Happy Easter from Kalene!

I’m missing the UK springtime with lambs and daffodils but the season is changing here and the rain is finally giving way to some sunshine!  I couldn’t resist some Easter baking to make me feel springy – who knew that hot cross buns take four hours to make from scratch!!  It usually takes me about five seconds to take them off the supermarket shelf!  We helped host an ‘Easter Party’ for the nursing students featuring various games including a variation on the hat-scarf-gloves-chocolate game where students had to don surgical wear and pick up Minstrels with a surgical instrument!  We had a lovely Easter Day and our friends, the Hannays and Poidevins, came over for a roast dinner!

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At the end of March a paediatric surgeon from Australia visited with his wife for two weeks.  Dr John had gathered quite a few children who needed different operations from hernias to hypospadias to Hirschsprung’s and including one little boy who was born without a bottom (anal atresia).  The children ranged in age from a few months to six years old so Phil was kept on his toes with some challenging anaesthetics.  Some of the children have been quite sick post-operatively but are slowly getting better now.  One little boy called Mukanda has been really unwell and has had to go back to theatre two times.  He now has a stoma and a really bad wound infection so please pray for him.

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Phil has found a new chess partner!  Robbie is 15 and comes round to play chess once a week.  One of the previous doctors gave him a chess set last year and he’s eager to learn some new tactics!

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The new theatre block is nearly finished!  Different teams have been working on the building for a few years now and it’s great to see it nearly ready to use!  There will be three new theatres with a proper recovery area and a high dependency unit as well as some theatre storage space and a lecture room.  Here you can see the ‘Express Route’ from Maternity to the new theatre block for emergency Caesareans – I just about resisted the temptation to write ‘Shinjika’ (Push!) in the concrete!!  We introduced you to Josiah a few months ago – he sees it as his job to ensure that the new block is kept clean and tidy and can often be spotted sweeping away!

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One of the teachers from nearby Sakaji School came to Kalene to have her baby earlier this week.  We set up one of the houses as the ‘Kalene Low-Risk Birth Unit’ and Phil and I had to pretend to be midwives because the real midwife, Rachel, was away in Lusaka.  They arrived in the pouring rain during a power cut so at least we were able to create an ambient atmosphere with low lighting and candles!!  Gwen had a beautiful little boy and here’s a photo of me having a cuddle!

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We’re so excited because our parents are coming to visit at the end of April.  They’ll be staying with us for a week at Kalene and then we’ll all be travelling back to Lusaka for a couple of weeks holiday together.  On the itinerary is a visit to South Lwanga National Park to see some of Zambia’s wild animals, a road-trip through Malawi back to the school where my dad taught with VSO and finally a visit to Victoria Falls where my good friend Anna will be meeting us before she comes to spend some time at Kalene.  We’re so looking forward to some time off as we’re feeling pretty tired.  There’s three doctors here and we’re two of them which means that the Bonnetts are on-call 48 hours out of every 72!  We work shifts back in the UK and we’ve never had to do 24-hour-plus on-calls before (older doctors who used to work really long hours would probably consider us complete lightweights!!) so adjusting to the ‘African Working Time Directive’ has taken a bit of getting used to!

We told you about some the wildlife in our house last blog.  I was sitting in our living room last week when the tiniest frog I have ever seen hopped past!  Here you can see how small it is in comparison to a pen!  We’ve also recently discovered a tarantula ‘nest’ in the garden to my great horror.  The gardener was quite excited and called me over to ask “What do you call these animals in English?” to which my answer was “TARANTULAS!!!!  AAAAAAAAH!!!!”

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More soon!  Thanks for reading!

Love Tess & Phil xx

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Ants in Your Pants…

Phil and I have discovered the true origin of this phrase after a recent encounter with some Kalene ‘red ants.’  These ants silently climb up your leg under your trousers and then all of a sudden start biting when they reach your pants.  You have to simultaneously drop your trousers (hoping that you’re not in a public place) and detach each individual ant from your skin at the same time as trying to run away from any other ants ready to try their luck!

Our work permits have still not been issued (despite paying two million Kwacha and making seven trips to the Lusaka Immigration Department!) so Phil and I have to present ourselves to an immigration officer every month in order to remain ‘legal residents.’  Last week our local immigration officer was on leave so we travelled to the immigration office at Jimbe on the border with Angola – an hour long drive along the most ridiculous ‘road’ I have ever seen.  We borrowed a hospital vehicle and Phil did a great job of negotiating various bumps, broken down lorries, ravines and small lakes: we arrived to discover that the Jimbe Immigration Officer was actually in Kalene, where we’d just travelled from!  By the time we had driven back to Kalene he was back in Jimbe!!  Imagine our joy at having to repeat the entire journey the next morning!  Check out the Trans-National Highway to Angola!

Mango Season is officially over but the local kids have found a new way to break bones!  We had four fractures in one afternoon earlier this week – the kids had been climbing trees to catch edible caterpillars!

On Thursday two patients presented with ruptured ectopic pregnancies within a couple of hours of each other.  An ectopic pregnancy occurs when a pregnancy implants into the Fallopian tube instead of the womb; as the pregnancy grows the Fallopian tube can rupture causing life-threatening bleeding.  The first patient had so much blood in her abdomen that I had to wash it out from between my toes at the end of the operation!  We only had one unit of blood left so one of the nursing students donated an extra pint.  Both patients are doing well and looking a lot better than when they came in!

One of the things I find most difficult at Kalene is helping patients with infertility.  Word seems to have spread that a ‘women’s doctor’ has arrived and loads of women have turned up over the last few months desperate to get pregnant.  Investigation and treatment options are very limited here at Kalene but childlessness has huge social implications.  I’ve met quite a few women who have been divorced by their husbands because they haven’t been able to have children.  We’ve devised a way use the portable Xray machine (C-arm) in theatre to check whether a women’s Fallopian tubes are open or blocked.  I’ve done around fifteen of these tests so far and the majority of patients have blocked tubes which is very difficult to treat.

The practice of men having two or more wives makes sexual health very complicated: four wives is the most I’ve come across so far.  Gentlemen – can you imagine how complicated your life would be with four wives??  If you diagnose a sexually transmitted infection in a women you also have to treat the husband and the other wives – but often the other wives may refuse treatment if they feel fine.  It’s like a Lunda version of the Jeremy Kyle Show!  I know that it’s important to respect cultural differences but I really believe that polygamy is a great injustice against women, demoting them to readily replaceable child-producers!

This is Ndongo.  She had a Caesarean section for a stillborn baby two years ago but unfortunately had already developed a vesico-vaginal fistula.  As it was a ‘Congo Special’ Caesarean her right ureter was also damaged (the tube that carries urine from the kidney to the bladder).

 

 

 

 

 

Ndongo has been to theatre four times so far.  The first time we identified a large fistula, the second time we tried to fix it but had to abandon the procedure as we couldn’t find the end of the right ureter (we didn’t know that it had been damaged at this stage).  The third time we downloaded an idiots guide to performing an intravenous pyelogram off the internet and used the portable Xray machine in theatre to diagnose that her right ureter was damaged.  The fourth time John and I were eventually able to repair the fistula.  She had her catheter and ureteric stent removed two days ago and is now not leaking urine!  We got there eventually!

A visiting paediatric surgeon has just arrived from Australia so Phil is set for a busy fortnight anaesthetising children of all ages for different operations.  We’ll tell you more about it in our next blog!

Lots of love, Tess & Phil xx

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Lost in Translation…

Welcome to ‘Consulting’!  Around one hundred patients attend Kalene Hospital every day; they are screened by the Outpatients Department and then the ones that need to see a doctor are sent to ‘Consulting’ which is basically like a GP surgery.  Neither Phil or I have ever fancied being GPs, this is why we trained in hospital medicine, so we find Consulting the hardest part of our work here at Kalene – Phil prefers his patients asleep!  It has definitely given me a new found respect for GPs.  You just never know what will come through the door, from poor vision to broken bones to ‘whole body pain’ through to a referral letter from the chief asking me to arbitrate in a witchcraft case (“Can you give a medical explanation for this patients symptoms?”).  Kalene patients describe their illnesses very differently to UK patients which adds to the challenge.  You often feel as if you are missing something in the translation, especially when the description is accompanied by sound effects and enthusiastic gesticulations.  Patients find pain particularly difficult to describe: the question “What’s the pain like?” frequently elicits the response “It is painful!”

I'm an anaesthetist - get me out of here!

This last week I’ve had a few ‘I want to go home’ moments, probably a combination of feeling tired after some middle-of-the-night Caesareans and also relating to the frustration of not having the basic things we need to treat the patients properly.  The hospital receives supplies from the government but what you order is very different to what you get so we have a kind of ‘shortage rotation.’  When I arrived there was no blood, no theatre gloves in my size or asthma inhalers.  Now we have enough theatre gloves and inhalers but no Xray films, blood tubes, laxatives, stomach medications or HIV tests.  I find healthcare rationing very difficult but inevitably you do have to make decisions about which of your patients most needs your last unit of blood.

We’ve had some visitors in our house recently.  There’s a bat called Barney who lives in the porch.  We have a family of mice who are now mostly dead; Phil has tried various methods of catching them but the most effective is borrowing next door’s dog, Rafiki!  A few weeks ago I was in the bathroom and looked down to find this tarantula standing next to my foot. It was gallantly slain by Phil who then flushed it down the toilet: one of its hairy legs came off and wouldn’t flush for nearly a week making every visit to the toilet a terrifying ordeal!

I thought I’d show you around Maternity this week as this is where I spend most of my time.  I’ll start with the ‘Ladies in Waiting.’  Many women in the surrounding area deliver their babies in the village with a traditional birth attendant or at a rural health clinic.  We ask all ‘high risk’ pregnant ladies to deliver at Kalene so that any help they may need is easily available.  This includes first time mums (high risk because they may have CPD – see previous blog), women who have had more than five babies (they have a greater risk of bleeding after delivery), previous stillbirth deliveries, twins and any other factors which makes labour more risky.  These women often have to travel long distances to get to the hospital so they’d arrive a bit late if they set off from the Congo when their waters broke!  They turn up at the hospital between 34-36 weeks pregnant and just wait until they go into labour.  If you think you had to wait a long time when you visited Antenatal Clinic (seems to be two hours minimum at the Jessops Antenatal Clinic!) just imagine waiting for eight weeks!!  The women stay in rooms next to Maternity and sit around chatting and plaiting each others hair – it’s particularly amusing when one of them goes into labour slightly earlier than they were expecting and comes to the delivery room with one half of their hair plaited and the other half standing on end!

In Maternity we have an antenatal bay, a postnatal ward, a room for women in the first stage of labour, a delivery room and an office (which doubles as the makeshift Special Care Baby Unit).  Here you can see two of our staff in the delivery room; this is Brighton, a nurse, and Maria, a health care assistant.

Let me introduce the two Alices; they are pillars of the Maternity unit having both worked here for over thirty years. They have no formal training but they have seen everything – I’ve certainly learnt a lot from these two amazing ladies. On the right is Rachel Reed, midwife extraordinaire and part-time hospital administrator. Rachel runs the Maternity unit along with Grace, another excellent midwife.

Last but not least here’s a taste of what you can expect if you break any of the Maternity rules! At first I was a bit taken aback by the ‘fine system’ but having seen the tragic effects that ‘village medicine’ can have on a women and her baby I now think a deterrent is entirely justified. I do think the fine for wrong visiting hours is a bit harsh – how can you blame a person for their relatives!?

A big thank you to Class 3/4 M at St Peter & Paul’s Primary School in Wallasey and their teacher Miss Mulcahy who are collecting coins to go towards Kalene medical supplies and to all who contributed to the amazingly well-timed package of gloves, tape and syringes which arrived last week – we are really grateful!

More soon! Lots of love, Tess & Phil

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Zambia – Champions of Africa!

Zambia were crowned winners of the African Cup of Nations on Sunday night after an agonising penalty shoot-out!  I must say that supporting Zambia is certainly much more rewarding than supporting England!  They played Ghana in the semi-finals and about 200 people squeezed around a television set up by one of the nurses, Gabriel, outside his house.  After it had gone dark Paul, one of the mission staff, projected the second half of the game onto the side of Gabriel’s house.  Ghana looked stronger the whole way through but Zambia scored a lucky goal in the last fifteen minutes.  It was incredibly tense as Ghana kept threatening to equalise but five minutes before the final whistle there was a massive thunder-clap and suddenly the heavens opened: Paul grabbed his projector, Gabriel grabbed his telly and about 200 people tried to squeeze into his house to escape the pouring rain!  There wasn’t enough room for us so we missed the last bit of the game and got very wet but knew Zambia had won by the cheering in the distance!  The real star of the game was the Zambian goalie, Mweene, who made some amazing saves – after the game he was given 250 hectares and 2 herds of cows by Chief Kanyensha from Central Province as a reward!

For the final against the Ivory Coast we were fully water-proofed and prepared for any weather with Paul’s projector set up in the boot of his car!  The game started at 9.30pm as it had been delayed by heavy rainfall – who decided it would be a good idea to stage the African Cup in the middle of the rainy season??   The atmosphere was amazing and we loved hearing all the Zambian versions of referee insults “Eh – this referee – but he must be blind!”  Zambia played brilliantly but the score was still 0-0 after the full ninety minutes and extra time so we moved on to an incredibly tense penalty shoot-out.  By the time the score had reached 5-5 both teams were literally on their knees praying (who does God support??)  When Zambia finally won the penalty shoot-out 8-7 everyone went completely crazy; dancing, cheering, shouting, singing, hugging.  This was followed by the ultimate technical hitch  when, just after the game had finished, the live feed from the stadium cut out, apparently depriving the whole continent of seeing Zambia lift the cup!  You may remember that the entire Zambian football team was killed in a plane crash in Gabon in 1993: this was very much on the nation’s mind when it became clear that Zambia would be playing this cup final in the same city.  Many people felt that it was fitting tribute to the men that died for this young Zambian team to win the African Cup in Gabon.

It’s good to be back at Kalene after our time in Lusaka!  Christmas cards are still arriving and receiving post is so exciting that I can’t resist putting them up for a week or two even though it’s February!  My Christmas cake ingredients have finally arrived in a box we sent overland from the UK before we left last August.  I think I’ll go ahead and make it anyway – I can fit a piece of Christmas cake in any time of year!  We had a Pancake Party last night with four frying pans on the go at the same time!  The Canadians were a little confused at first as they consider ‘pancakes’ to be small, thick and fluffy!  Phil and Mike, the medical student, presided over a pancake flipping competition with marks awarded for difficulty and execution!

 

Back in the UK my (abnormally tall) friends tease me for being short (I’m 5’5”) but here in Lunda-land I am a relative giantess!  In some ways Lunda women are amazing at giving birth – they don’t make a sound when they are in labour – but in terms of physique they are really not built for having babies!  Many Lunda women are less than 5 feet tall and they have the tiniest feet.  Short stature is often the result of poor nutrition and unfortunately means that a condition called ‘Cephalo-Pelvic Disproportion’ (CPD for short) is common:  this basically means that the pelvis is too small for a baby’s head to fit through.  Women with this condition can be in obstructed labour for many days: this often results in the delivery of a dead baby and complications for the mother like haemorrhage or fistula formation.  CPD doesn’t really exist in our well-nourished UK population so I’ve had to adapt my obstetric practice accordingly.  I’ve always thought that taking shoe size into consideration was a an old wives tale but I’m starting to change my mind!  I’m not saying that I’d suggest a Caesarean purely on the basis on someone’s shoe size but tiny feet certainly does alert you to the possibility of CPD here at Kalene!  This is Tina who almost certainly has CPD: she is 19 years old and must be about 4’10”  Her labour wasn’t progressing well and her baby was getting distressed so she had a Caesarean (done by Phil!) to deliver the baby safely.

We had some money kindly donated to buy equipment before we came out to Kalene: one of the things we bought was a model pelvis and baby so that we could do some training with the maternity staff in the management of maternity emergencies.  With help from Emma (midwife) we started a training programme in December with workshops covering eight different maternity emergency scenarios.  We are hoping that each member of staff will have been able to attend all of the sessions before we leave in July.  The mamas on the maternity ward all fall about laughing when I walk past with my baby and pelvis!

Phil has been trying his hand at some orthopaedics recently!  He reckons that he’s sat through enough trauma operating lists in the UK to have a general idea what to do!  This man arrived last week from the Congo having travelled a long distance.  He had broken his femur (thigh bone) last October and had a metal pin put in.  The pin was in the wrong place on x-ray and unfortunately it had got infected resulting in a thigh full of pus.  This definitely rates as a ‘Congo Special’ which is the generic term for any moderately dodgy operation performed somewhere in the Congo (although to be fair, working as a doctor in the Congo must be nearly impossible given the desperate state of the country)  Phil and John-Paul (theatre nurse) spent Thursday morning removing all the infected metal work from this man’s leg, inserting a traction pin through his lower leg and setting him up in traction.  Kalene is very fortunate to have a visiting UK orthopaedic consultant called Peter Gill working at the hospital for six months of the year and he provides an excellent orthopaedic service.  While he’s back in the UK we email him for advice and fill in the gaps as best we can!

More soon and thanks for all the Christmas post!

Lots of love, Tess & Phil xx

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The Bright Lights of Lusaka…

January is a time for New Year’s Resolutions, usually relating to doing more exercise in my case!  Exercise options are limited at Kalene so we often go running on the airstrip next to the hospital.  If you go at dusk you are often treated to beautiful sunsets over Kalene Hill.  Sometimes you get encouragement from a ‘support crew’ of local kids who can all run faster than you even though they are wearing flipflops and sometimes you get chased by wild dogs – a run on the airstrip is always eventful!  Not content with the airstrip, Phil and Chris took their running to the next level a couple of weekends ago by running 25km to nearby Hillwood Farm.  We all thought they were crazy and half expected to have to retrieve them from the side of the road on the way but they arrived at Hillwood before the rest of us and then spent the rest of the weekend nursing their aching muscles and sunburn!

We were sorry to say goodbye to our friends Emma (midwife) and Chris (surgeon) who left Kalene to head back to the UK at the beginning of January.  We have really enjoyed working with them and they will certainly be missed.   This means that we are now down to three doctors!  Luckily we have three student doctors on elective placements at Kalene at the moment so they’ve all been ‘promoted’ to help cover the work on the wards.

Since Chris has left I’ve taken over looking after Fisher (female) Ward.  There’s plenty of gynaecological problems to keep me busy but also general medicine too with lots of malaria, TB and HIV.  Strangely I still haven’t come across a single women who has fallen out of a mango tree – climbing mango trees is obviously a male occupation!  You might remember Ngambu from a few weeks ago – she had had three stillbirths and developed a vesico-vaginal fistula after the second birth.  She had a Caesarean to deliver her first live baby in November and the plan was for her to come back to have her fistula repaired in December.  She has to travel a long way from the Congo and was delayed for a month by the rains and the Congolese general elections.  She finally returned at the beginning of January to have the fistula repaired.  The surgery went well and so far she is  dry and not leaking any urine – she won’t get the final all-clear until three weeks after the operation  but things are looking good so far!

We’ve had a group of black kites visiting Kalene recently.  In the UK I get pretty excited about seeing one bird of prey but we’ve had about twenty of these birds sitting on a tree next to our house for a few weeks.  Thanks to my uncle, Brian, for his assistance in identifying the birds via our online ‘Name That Zambian Bird’ arrangement!

We have spent the last two weeks of January in the capital city, Lusaka.  I just cannot tell you how exciting it has been to drink fresh milk, walk on tarmac and visit a supermarket!  Phil has been teaching on the MMed Anaesthesia course at the University Teaching Hospital.  Anaesthesia doesn’t really exist as a medical specialty in Zambia (terrifying!) and the MMed course is the first anaesthetic postgraduate training course to be run in Zambia.  There are eight Zambian doctors training and the course started in August 2011.  Phil was joined by two other anaesthetic registrars from the UK, Carin and Roni, and between them they taught the Obstetric Anesthetic module.  They supervised the students giving anaesthetics during the operating lists in the morning and gave lectures in the afternoon.  I was drafted in to give a lecture from the obstetric perspective – ‘A View from the Other End!’  The students were a great group and really receptive to the teaching.

Phil and Carin met their airway nemesis when this patient turned up for an anaesthetic!  This man had a melon sized benign growth on his neck which needed to be removed so that he didn’t obstruct his airway.  He had already had his operation cancelled seventeen times because of anaesthetic concerns/objections!  Managing his airway until they could get a tracheostomy in was a bit hairy but the surgery went well and he’s been making a good recovery.

Phil finished his teaching and we had a week before we could catch a flight back to Kalene so we decided to embark on an adventure up to the Northern Province!  Getting there was quite an adventure and involved a variety of transport.  We started off with a nine hour bus journey on the ‘post bus.’  We were worried that we’d packed too much but then we turned up and saw the amount of luggage everyone else was trying to squeeze on the bus – at least four people brought a mattress onto the coach as ‘hand luggage’!!  Other transport included hitching on the back of a truck and a lift with a dead body and a party of mourners.  The long journey was certainly worth it when we reached Mutinondo Wilderness which is a beautiful unspoilt area of miles and miles of African bush.  It’s fairly unusual in Africa in that you can walk/swim without meeting anything that wants to eat you and we had a great time walking, swimming in the river and canoeing!  We also visited some hot springs and a stately home built by an mad Englishman in the early 1900s (sadly there was no National Trust tearoom!)  It was so good to have a break and we feel refreshed ready for another dose of Kalene!

Lusaka is currently in the grip of football fever as Zambia are through to the semi-finals of the Africa Cup of Nations.  After leading their group, Zambia beat Sudan last night 3-0 in the quarter-finals.  We were still on the bus travelling back from northern Zambia whilst the game was being played: you could tell when Zambia had scored because there was an eruption on the bus as well as honking car horns and people dancing on the streets.  The vuvuzela has well and truly arrived in Zambia – those things are so loud!  Next they meet either Ghana or Tunisia in the semi-finals on Thursday.  Come on Zambia!!

Back to Kalene on Tuesday!

Lots of love, Tess & Phil xx

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Christmas at Kalene: Chemo, carols and crocs…

Happy New Year from Kalene!  It’s easy to forget it’s December when the weather is so warm so we’ve done our very best to get into the festive spirit over the last few weeks!  The Christmas festivities kicked off with ‘The Old Ladies Party’ at the beginning of December. All of the ‘old ladies’ have been falsely accused of witchcraft in the past and thrown out of their communities.  This treatment of widows is not uncommon as it means the extended family no longer have to support the women. Many years ago the hospital built a compound to house these women and five of them remain.  Their Christmas party is an annual event and is the highlight of their year: they play games and each receive a new set of clothes and some Christmas gifts.  Their favourite party game is playing with balloons and tradition dictates that they all get balloons tied to their headscarves!  The activities included a three-legged race – they were pretty nimble for ‘old ladies’!

On Christmas Eve the hospital staff gathered to sing Christmas carols (in Lunda!) to the patients on the wards and read out parts of the Christmas Story.  This was a special evening as the lights went out and the wards became filled with candlelight and singing.  One of the Zambian staff had assembled a choir of children from one of the local villages. Here you can see one of the children, Obvious, with Josiah who also joined us.  Multi-tasking award goes to Rachel, the midwife, who managed to put in an IV drip by candlelight whilst we were singing on Men’s Ward!

After the carols we assembled at our house for Christmas cake, mince pies and hot chocolate.  We tuned into the Norad ‘Santa-Tracker’ on the internet: this website is set up by the American airspace authority and they ‘track’ Father Christmas as he travels around the globe!  At around 00:20 Father Christmas touched down in Kabwe, Zambia, and we all went to bed!

On Christmas Day we went to church in the morning: as it was a special day they had decorated the church with toilet paper!  All I could think was ‘what a waste of toilet roll’ – we’re down to our last two rolls!!  We had a meal of nshima and relish at the church and then went to the hospital in the afternoon to give out tea and gifts to the patients. In the evening we had Christmas dinner complete with sprouts and cranberry sauce (out of a tin that was three years past it’s sell-by-date but tasted fine!).  I’m pleased to report that we did indeed source a turkey and it was eaten enthusiastically on Boxing Day when all the   ex-pat staff met for a bring-and-share Christmas meal.

We had two sets of twins born in quick succession earlier this week!  The first were breech twins who had a nice straight-forward delivery.  The second set were both facing head-down but proved to be much more problematic!  The first twin delivered without any problems but the second twin (Kapa, as you might remember!) was much bigger than the first so eventually ended up being delivered by Caesarean.  When I got back to Maternity after the operation the staff had helpfully labelled the twins – no chance of getting these two mixed up!!

Phil has been looking after a twelve-year boy called Adrian over the last week.  He presented eight weeks ago with a swelling in his neck.  We took a biopsy and sent it in the post to a hospital in the UK which very kindly processes our histology specimens: the biopsy was reported as a high grade lymphoma, similar to Burkitt’s Lymphoma.  Our nearest cancer specialists are 1000km away in Lusaka so we have had to start chemotherapy ourselves: we have a limited supply here at Kalene.  Adrian has just had his second round of chemotherapy and his tumour is starting to shrink.  We feel very much out of our comfort-zones administering chemotherapy!

There was high drama on Thursday afternoon when a man was brought in from Angola after being attacked by a crocodile.  The croc had attacked him at 7pm the previous night as he was fishing.  His bowels were hanging out (wrapped up in a piece of material when he arrived) and he had multiple bite marks all over his body including one that had pierced his lungs.  His family had strapped a chair onto a motorbike, strapped the man to the chair and then driven for 12 hours until they reached Kalene Hospital. Phil, Chris and Emma spent the afternoon in theatre putting his bowels back, inserting a chest drain and cleaning out his wounds (crocs do not have very clean teeth!)  He had lost a lot of blood but is doing quite well now on the ward.  This is the least gory picture we have – believe me, you don’t want to see the other side of this man!

Last night we had a New Year’s Eve party and before midnight there was a special Kalene Awards Ceremony.  Phil received an award for ‘Services to Dentistry’ and I was very honoured to receive ‘The 2011 Chop Chop Prize for the Quickest Caesarean Section at Kalene Hospital’ although this was disputed by Dr Chris!  You will see that my certificate is made out to ‘Dr Tessie’ – no Lunda words end with an ‘s’ so Zambians find it very difficult to say ‘Tess’ and so all call me ‘Dr Tessie’!

We had a lot of fun seeing in the New Year two hours ahead of the UK but felt that something was definitely missing – Big Ben bongs!!  We’re really looking forward to our Zambian 2012 and wish you all a very happy New Year!

Lots of love, Tessie and Phil xx

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Midnight oil, mulled Jolly Juice and the Great Turkey Hunt…

I’m writing this at 4am sitting in theatre with a post-operative patient who is really poorly and needs to be ventilated overnight – this is intensive care unit Kalene-style! Me, Phil, Dr Chris and Mark have taken it in turns to do ‘shifts’ looking after the patient (Mark is a medical student doing his elective with us at the moment). Phil taught us everything we need to know about the anaesthetic machine (!!) in a ten-minute crash-course tutorial last night. I managed to get a bit of sleep on the theatre trolley next door whilst Mark was looking after the patient, and now it’s my turn. Thankfully the patient is quite stable but ventilating patients isn’t in my usual line of work so I’m finding it fairly terrifying!

I did my first solo ward round yesterday without taking any of the nursing staff to help me translate – this is progress! I was probably speaking Lunda like a five-year-old but the patients seemed to understand and helped me with pronunciation as I went round. They seem to find my efforts to speak Lunda hilarious which is slightly off-putting! Phil has just finished producing the second edition of the Kalene Lunda phrasebook which Emma and Chris Houlden originally developed – he’s added an anaesthetic section!

We are looking after a very ill patient at the moment who has an enormous pericardial effusion (fluid collection around the heart). When she came in she was twenty weeks pregnant but unfortunately she has been so sick that she has miscarried. We think the pericardial effusion has been caused by TB so we’ve started her on TB treatment. Phil drained the pericardial effusion last week in theatre under ultrasound guidance and she seems much better. You can see John displaying the fluid that was drained from around the heart below!

Each Friday a doctor visits one of the surrounding rural health clinics. Last week I visited Kafweku Clinic with the HIV team and one of the maternity staff. Each clinic gets visited one a month so they save up all their patients to be seen and we also do an antenatal clinic. There is usually a great variety of health problems to address and the patients vary between babies, children, pregnant women, adults and elderly people. One couple asked me if I would check their baby: she was a second twin and had been born about three weeks earlier in Angola. The first twin had died one week after it was born. They unwrapped this bundle to reveal a tiny baby. It only weighed about 3lb so we brought it back to our makeshift ‘special care unit’ at Kalene to be cared for in an incubator. She is putting on weight and doing really well. This little girl’s name is ‘Kapa,’ same as the other second twin I mentioned a few weeks ago. Names are often given to reflect to circumstances surrounding a child’s birth; Kapa means ‘2nd Twin’, ‘Kasela’ means born feet first, ‘Kalomba’ means born hand first (no thanks!!) and ‘Minjiŋa’ is the name for a baby born with it’s cord around it’s neck.

Phil gave a tricky anaesthetic last week for a nine day old baby called Emily who hadn’t opened her bowels since she was born. She had an atresia (narrowing) of her small bowel so Drs John and Chris had to remove that part of the bowel and stitch the ends back together. Bowel surgery is pretty high risk as an adult but even more so for such a tiny baby. I’m pleased to report she is doing fine and now pooing with gusto!!

We are truly getting into the festive spirit here at Kalene despite the warm weather! We had ‘Christmas Craft Afternoon’ last weekend and had lots of fun making a gingerbread house with some the children. Also on the agenda is ‘Sing-Along-Messiah’ on Saturday, ‘Carols by Candlelight’ with mince pies and mulled Jolly Juice on Sunday followed by singing Christmas Carols around the hospital wards on Christmas Eve. I managed to ‘borrow’ Christmas tree from nearby Sakaji school after their term ended on November 30th so thankfully I avoided improvising with some twigs and Blue Peter tree decorations!

All the hospital staff are invited to meet at the church on Christmas Day for a shared meal of nshima and then the ex-pat staff meet on Boxing Day for proper Christmas Dinner! It’s touch-and-go as to whether we’ll be able to source a turkey for Christmas – hospital staff are visiting both Solwezi and Lusaka this week so hopefully the ‘Turkey Hunt’ will be successful! There were no turkeys available in the whole of Zambia in 2007 due to government permit problems (sounds familiar!) but hopefully we’ll be lucky this year!

Wishing you all a very happy Christmas!

Love Tess & Phil xx

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