vegetables or some nuts may be pollen-food syndrome, also called oral allergy syndrome. Proteins in the food resemble pollen you are allergic to. Symptoms are often local and cooked food is sometimes tolerated, but a primary food allergy may cause a more severe reaction. Have the pattern assessed and do not try a suspect food again yourself if you have had throat symptoms or a whole-body reaction.Sensitivity to milkHere, sensitivity to milk means lactose intolerance: insufficient lactase means milk sugar causes bowel symptoms. This differs from cow’s milk allergy, where the immune system reacts to milk protein and anaphylaxis can sometimes occur.SepsisSepsis is a life-threatening response to infection that causes organs to stop working properly. A person can deteriorate quickly. Confusion, severe breathlessness, ashen skin, little urine or difficulty waking requires immediate emergency care.Severe finger infection (felon)A deep bacterial finger infection is painful and often affects the fingertip. Pressure can build up in the small enclosed spaces, and the infection can spread to bone, a joint or a tendon sheath. Have a finger with severe throbbing pain, swelling or difficulty moving assessed promptly. Never pierce or cut it open yourself.Severe scrotal painSudden severe pain in the scrotum is a warning sign. A twisted testicle, or testicular torsion, is an emergency that threatens the organ: the blood supply can be cut off, so quick action is needed. Do not wait if there is sudden pain on one side, a testicle sitting higher than usual, nausea, swelling or scrotal pain in a child or young person.SexSexual health includes physical and emotional wellbeing, pleasure, safety, respect, boundaries, relationships, STI prevention and pregnancy. Sex should be voluntary: everyone can stop at any time. Condoms reduce STI and pregnancy risks, but no method provides complete protection.Sexual problems in menSexual problems in men can involve desire, arousal, erections, climax, pain or satisfaction. Physical health, medicines, relationships and emotions often interact. A conversation with the GP can clarify causes and suitable help.Sexual problems in womenSexual problems in women can involve desire, arousal, lubrication, orgasm, pain or satisfaction. Physical factors, hormones, medicines, relationships and experiences often interact. Help should be voluntary, respectful and non-judgemental.Sexually transmitted infections (STIs)An STI is an infection mainly passed on through sexual contact. Many STIs cause no symptoms. Testing, appropriate treatment, partner notification and safer sex prevent complications and further transmission.Shin painShin pain often results from overloading bone and surrounding tissue after a rapid increase in running, jumping or marching. Pain along a longer section of the inner edge fits shin splints, but localised bone pain, pain at rest, swelling or loss of function may indicate a stress fracture or another cause.ShinglesShingles is a painful rash caused by reactivation of the chickenpox virus. Blisters usually form in a band on one side of the body or face. Treatment works best when a doctor assesses early whether an antiviral is needed. A rash near the eye, nose or ear, a severely weakened immune system, pregnancy or rapidly becoming more unwell needs particularly prompt assessment.Shoes and your feetWell-fitting shoes protect feet and distribute pressure without squeezing the toes or skin. The wrong size, shape or use can worsen blisters, calluses, nail problems and pain. With diabetes, loss of sensation, vascular disease or a previous foot wound, fit is particularly important and new skin damage needs prompt assessment.Shoulder problemsShoulder problems can arise from tendons, a bursa, the joint capsule, a joint, the neck or nerves. Many improve with adjusted activity and gradual movement. Pain after a serious injury, a red and warm joint, loss of arm function or pain with chest symptoms needs prompt assessment.Shoulder replacementA shoulder replacement is a prosthesis fitted when pain and loss of function from joint damage do not improve enough with other treatments. Surgery can greatly reduce pain, but it is a major procedure. Beforehand, understand which type of prosthesis is needed, how the tendons function and what rehabilitation involves. Important risks include infection, thrombosis, nerve injury, loosening and sometimes dislocation or instability. Always tell your dentist and other doctors that you have a prosthesis, but antibiotics for dental procedures are not routine for everyone; follow your orthopaedic specialist's and dentist's advice.Sick childA sick child often has a harmless infection, but can deteriorate quickly, especially as a baby. Look beyond the temperature: breathing, colour, responsiveness, how easily the child wakes, drinking, urination, pain, rash and the parent's sense that something is wrong determine how quickly assessment is needed.Side effects after vaccinationAfter vaccination, the injection site may hurt and you may feel tired or have a headache or mild fever. These common reactions are usually mild and go away within a few days; serious side effects are possible but very rare.SinusitisSinusitis is swelling of the cavities in the bones around the nose, usually after a cold or flu. Most cases improve within a few weeks without antibiotics.Skin cancerSkin cancer is a collective name for several malignant skin conditions, including melanoma and non-melanoma skin cancers such as basal cell carcinoma and squamous cell carcinoma. Sunlight and other sources of ultraviolet (UV) radiation play a major role, especially on a sunny island like Curaçao. However, skin cancer can affect every skin tone and does not always look like a dark mole. New, growing, bleeding or poorly healing patches need assessment. The diagnosis is usually confirmed by taking a biopsy or removing tissue for examination.Skin cysts (epidermoid and pilar cysts)A so-called sebaceous cyst is usually an epidermoid or pilar cyst: a benign sac under the skin containing keratin. Have an unexplained or changing lump assessed; redness and pain can result from rupture or infection, and squeezing increases the risk of inflammation.SLE (systemic lupus erythematosus)SLE, systemic lupus erythematosus, is an autoimmune disease that can cause inflammation in different organs. Its course alternates between quiet and active periods. New breathlessness, chest pain, loss of neurological function or little urine needs prompt assessment.Sleep apnoeaIn sleep apnoea, breathing repeatedly stops or decreases during sleep. This disrupts sleep and can cause oxygen levels to fall. Loud snoring, witnessed breathing pauses and daytime sleepiness need investigation, especially after near-accidents or with cardiovascular disease.Sleep problemsSleep problems mean difficulty falling asleep, staying asleep or waking refreshed despite having enough opportunity to sleep. Short-term problems are common. When problems last for weeks, behavioural therapy for insomnia is usually the preferred treatment.Small tears in the anus (anal fissures)An anal fissure is a small tear in the lining at the anus. It often causes sharp pain when pooing, burning pain afterwards and a little bright red blood. Bleeding or pain can also have another cause and needs assessment if the pattern is not typical or does not improve.SnoringSnoring results from vibrating tissue in a narrowed upper airway. It is often harmless, but pauses in breathing, choking sounds and severe sleepiness may indicate sleep apnoea.Social anxiety disorderSocial anxiety disorder involves a strong, persistent fear of being judged negatively or humiliated. Avoidance often maintains the anxiety. Cognitive behavioural therapy is an important effective treatment.Someone close to you has COVIDWhen caring for someone with COVID at home, you need to consider their recovery, the risk of infection and your own ability to cope. Good ventilation, distance where possible and recognising warning signs early are important.Sore throatA sore throat is often caused by a virus and usually clears up on its own. However, watch for difficulty breathing, drooling, inability to swallow, dehydration, a muffled voice, a uvula pulled to one side or marked swelling on one side of the throat. These may indicate a more serious infection or an abscess. Rest, fluids and soft food often help, but a doctor needs to assess warning signs promptly.Spinal cord injuryA spinal cord injury damages the spinal cord, changing movement, sensation and automatic bodily functions below the level of injury. After an accident, avoid unnecessary movement of the neck and back and seek emergency care. Living with a spinal cord injury requires specialist rehabilitation and ongoing attention to breathing, skin, bladder, bowel, blood pressure, pain, sexuality and mental health.Spinal stenosisIn spinal stenosis, the space for the spinal cord or nerve roots becomes smaller. In the lower back, this often causes leg pain, tingling or weakness when standing and walking that eases with sitting or bending forwards; in the neck, pressure on the spinal cord may cause clumsy hands and walking difficulties. Inability to urinate, loss of bladder or bowel control, or numbness around the anus and genitals is an immediate emergency.Sports injuriesA sports injury may happen suddenly after a fall or twist, or develop gradually through overuse. Severe pain, deformity, numbness, inability to bear weight or head and neck symptoms need assessment.Sprained ankleIn an ankle sprain, one or more ankle ligaments stretch or tear when the foot unexpectedly rolls. Pain, swelling and bruising are common, but a fracture, tendon injury or dislocation may look similar. Protect the ankle and cool it briefly, build up weight-bearing and exercises in good time, and have severe pain, deformity or poor circulation assessed immediately.Squamous cell skin cancerSquamous cell skin cancer often develops on sun-damaged skin. A growing scaly, crusted, bleeding or non-healing lesion needs assessment and usually confirmation with a skin biopsy. Early treatment often cures it.Squint in childrenWith a squint, the eyes do not always look at the same point. One eye may turn inwards, outwards, upwards or downwards. Early assessment matters because the brain can suppress the image from one eye, leading to a lazy eye and permanently reduced vision.Sticky eyes in babiesSticky or watery eyes in a baby are often caused by a tear duct that is still narrow or blocked, especially if the white of the eye is not red. Redness, swollen eyelids, a lot of pus, fever or signs of illness may indicate an infection. A red eye or pus from the eye in a newborn always needs prompt medical assessment.Stomach cancerStomach cancer usually develops in the stomach lining. Early symptoms are often vague, but persistent stomach pain, feeling full quickly, difficulty swallowing, bleeding or unintentional weight loss need investigation.Stomach symptomsStomach symptoms include pain, burning, nausea, regurgitation or feeling full quickly in the upper abdomen. The cause is often not dangerous, but persistent or new symptoms with bleeding, difficulty swallowing, weight loss or signs of serious illness need prompt assessment.Stomach ulcerA stomach ulcer is a sore in the lining of the stomach or duodenum. Helicobacter pylori and anti-inflammatory painkillers are the main causes. Vomiting blood, black stools or sudden severe abdominal pain are warning signs.Stopping medicines as you get olderAs you get older, the benefits and risks of medicines can change. A planned medication review may lead to reducing or stopping medicines, but some must be reduced slowly and others remain essential.Stopping medicines for urinary problemsMedicines for urinary problems can sometimes be stopped if they do not help enough, cause side effects or are no longer needed. First, it must be clear which medicine is involved, why it was started and whether urinary retention could occur.Stopping smokingStopping smoking at any age quickly and lastingly reduces the risk of heart, lung and vascular disease and cancer. Combining support with proven stop-smoking medicines gives the best chance of staying smoke-free.Stopping vapingVapes can deliver large amounts of nicotine and cause dependence. Stopping works better with a plan for nicotine withdrawal, triggers and relapse. Young people, pregnant people and those with lung symptoms deserve extra support.Strawberry birthmarkAn infantile haemangioma is a group of small blood vessels that forms a red, sometimes bluish patch or swelling. It often appears in the first few weeks after birth.StressStress is a normal physical response to demands. Prolonged tension without recovery can disrupt sleep, mood, the body and functioning. Management addresses both the sources and recovery.Stress-related exhaustionStress-related exhaustion occurs when ongoing stress and insufficient recovery lead to emotional and physical symptoms and reduced functioning. Recovery requires rest and a gradual return to activities, addressing the causes and assessing depression, anxiety and safety.Stretch marksStretch marks are linear, scar-like changes when skin stretches quickly or becomes more fragile because of corticosteroids. They are usually harmless and fade, but often do not disappear completely.StrokeA stroke happens when the blood supply to part of the brain is blocked or a blood vessel bursts. Every minute counts: recognise the signs and call 912 immediately.Strong painkillersStrong painkillers, usually opioids, can reduce severe acute pain, cancer pain or pain in palliative care, but cause sleepiness, constipation, dependence and breathing risks. Their use requires a clear goal and regular review.Stubbed toeA stubbed toe is often bruised but may also be broken or dislocated. Cooling, elevation and a roomy shoe help with mild injury; a crooked toe, open wound, numbness, poor circulation or injury to the big toe needs prompt assessment.Stung by an insectA sting from a bee, wasp or ant usually causes local pain, redness and swelling. This is often unpleasant but harmless. Danger arises with breathing difficulty, tongue or throat swelling, fainting, repeated vomiting after an allergic reaction or many stings at once. Call Ambulance 912 immediately in these situations.Sudden hearing lossSudden hearing loss in one or both ears can result from earwax or middle ear problems, but also acute damage to the inner ear or hearing nerve. Unexplained sudden sensorineural hearing loss needs medical and ENT assessment the same day; early steroids may be appropriate.Suicidal thoughtsSuicidal thoughts can arise when pain, despair or problems seem unbearable. You do not have to carry this alone: tell someone you trust today and seek professional help. For immediate danger, call Ambulance 912; for urgent family-doctor care outside office hours, call HAP 9252.Sun allergySun allergy is an umbrella term for skin reactions to light. Most often it is polymorphic light eruption, with itchy bumps or patches hours to days after sun exposure. A first severe reaction, blisters, mucosal sores, fever or symptoms after a new medicine need assessment so lupus, medicine reactions and other causes are not missed.Sun and sunburnSunburn is acute skin damage from excessive ultraviolet radiation; accumulated damage increases the risk of premature skin ageing and skin cancer. Cool the skin, drink enough and avoid further sun. Confusion, a seizure or collapse in the heat may be heatstroke and requires Ambulance 912.SurgerySurgery is treatment in which a surgeon repairs, removes or examines tissue through an incision or with a viewing instrument. Good preparation, safe medicine arrangements and early recognition of complications help recovery.Surgery to realign your leg for knee osteoarthritisIn realignment surgery for knee osteoarthritis, the bone is corrected so that more weight passes through the less worn part of the knee. The procedure can reduce pain and delay a knee replacement, but requires months of rehabilitation.Swallowed objectA small blunt object that reaches the stomach often passes by itself, but a button battery, multiple magnets, a magnet with metal, a sharp or large object and oesophageal blockage are time-critical. Do not wait for symptoms: arrange immediate medical assessment, do not induce vomiting and give nothing to eat or drink unless an expert explicitly advises it. For choking or severe breathing difficulty, call Ambulance 912.Swallowing problemsWith swallowing problems, food, drink or saliva does not pass safely or smoothly from the mouth to the stomach. The cause may lie in the mouth, throat, nervous system or oesophagus. Choking, weight loss and dehydration need timely assessment.SweatingSweating cools the body in hot conditions and during exercise. Excessive sweating, new sweating all over the body or night sweats may be due to primary hyperhidrosis, fever, hormones, low blood glucose, medicines or another condition. Confusion or collapse in the heat may be heatstroke and requires Ambulance 912 immediately.Swimmer’s itchSwimmer's itch is an itchy skin reaction after larvae of animal blood flukes briefly enter the skin in natural water and die there. The rash is not contagious and usually clears within days, but severe breathlessness, swelling of the mouth or throat, or collapse are not ordinary swimmer's itch and require Ambulance 912.Switching medicine brandsAn approved generic medicine has the same active ingredient, strength and dosage form as the branded medicine, but its name, colour, shape and inactive ingredients can differ.Swollen ankles or lower legsSwollen ankles or lower legs usually result from fluid building up in the tissues. Heat, prolonged standing, veins or medicines may play a part, but swelling can also indicate a blood clot or a heart, kidney or liver condition. Sudden swelling in one leg particularly needs prompt assessment.Swollen eyes or lipsSwollen eyelids or lips may result from irritation, infection, allergy or angioedema. Swelling is often harmless but can be dangerous if the tongue or throat is involved, or breathing, voice, swallowing or consciousness changes. These signs require immediate help.SyphilisSyphilis is a sexually transmitted bacterial infection that progresses in stages and can remain symptom-free for a long time. Blood tests and treatment with appropriate penicillin prevent organ damage and harm during pregnancy.Tailbone painTailbone pain occurs at the bottom of the spine and often worsens with sitting, standing up or leaning back. The area usually recovers with time and reduced pressure, but assessment is needed after a hard fall or with warning signs.TapewormsTapeworms are parasites that can live in the bowel. Some people mainly notice worm segments in their stools; others have abdominal symptoms, nausea or weight loss. Infection may relate to undercooked food, travel or, in some cases, exposure to contamination in the environment. With Taenia, cysticercosis also needs consideration in the right context. Have a doctor manage diagnosis and treatment; do not choose a deworming dose yourself.Tendon painTendon pain often develops when loading increases faster than the tendon can adapt. A tendon usually recovers with targeted, gradual loading; complete rest and passive treatments alone are often not enough.Tennis elbowTennis elbow causes pain on the outside of the elbow through overloading the tendons that extend the wrist and fingers. Symptoms often improve gradually with adjusted activity and exercises; sudden weakness, a red hot joint or an injury with deformity needs a different assessment.Tension-type headacheTension-type headache usually causes pressing or tightening pain on both sides of the head, without serious illness. A new or unusual pattern and neurological warning signs do need assessment.Testicular cancerTesticular cancer usually develops from germ cells in one testicle. A painless lump, enlargement, hardening or new heavy feeling needs prompt investigation; sudden severe pain instead raises concern for twisting of the testicle and needs immediate emergency assessment.Testing for bowel cancerScreening can find bowel cancer or precancerous changes before symptoms develop. A stool test, colonoscopy or another test has benefits and drawbacks; you need to ask locally which programme is available in Curaçao.Testing for prostate cancerA PSA test can detect prostate cancer early but can also cause false alarms and overdiagnosis. Testing without symptoms is therefore a personal choice after explanation of the chance of benefit, further tests and potential harm; symptoms such as inability to urinate, bone pain or bleeding require diagnostic assessment and are not ordinary screening.Tests for your baby during pregnancyTests during pregnancy can provide information about your baby's growth, development and some conditions. Screening estimates a chance. Only targeted diagnostic testing can confirm certain conditions.TetanusTetanus is a rare but life-threatening nervous system disease caused by toxin from Clostridium tetani spores in a wound. It does not spread between people and is prevented through vaccination and good wound care; jaw stiffness, swallowing problems or painful spasms after a wound require immediate hospital care.The contraceptive pillThe contraceptive pill can prevent pregnancy when you use the right type correctly. The combined pill and progestogen-only pill differ in hormones, risks, how late a dose can be taken and advice about missed pills, illness or other medicines.The menopause transitionThe menopause transition is the stage of life when ovarian function changes and periods eventually stop. Hot flushes, sleep and mood symptoms are treatable; bleeding after menopause must always be investigated.Thickened heart muscleA thickened heart muscle can result from hypertrophic cardiomyopathy, long-standing high blood pressure, a narrowed heart valve or other diseases. The cause determines risk and treatment; fainting during exercise, severe chest pain or sudden breathlessness needs immediate assessment.ThreadwormsThreadworms are small white worms that mainly cause itching around the anus or vulva at night and often spread within families and schools. They are usually harmless and treatable, but severe abdominal pain, fever, bleeding, weight loss or another type of worm needs a different medical assessment.ThrombosisThrombosis is the formation of a blood clot in a blood vessel. A clot in a vein can cause, for example, deep vein thrombosis in the leg or a pulmonary embolism; a clot in an artery can cause a heart attack, stroke or acute blockage in an arm or leg. Symptoms and urgency depend on the location.Thymoma and thymic carcinomaThymoma and thymic carcinoma are rare tumours arising from cells of the thymus, an organ behind the breastbone. A thymoma often grows less aggressively, while thymic carcinoma more often invades surrounding tissues or spreads. Assessment and treatment belong with a specialist team.Thyroid problemsThe thyroid gland makes hormones that affect energy use, heart rate, temperature, bowels, muscles and mood. Underactivity, overactivity, inflammation, enlargement or a lump can cause a range of symptoms. Diagnosis requires blood tests and sometimes imaging; symptoms alone are not specific enough.Tick biteRemove a tick as soon as possible with fine-pointed tweezers close to the skin. Not every tick bite causes illness, and risk depends greatly on the country, tick species and travel; record the place and date and have fever, an expanding ring, a black scab or neurological symptoms assessed.Tietze syndromeTietze syndrome is a rare, benign inflammation causing pain and visible or palpable swelling at one or a few rib cartilage joints. New chest pain must first be assessed for serious causes.Tight foreskinA foreskin that cannot be pulled back is usually normal in young boys. Treatment is needed only for symptoms, scarring or recurrent inflammation; never force it. A retracted foreskin that becomes trapped behind the glans and causes swelling is an immediate emergency.TinnitusTinnitus means hearing sound without a source outside the body, such as ringing, humming or hissing. It is often harmless but can have a major impact. One-sided, pulsating or sudden tinnitus with hearing loss, dizziness or neurological symptoms needs prompt assessment.Torn meniscusA torn meniscus is damage to a tough cartilage pad in the knee. The knee may hurt, swell, click or lock. Many tears improve without surgery, but a truly locked knee needs prompt assessment.TranquillisersTranquillisers can provide temporary calm, but also cause drowsiness, falls, dependence and withdrawal symptoms. Never abruptly stop medicines you use regularly. Alcohol, driving, pregnancy and combinations with other depressant medicines need extra caution.Traumatic experiencesAfter a traumatic experience, you may feel easily startled, tense, low, numb or overwhelmed. Many early reactions are normal responses to an abnormal event, but sometimes symptoms persist or increase. Prompt help is needed if you are no longer safe, think about suicide, hardly sleep, become severely confused or can no longer function.Treatments of the cervixIf screening shows abnormal cells on the cervix, further tests and treatment when needed can prevent them becoming cancer. An abnormal result does not automatically mean you have cancer.TrichomoniasisTrichomoniasis is a sexually transmitted infection caused by the parasite Trichomonas vaginalis. Many people notice nothing. Symptoms may include discharge, odour, itching, pain when urinating or irritation. Treating both you and your sexual partners often prevents reinfection.Trigger fingerWith trigger finger, a flexor tendon does not glide smoothly through its sheath. The finger or thumb clicks, catches or stays bent and is often stiff in the morning. Reducing strain, a splint, an injection or a small operation may help.Troublesome scarsA scar can cause itching, pain, tightness, pulling or a troublesome thickening. Some scars become thicker than expected, such as hypertrophic scars or keloids. Others limit movement as skin contracts, known as a contracture. Redness, warmth, pus, a wound reopening or a new suspicious area in an old scar needs assessment because infection or another skin condition is also possible.Trying to get pregnantBefore conception, you can start folic acid, have medicines and vaccinations checked and optimise chronic conditions. Regular sex without contraception around the fertile period gives a chance of pregnancy. Earlier investigations are needed with older age, irregular cycles or known fertility risks.Type 1 diabetesIn type 1 diabetes, the body makes almost no insulin because of an autoimmune reaction. Daily insulin and glucose monitoring are essential for life. Severe low blood sugar or diabetic ketoacidosis can quickly become life-threatening and requires immediate help.Type 2 diabetesIn type 2 diabetes, the body responds less well to insulin and the pancreas may gradually become unable to make enough insulin. Lifestyle, medicines and checks of the heart, kidneys, eyes and feet are combined in a personal plan. The condition is not simply someone's own fault.Ulcerative colitisUlcerative colitis is chronic inflammation of the innermost lining of the large bowel. It causes periods of symptoms such as bloody diarrhoea, urgency, abdominal pain and tiredness, alternating with quieter periods. Treatment reduces inflammation, prevents complications and requires regular check-ups.Ultrasound scanAn ultrasound scan creates images using sound waves. It can assess organs, blood flow, pregnancy and superficial tissues without X-rays. The preparation needed and what a result means depend on the type of scan and the medical question.Umbilical hernia in childrenAn umbilical hernia is a soft lump caused by the opening around the belly button not yet closing after birth. In children, it is usually painless and harmless, and often closes on its own.Underactive thyroidWith an underactive thyroid, the body produces too little thyroid hormone. Symptoms often develop gradually and are non-specific; blood tests confirm the diagnosis. Levothyroxine helps when treatment is needed, but the dose and monitoring must be tailored to the individual.Uneven or flat head shape in babiesAn uneven or flat head in a baby often develops because the same soft part of the skull is under pressure for a long time. This is called positional plagiocephaly or brachycephaly. The shape usually improves with growth, varied positioning and treatment of a stiff neck, but premature closure of a skull suture must be ruled out.Unexplained physical symptomsUnexplained physical symptoms are real symptoms for which appropriate investigations have not yet found a complete physical explanation. This does not mean they are imagined. A regular doctor, a broad explanation and gradual recovery may help, while new warning signs are investigated again.Unintended pregnancyAn unintended pregnancy can bring many emotions and practical questions. Confirm the pregnancy, watch for warning signs and discuss calmly and confidentially which options, medical care and support are available locally.Unintentional weight lossLosing a lot of weight unintentionally can result from eating less, gastrointestinal problems, an overactive thyroid, diabetes, infection, mental health problems, medicines or cancer. The rate of loss, muscle loss and accompanying symptoms determine urgency; have clear unintentional weight loss medically assessed.Urinary incontinence in womenInvoluntary urine leakage in women is common and usually treatable. Leakage with coughing or sport is called stress incontinence; sudden strong urgency suggests urge incontinence. Blood, fever, pain or inability to urinate needs assessment.Urinary problems in menMen may have difficulty starting, a weak stream, dribbling afterwards, a frequent urge to pass urine or passing urine at night. An enlarged prostate is a common cause, but infection, medicines, bladder problems and prostate cancer should be considered depending on the pattern.Urinary problems in womenWomen may have frequent urgency, urine leakage, burning or difficulty emptying the bladder. Infection is one possibility, but the pelvic floor, prolapse, medicines, nerves and other bladder problems can also play a part.Uterine fibroidsA fibroid is a benign lump of muscle and connective tissue in or on the uterus. Many fibroids cause no symptoms; others cause heavy bleeding, pain, pressure or fertility problems. Location, size, anaemia and plans for children determine whether waiting, medicines, embolisation or surgery is appropriate.UV injury to the cornea (photokeratitis)An injury to the cornea caused by intense light is called photokeratitis. It usually results from ultraviolet light, for example welding without proper protection, strong sunlight reflected from water or snow, or sometimes a sunbed or UV lamp. Pain often starts hours later and commonly affects both eyes at once. Rest, avoiding contact lenses and medical assessment for severe symptoms are important.UveitisUveitis is inflammation inside the eye that can cause pain, redness, light sensitivity, floaters and reduced vision. Some forms cause few symptoms but still threaten sight. A newly painful red eye or a sudden increase in floaters with blurred vision needs same-day eye examination; never use corticosteroid eye drops on your own initiative.Vaccination injections and drops for childrenVaccinations teach a child's immune system to recognise serious infectious diseases. In Curaçao, follow the current local vaccination schedule and discuss missed injections, side effects and individual medical circumstances with child health services or your GP (family doctor).Vacuum-assisted birthIn a vacuum-assisted birth, a qualified healthcare professional places a suction cup on the baby's head to help during contractions and pushing. This is suggested only when the team considers it a suitable way to make birth safer.Vaginal bleedingVaginal bleeding outside a normal period, after sex, during pregnancy or after the menopause needs assessment. Many causes are not serious, but some need prompt treatment.Vaginal dischargeVaginal discharge is often a normal mixture of mucus, fluid and bacteria that changes during the menstrual cycle, pregnancy and sexual arousal. A new strong smell, changed colour or texture, itching, pain, bleeding or lower abdominal pain may suggest infection or another condition and needs targeted assessment rather than self-treatment based on appearance alone.Vaginal thrushA vaginal yeast infection is usually caused by Candida and often causes itching, redness and white discharge. The symptoms resemble other vaginal conditions. Have an assessment for a first episode, pregnancy, recurrent symptoms or insufficient recovery.Varicose veinsVaricose veins are enlarged, twisting surface veins, usually in the legs. They are often harmless, but pain, skin changes, wounds or sudden leg swelling need assessment.Vascular access for dialysisVascular access is the site where blood leaves and returns to the body during haemodialysis. It may be a fistula, graft or catheter. Daily checks and good care help prevent infection, clots and dangerous bleeding.VasectomyVasectomy is highly reliable contraception intended to be permanent, in which both sperm ducts are interrupted. It does not work immediately: other contraception is needed until semen testing confirms that the procedure has succeeded.Vein inflammation with a blood clotIn superficial thrombophlebitis, a vein just beneath the skin is inflamed and contains a blood clot. It often affects the leg and needs assessment for spread into deeper veins.Venous eczema of the lower legsEczema on swollen lower legs may develop because blood returns poorly through the veins. Skin itches, flakes and often changes colour around the ankles. Treatment addresses both skin and fluid build-up. A suddenly swollen, painful leg, rapidly spreading warm redness or a wound needs prompt assessment.VertigoVertigo makes you feel as though you or your surroundings are spinning or moving. The cause is often in the inner ear's balance system, but sudden persistent vertigo with loss of neurological function may be a stroke. The pattern of episodes, hearing symptoms and warning signs determines what assessment is needed.Very preterm birthA baby is preterm if born before 37 completed weeks; very preterm often means before 32 weeks, and extremely preterm means before 28 weeks. Regular contractions, pressure, bleeding or leaking amniotic fluid before 37 weeks requires immediate contact with the maternity team, because prompt treatment and transfer if needed can improve the baby's chances.Vestibular neuritisVestibular neuritis causes sudden, severe, persistent spinning dizziness due to loss of function in one vestibular nerve. Hearing loss does not fit well, and a stroke must be ruled out quickly when warning signs are present.Visiting your family doctorGood preparation helps you make the most of time with the doctor. Think beforehand about what you want to discuss, bring medicines information and ask for explanations until you understand the plan.Visual impairment and blindnessLow vision means sight remains limited even with ordinary glasses or treatment; blindness has different degrees. Causes and options vary greatly. Sudden loss of sight, a dark curtain, a painful red eye or loss of neurological function needs immediate assessment.Vitamin B12Vitamin B12 is needed for blood cell production, the nervous system and DNA. Deficiency can result from too little reliable B12 in the diet or, more often, an absorption problem. Symptoms are not specific, and nerve damage can occur without anaemia; have the cause and treatment established carefully instead of using high doses or injections long-term on your own initiative.Vitamin DVitamin D supports calcium absorption and is important for bones and muscles. The body makes vitamin D in the skin under the influence of sunlight; food provides a smaller share. Some groups need a preventive supplement, but high doses without an indication can cause dangerously high calcium levels.VitiligoVitiligo is a non-contagious condition in which pigment cells disappear and sharply defined pale or white skin patches develop. Its course is unpredictable, and both physical and psychosocial effects vary greatly. Protection from sunburn and individually tailored treatment can slow spread or allow some pigment to return.Voluntarily stopping eating and drinking to hasten deathVoluntarily stopping eating and drinking is a major end-of-life decision that leads to death. It requires early assessment of decision-making capacity, treatable causes, alternatives, care wishes and intensive palliative support.VomitingVomiting means forcefully emptying the stomach through the mouth. It is often caused by a gastrointestinal infection and stops on its own, but dehydration, blood or green vomit, severe pain and drowsiness are warning signs.Vulval cancerVulval cancer is a malignant tumour of the external genitals, usually a squamous cell carcinoma. A persistent itchy, painful, thickened, discoloured or ulcerated area, a lump or unexplained bleeding must be investigated, even if embarrassment or a known skin condition makes the symptom seem explainable. Diagnosis usually requires a targeted biopsy; treatment is provided by a gynaecological oncology team.WartsCommon warts are benign, rough skin bumps caused by skin types of human papillomavirus, mainly on hands and feet. They often disappear on their own; treat them only if troublesome, and have a bleeding, rapidly changing, dark, painful or uncertain area assessed before using a wart treatment.Warts in childrenWarts are common in children and usually disappear on their own as the immune system clears skin HPV. Treat only for pain or clear difficulties, avoid unnecessarily painful or aggressive methods, and have uncertain, bleeding, rapidly growing or anogenital areas assessed carefully.Watery eyesWatery eyes occur when the eye produces extra tears or tears do not drain properly through the tear passages to the nose. Irritation or a dry eye surface is often the cause; sometimes the tear drainage system is blocked. Pain, light sensitivity or reduced vision needs prompt assessment.Weight-loss surgeryWeight-loss surgery treats severe obesity and related diseases. The procedure can greatly improve health, but requires lasting changes to eating, regular check-ups and lifelong attention to vitamins, protein and warning signs.WhipwormsWhipworms are intestinal parasites acquired by swallowing mature eggs from soil or food contaminated with faeces. A mild infection often causes no symptoms; a heavy infection can cause prolonged or bloody diarrhoea, anaemia, poor growth and rectal prolapse, and requires targeted stool testing and treatment.Whooping coughWhooping cough is an infectious respiratory illness that often starts like an ordinary cold and can later cause severe coughing fits. Young babies in particular are at risk of serious symptoms, including pauses in breathing, turning blue and exhaustion. It spreads through coughing and sneezing, often before it is clear that the illness is whooping cough. Vaccination, including during pregnancy, helps protect babies but does not completely prevent illness.Womb cancerWomb cancer usually begins in the lining inside the womb, called the endometrium. Unusual vaginal bleeding, especially after menopause, is the main warning sign that needs investigation.Work-life balanceWhen work stress continues at home, recovery can suffer and sleep, mood, relationships and physical health may deteriorate. Identify causes and boundaries clearly, discuss feasible adjustments with your manager or an occupational health professional, and seek medical help for persistent or severe symptoms.WoundsA wound is a break in the skin or deeper tissue caused by cutting, scraping, puncturing, tearing, biting or pressure. First stop bleeding with firm direct pressure, rinse away dirt with clean running water and have deep, gaping, contaminated, numb or poorly perfused wounds assessed in good time.X-raysA plain X-ray quickly and painlessly produces an image using a small amount of ionising radiation. It is particularly useful for bones and lungs. Tell staff beforehand if you might be pregnant, but do not delay medically necessary imaging because of fear.Yellow bump on the white of your eyeA small raised yellowish-white spot on the white of the eye is often a pinguecula: a benign change in the conjunctiva, the thin covering over the white of the eye, associated with factors such as sun, wind and dryness. The spot usually does not grow over the cornea and often needs no treatment. Pain, light sensitivity, poorer vision, an injury or a suddenly very red eye does not fit an uninflamed pinguecula and needs prompt assessment.Yellow skin or eyes in a babyMany newborn babies become slightly yellow in the first few days as bilirubin builds up. This usually resolves, but colour alone cannot show whether the level is safe. Yellowing on the first day of life, drowsiness, poor feeding, dark urine or very pale stools needs prompt assessment.Your baby's shoulder became stuck during birth (shoulder dystocia)In shoulder dystocia, the baby's head has been born but a shoulder remains stuck behind the pubic bone. This is an emergency during birth; afterwards, mother and baby are checked for injuries and complications.Zika feverZika fever is a usually mild viral infection transmitted by Aedes mosquitoes and also through sex. The greatest risks are serious harm to an unborn baby and rare nerve complications. Pregnancy after possible exposure, increasing muscle weakness or signs of severe dengue require prompt assessment.