Life at Kalene

I have been very busy lately (hence no updates). The main reason being that I have been attached to the maternity ward. It has been really good. I've been able to do some normal deliveries and observe some abnormal ones. I have diagnosed twins, using the ultrasound was very fun. I have listened to the chests of countless coughing babies and resuscitated a prem.

I also observed a destructive extraction. A woman arrived from the Congo border having had seizures at home. By the time I saw her she was unconscious and unfortunately her baby was dead. She continued to have seizures despite a huge dose of diazepam. To complicate things further she had bad CPD (baby too big, pelvis too small). The midwife tried to do a vacuum extraction then called the Dr to do a craniotomy and forceps extraction. It was awful. I will never get used to the sight of a dead baby.

However, after another huge seizure, lots of phenobarb and a four day coma; the woman woke up, declared that she was hungry and demanded meat. The fact that she walked out of hospital under her own steam was an answer to many prayers.

I continued on maternity for the start of this week. Then Clement the paeds nurse went away for the day and asked me to run his ward for him. (he was supposed to be back that afternoon) two and a half days later i was still running his ward.

Meanwhile the head Dr got very sick with uro-sepsis and then nitrofurantoin lung (well we think it might have been that) and then c. dificile...

The end result being an emergency evacuation to Jo'burg. And as the medical lear jet couldn't land at Kalene Justin (the other Dr) had to go with him to care for him on the way. They went in a Cessna to Lusaka then the jet to Jo'burg. Luckily he had stablised in the 24 hours that it took to organise the evacuation and coped with the cessna trip well.

So... are you spotting a problem?

No Doctors left at Kalene.

Well not quite. They had managed to fly a Dr from another mission in on the morning that John and Justin left. He's a plastic surgeon from Hamilton.

But... guess who got to show him around, and organise him to do the theatre list, and assist with the first case, and find the ill patients that needed seeing... all the while still running children's ward!
Lucky me.

Today was even more insane. Starting with a 6.45am phonecall 'we can't get hold of the midwife and there's a woman that's fully dilated and refusing to push'!

I found the midwife.

Then got a phonecall to say "there's an infectious disease specialist coming can you organise patients for him to see tomorrow morning"
Sure.

Went to hospital.

Woman in labour, no one around, midwife not there yet. FHR 80 (without a contraction)!!!!Head nearly on perineum.Luckily the midwife turned up and a vacuum delivery + large episiotomy later I got handed a gasping meconium smeared baby. (who seems to be doing fine now)

And this is all before 8am.

You get the picture. The rest of the day continued on a similar vein and included an earful from on of the Zambian nurses (he didn't like the contents of the message I was passing on), a 3.5 hr paeds ward round and a dying patient among other things.

Oh and I also had meconium on my foot for 2 hours before I noticed (and it was another two hours before I had the chance to wash it off :)

This elective sure is exciting.

Long Overdue Update

Well lots of things have happened since I last posted. Some have been good, some bad but all thought provoking. I have witnessed witchhunts and patched up the elderly women afterwards, done CPR on a dying person rather than a mannequin, seen the death dance and heard the mournful wailing, watched someone die of a black mamba bite, rehydrated a baby who then died anyway, heard about a 2 year old that died of alcohol poisening and helped stitch up a woman who was attacked by a rabid fox. I think that's enough for the bad...

I have handed out presents of soap and toothpaste to immensely grateful patients (they also got fruit and a cup of tea), played chase with a formerly malnourished toddler, taught a young boy how to write hello/mwani and boy/girl (he is in hospital to start ARV therapy as he is HIV+), seen a severly malnourished baby who was started on Tb treatment and has improved, helped in c-sections, drained many abscesses, seen a sucessful breech extraction and a symphysiotomy (sp?), and given Oxygen (among other treatments) to a septic baby with sats = 82% and HR = 220 - he was happy and breastfeeding well when I last saw him.

I have also drunk a lot of tea (our favourite pastime), tidied the paeds ward office, had a go at cutting grass with a 'slasher' (kind of a manpowered weed eater), made an edible pizza without cheese, wandered around the village during New Year's Day celebrations and toasted marshmallows over a NYE bonfire.

I am now in Livingstone on holiday with my mum. She is due to go back to NZ next week. She has a blog at 5weeksinzambia.blogspot.com

That's all for now. There are lots of photos on Winsome Brown's Facebook page, which is public, if you are interested.

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.

Travels

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.

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:

Monday:
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.

Tuesday:
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.

Wednesday:
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.

Thursday:

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.

Friday:

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!

Saturday:

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.

Kalene

Well I'm finally at my destination. Three jumbo-jet rides, a taxi, a night in a mission run guest house, a five hour cessna flight and a ride in a four wheel drive later ... It could have been a lot harder to get here considering I am in the far north-western corner of Zambia.

The mission is a small collection of houses and a largish rambling hospital. There are about 20 ex-pats living here and many Zambians.

The hospital is really good considering the location and the difficulties involved in funding and supplies. It has three wards. Men, women and children. Though interestingly the children's ward is only for kids up until the age of six so there are some very small children in the 'adult' wards. There is an out-patients department, pharmacy and operating theatre. The senior Doctor, John Woodfield from Dunedin, has been here for five years and there is a med reg from Hamilton, who is here for six months. The head matron, Sister Alice from Canada, has been here for twelve years. Rachel runs the maternity ward and she is also a permanent staff member. I share a house with Nikki who is a nurse and she is here for six months.

The rest of the staff are Zambian. There are several registered nurses and many trained nurses (i.e. learned mostly on the job). There are also clinical officers that have practical training and often years of experience but have not been formally trained at a Medical school.

Anyway that's a bit of background. Right now it's Sunday so I've been to church (amazing african harmonies, long rambly sermon that was translated into English but I still couldn't say what the main points were). After this I'm going to pick mangos and maybe eat some/many.

Mmmm mangos ....

Hope everyone is doing well. For those on electives I would love to hear how it's going.