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.


Delia said...

It sounds like you're able to get in there and do quite a bit, as well as the elective type 'woah' observations... keep writing chicken, and I'll keep facebook stalking ;P

Winsome said...

only just seen this! (Tue evening) I can't work out how to make the blog thingy alert me. Anyway - really interesting - can't wait to get there but I'll skip the ward rounds thanks heh heh.
3 sleeps - and the list is finally diminishing :-)

Rosalie said...

Reading your blog really makes me miss Zambia / Kalene. Say hi for me to the people there I might know. I advise you to eat as many mangos as you can. Did you get the tropical med textbook before you left NZ?

Steve said...

Hi Fi - sounds exciting - better than my whining chronic disease management - cannot really remember the last exciting diagnosis I made... that sounds a bit sad doesnt it - but making a difference all the same. Great that Andre was there when could be useful - not much of a holiday though.
Great read - keep up the detail - thanks
Love dad

theKiwi said...

Hi Fiona

Great to hear your tales from a very disant part of the world.

Cousin Roger

Emilyjane said...

Hey chicken - that sounds like an awesome experience!! I love the detail. Do you have many problems with english / other languages? My crew partner and I spent over an hour today trying to explain to a russian couple that (1) we are not doctors (2) we dont carry pethidine, and (3) in NZ on a SATURDAY your only options are afterhours or public hospital - both which involve 3+ hrs waiting. Grrrrr.