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