Wednesday, December 24, 2008

Merry Christmas

Me, Nikki the Nurse and Justin the Doctor up Kalene Hill at Sunset.

I am back at Kalene Hospital and back to business! I arrived at 4pm yesterday and by 11pm had seen my first breech extraction, helped resuscitate the baby and seen an emergency c-section on a tiny woman with a rather large baby. Baby was OP presentation and in distress. It was interesting estimating the extent of late decals with only a doppler and no CTG monitor. (that was lots of med speak for baby stuck and heart rate decreasing which is not good!) Both babies and mums were doing fine this morning.

Tomorrow is Christmas day so there will be presents and a special lunch for the patients. We will have our Christmas celebrations on the 26th.

God's blessings on you all. I hope you have a peaceful and safe Christmas.

Sunday, December 21, 2008


Greetings from Solwezi, a city in Northern Zambia. I have come here to organise my temporary permit at the immigration office.

I was going to be leaving the mission today but our trip got brought forward one day and we (my mother and I) left at 30mins notice. It was all very haphazard but I'm now in Solwezi and will hopefully get my temporary permit tomorrow. I missed the staff Christmas lunch yesterday and the carol singing in the hospital with the nursing students (tomorrow) but it couldn't be helped. I'll just have to come back next Christmas to take part in the festivities ;)

Solwezi is interesting. I guess it's a typical African city. Very dusty, lots of people and little infrastructure. The main road is tarsealed but apart from that there are just rutted lanes. It did have a supermarket but it burnt down! It has a market place and various shops selling much the same thing (maize meal and bike parts). I'm hoping to be able to buy some material (chatenge) tomorrow.

We are staying at a nice but basic guesthouse. A tiny room with ensuite and twin beds costs over $60 NZ per night. Very different from travelling in South East Asia. And we aren't staying in the recommended lodge which is $200+ per night. Last night we stayed in Mwinilunga with a really nice man called Charlie. His parents were missionaries so he has lived in Zambia for most of his life. We went out for dinner with him and his nephew Shane. Shane had come up from Zimbabwe to help set up a game park with his uncle, at the moment he is building a road by hand. Tough. We were halfway through our meal (two menu choices; chicken or steak and chips:) when Shane's girlfriend turned up. She is a peace corps worker and lives in a remote village with no vehicle and no cell phone reception. Shane had said to her that if she didn't hear from him by the 20th to come and find him in the restaurant in Mwinilunga so she managed to hitch a ride with the Malaria health workers who were driving past. It was an amazing example of life without instant communication or reliable transport and roads.

Merry Christmas everyone. I will have another post about the festive season in Zambia later in the week. (unless I get thrown in jail by the immigration people!)

Photos ... well sort of

Please excuse the angle. It has been such an effort to upload the picture that i'm not going to change it now! You'll just have to crane your necks.

The second picture is of Gift and his inhaler (story on prev post).
The first picture is a few of the boys that are on Men's ward. I am making a collar and cuff out of a ripped bedsheet. The boy had broken his arm by falling out of a mango tree. He'd done a really good job of it. Fractured straight through the surgical neck of humerus and dislocated the humeral head. He (along with another girl with an identical #) are on their way to the capital city to be seen by an orthopod. We don't have the facilities or expertise to fix that kind of injury at Kalene. The other two boys in the photo have chronic osteomyelitis.
I have now been in Zambia for three weeks. I'm starting to get used to it. My mother has come to visit for five weeks. She is taking over teaching some of the missionary kids and also helping with admin at the hospital.

Sunday, December 7, 2008

First Full Week

It feels like everything is so new and different here but then at the same time I also feel like I've been here forever. Here's a summary of my week:

Ward round on women's ward. Saw some post op patients. One that had had a huge dermoid tumour removed, complete with hair and teeth. She was opportunistically diagnosed when she brought her son in for malaria treatment. The other post-op patients were mostly BTL (bilateral tubal ligation for permanent contraception)) which is a popular operation here as the men think that a vasectomy will sap their power! I also saw a woman with massive ascites due to Tb.

On Monday evening my flatmate (Nikki) and I decided it was time we cooked a proper meal. This was hard as the man selling vegetables keeps coming when we are not home. We introduced ourselves to canned peas.

Did a post ward round paper round to make sure all the investigations were done and check up on a few patients. There was one young girl who was very sick. I had managed to convince her parents to keep her in hospital rather than take her home (or to a witch doctor) because we had just started Tb treatment and were hoping it would work. She was still very sick and almost unconscious. There were some old women telling the family that there was a curse on her and they were being punished. Not helpful. I tried to reassure them the best I could then sent the Dr in to explain further. He basically told them that medically we were doing all that could be done and it was in God's hands now. Luckily they accepted that.

Tuesday is operating theatre day so I went and watched a pretty crazy operation. There was a 20 year old man (L) with a bone tumour (sarcoma) on his chest. It was right underneath the collar bone and about 15cm in diametre. If it was left it would have continued growing and likely invaded into the chest eventually killing him. Dr John and a Prof Van Rij (visiting from Dunedin) decided to take the tumour out. 10 hours later the young man was minus tumour, 3 ribs, most of his collar bone, half his breast bone and part of his pectoralis muscles. He had the hole covered with another muscle (lat dorsi- divided and angled upwards with blood supply intact), and his 10th rib which had been wired onto his breast bone and clavicle (collar bone) to help his shoulder to move. He did, of course have the skin covering the hole too (sutured up by yours truly). I spent most of the operation holding his arm up and watching his heart beat. I was stressing when two very tired surgeons were wiring the rib in place as the ends of the wire were scarily close to piercing his heart.

Tuesday night was prayer meeting but I was really too tired to take much notice.

The fun was just beginning with the L. We have no ICU and he was mostly being looked after by untrained staff. Even the trained staff were causing havoc Nikki moved his chest drain and managed to make it drain 500mls at once. Which was ok because it is better out than in but poor L decompensated and we stressed out. Luckily the real Dr turned up and calmed everyone down.

The sick girl on womens' ward was sitting up and eating small amounts of porridge. Looks like God had everything under control. She is still very sick but slowly making progress so it seems we are on the right track with her treatment.

In the afternoon I went to Sakeji school for their end of term concert. The school is run by the CMML mission. It started out being just for mission children but now the students are mostly Zambian. It's a full boarding school for Grade 1-7 (6-13yrs). The children were very cute and the school is in a beautiful area. It's higher than Kalene so I enjoyed the cooler temperature.


More of the same. Nikki and I sorted through the 35 patients on men's ward and sent a few home. I met a fantastic 9 year old boy called Gift. His asthma was so bad that you could hear him wheezing from the end of the bed. He got some ventolin and oral prednisone (steroids). Asthma is not a common problem here but when they do get it, they get it very badly. There are no preventor inhalers here so we can really just treat the symptoms.

a woman came in with a polyarthritis including a huge knee effusion (fluid in the knee joint), so I took some of the fluid out and sent it to the lab for testing. Our lab isn't very good so hopefully they'll actually look at the sample.


Paediatric ward round. Lots of screaming children. The parents threaten to take the children to the Dr as a punishment when they are naughty so naturally they're all terrified. Problem is the mothers seem quite scared of the Dr too. Saw some very cute babies.

In the afternoon I managed to convince Justin (one of the Drs) and Nikki to go for a walk to the village with me since I hadn't been there yet. The village has a market (i bought some tomatoes), a restaurant and several shops (I bought an umbrella). It also has "The Blessed Hope Liquor Store". Hmm something got lost in translation there.

On friday night one of the teachers from Sakeji came to stay with us. She is an 18 year old from Canada called Tara-Jo. We have been having fun conversations as she can't understand half of what I say because of my accent and I can't understand half of what she says because when she's tired she speaks French!


A boy turned up from Angola. He had walked (or limped with a crutch) for two days to get to the hospital. His left leg was twice the size of his right one, hot and exquisitely tender. We took him to the operating theatre and drained a huge abscess. Blood covered pus squirting out of a boy's leg is not a pretty sight but it will make him feel so much better. The anaesthetic tech was away so I gave the ketamine injections (for sedation) and then stared at the monitor to make sure nothing went wrong. Anaesthetics may be mostly uneventful but it is stressful. He coped fine with it though and I didn't make a major maths blunder and give him an overdose.

The afternoon was hot so we (Justin, Nikki, Tara-jo and I) decided to go to the hydro lake for a swim. Unfortunately transport was an issue and we only had two bikes. Tara-jo and I elected to run but we were only halfway there and it clouded over. It was a good run though and caused great amusement for the local children.

Right, that is enough writing for another week. I hope the stories have not grossed you out too much (Mum) and are technical enough for you (Dad). It is hard to write without too much jargon. I will try to post some pictures soon.

Hope everyone in NZ is happy and enjoying their holidays/starting as a TI.