Cleft lips, cucumber sandwiches and the Commonwealth Games…

From reading the newspaper on the internet it seemed as if Britain was in the grip of Jubilee fever last weekend!  I do love a good old British knees-up so we couldn’t possibly let the Diamond Jubilee pass without marking it in our own Kalene way!  Celebrations kicked off with ‘The Commonwealth Games’ with representatives from Britain, Zambia, Australia, New Zealand and Canada.  In contrast to the Jubilee celebrations back home we were able to arrange an outdoor event with guaranteed blue skies and sunshine!  Events included welly throwing, national anthem renditions, tug-o-war, egg-and-spoon, three-legged, wheelbarrow and sack races.  Britain emerged victorious despite me letting the side down and throwing the welly into a mango tree twice!

Afterwards we had a royal tea-party with cucumber sandwiches, Coronation chicken, trifle, scones and Union Jack cake!  People had sent us some brilliantly British decorations including bunting, Union Jack plates and serviettes, crown table confetti and corgi cupcake decorations!  You wouldn’t believe how much old china we found around the place when we started poking around in the back of cupboards! Our friend Jill unearthed an original framed black and white photo of the Queen’s wedding from nearby Sakeji School.  Next door’s dog, Rafiki, stood in as an honourary Corgi.

You might remember me telling you about Mukanda, the little boy who was very ill after a bowel operation for a condition called Hirschsprungs Disease.  His abdominal wound kept breaking down leaving his bowels exposed and he had a really bad infection.  He has improved in leaps and bounds over the last couple of weeks and was discharged earlier this week after his abdomen finally healed!  He’ll be returning in a month or two to have his stoma reversed.  It’s so good to see him looking so well: there were many times we thought he wasn’t going to survive.

*Squeamish Alert*  I love being in theatre and operating but the thing that I really can’t stand is PUS!  A large part of our surgical workload here at Kalene involves draining pus from various bodily locations.  I never cease to be amazed at some of the strange places that people develop abscesses here.  Real surgeons LOVE squeezing pus out of abscesses but my deep hatred of pus makes me think I’m not cut out for tropical surgery!  Phil caught me unawares and took this highly unflattering photo of me draining a pelvic abscess – eeeugh!

It’s always very sad when a baby dies in the womb (stillbirth) and the biggest challenge is offering support to the mother who, understandably, will be devastated.  Earlier this week we had a patient called Loveness who came to Maternity to report that she couldn’t feel her baby moving.  Unfortunately when we scanned her there was no heartbeat and the baby had died.  This was Loveness’s seventh pregnancy; she had already had three stillborn babies as well as three live babies.  She was obviously very upset  but the first thing she said was “What are my family going to do to me?”  After a bit more probing it turned out that her family hold her personally responsible for the previous three stillbirths and keep telling her that it’s all her own fault because she’s ‘not good at pushing.’  I had to hold a conference with four of the men from her family to explain that it’s likely that she has a medical condition causing these stillbirths and they shouldn’t blame her.  The whole episode made me feel very angry – you really shouldn’t have to defend a women from her relatives when her baby has just died.

We had a busy few days last week when we were visited by Goran Jovic, Zambia’s only plastic surgeon!  He flew in last Thursday and managed fifteen operations in just 48 hours so the theatre team were on a tight schedule!  He specialises in cleft lip and palate operations.  Phil’s gassing skills were tested to the maximum as cleft palate surgery requires a ‘shared airway.’   This means that the tube being used by Phil to ventilate the patient is in very close proximity to the surgery taking place.  We had two children who travelled from the Congo to have their cleft lips repaired.  Many such children ‘disappear’ soon after birth in the Congo such is the stigma attached to cleft lips and palates: the grandmother takes the baby away, never to be seen again.  More and more patients have been arriving from the Congo over the last few years as word spread has that the condition can be treated.

Sandwiched in between all these cleft palate operations was a challenging obstetric case.  A lady arrived from Angola with a referral letter in Portuguese.  My Portuguese isn’t up to much but the gist was that she’d been bleeding for a week and had a low lying placenta.  The lady was around 32 weeks pregnant but unfortunately by the time she had reached us the baby was dead.  Her haemoglobin level was 4.1 (should be >11.0) and she was still bleeding.  When I scanned her the placenta was completely covering the cervix making a normal delivery impossible: to add further complication she’d previously had two Caesarean sections.  We took her to theatre for a Caesarean and on opening the uterus it became apparent that the situation was even worse than expected because she had a placenta accreta which means that the placenta had invaded the muscle of the womb, making removing it particularly difficult.  She ended up with a Caesarean hysterectomy and a six unit blood transfusion.  She already had three children so she was fairly philosophical about her hysterectomy and was mostly just glad to be alive!

Do you remember me telling you in the last blog about the six thyroid patients that Dr John had saved up by the time we got back from our holiday?  We’ve done five and there’s one more to do next week!  Thyroid operations take hours and the big neck lump is right next to the patient’s airway making anaesthetising these patients quite tricky for Phil.  Here’s a before and after photo of Grace who won the ‘biggest thyroid lump’ competition!

Time is flying and we’ve reached our last few weeks at Kalene.  There’s not many spare moments for reflection here at Kalene but we both feel that we have a lot of think about and process in relation to our time here.  Sometimes you end up with more questions than answers!  We’ll certainly feel sad to leave this little community of friends and colleagues and it feels like there is still so much work to be done!  Nearly time to start packing!

Lots of love, Tess & Phil xx

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10 Responses to Cleft lips, cucumber sandwiches and the Commonwealth Games…

  1. Ruth says:

    As always, an inspiring and thought provoking blog… I bet Kalene will be devastated to see you go but we will be delighted to have you home!xx

  2. Anna Caley says:

    we were thinking about you guys yesterday at a new restaurant in brum, won’t be long before you get to do us a 7 course meal!! what are ur plans when u come back, how do you feel about being back working for the NHS? Will be praying for u both xxx

    • Tess bonnett says:

      Thanks Anna! Can’t wait to catch up – we’ll start working on the menu!! The bicycle-powered disco sounds amazing! Back to work the first week of August and very mixed feelings about re-entering the NHS! On one hand it will be great to have enough medications, xray films, blood bottles etc. but I might struggle dealing with patients who don’t realise how lucky they are to be treated by our world-class NHS!! We’ll be in touch soon! Love Tess x

  3. June Beddall says:

    The time has gone so quickly, hope you bring some summer sun with you. New Brighton was wet and bleak early this morning with wind and driving rain. The afternoon was sunbathing in the garden weather. No wonder we talk about the weather so much when it changes so frequently. Sarah has been home for Father’s Day/Mum’s Birthday weekend so it’s all been very busy with Turkish Dinner and Belly Dancing on Friday, June Birthdays BBQ on Satrday with all the girls friends and Dad’s Day Lunch with a Toolbox Coffee Cake for H today. Start the diet tomorrow!!!!

    Pleased to hear you made the most of your Jubilee decs etc., after all the practise with wellies as a Guide I’m suprised you didn’t win outright immediately. Grace looks fantastic, well done to everyone. Your ups and downs leave me breathless. Praying for you all and so looking forward to seeing you both back in the UK.

    Ellie S left for pastures new today, all very excited for her and she will be back over the summer break

    Good night xx

    • Tess bonnett says:

      Thanks for filling us in on the New Brighton news June! Can’t wait to catch up in person soon! Love Tess xx

  4. Graham Matthews says:

    Phil & Tess, I’ve been really enjoying reading this blog. It has been fascinating to read the adventures you’ve been having, all the high and lows through the year. It such a different job and culture to me that it’s a real insight. Clearly if you don’t have access to coca-cola I know Kalene must be remote! I think your Jubilee celebrations and commonwealth games sounds more fun than the wet street parties here so don’t feel you missed out. Maybe you’ll be back in time for the Olympics. I hope it isn’t too sad leaving. Thanks for sharing your time out there in such a great blog.

  5. Maddy says:

    Dear Phil and Tess
    thank you so much for your blog. The insight you have given us on your experience has been fascinating and inspiring. You’re right the time has gone so fast! On your return you maybe the only people in Britain glad of our wet summer!

    • Tess bonnett says:

      Thanks for reading Maddy! Hope you’ve had a good year and looking forward to catching up with you! Love Tess x

  6. jean says:

    Hi Tess and Phil ,wat a fab blog this as been to read.what truly amazing people you are and have been in Kalene.you will be truly missed .was very pleased to hear that you will be back at ROTHERHAM very soon ,so looking forward to seeing you again,take care both of you xxx

    • Tess bonnett says:

      Thanks for following the blog Jean! Looking forward to working with you again in August! Rotherham will be a bit different to Kalene! Looking forward to chatting around the tea-trolley soon! Love Tess x

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