Snake bites, pus and leggae leggae music.

St Francis' Hospital

It's been a while since I last posted so it's about time I filled you in on some more details of life in Zambia. I am now feeling very settled and at home here. I’ve just about adapted to the heat and continue in my attempts to speak Chewa, the local dialect with mixed results.

The regimented garden

 

My little house is now very much feeling like home. The veggie patch is coming on nicely, the rocket is almost ready for the first harvest and the tomato seedlings are thriving despite my lack of watering. Having paid a visit to the permaculture project over the other side of the Great East Road a few weeks ago I feel rather ashamed of the regimented angular layout of my garden (although the beds were already rectangular when I arrived), having admired their spiral beds of mixed vegetables, the nitrogen fixers complementing the non-leguminous plants. The window ledges are decorated with yoghurt pots and milk cartons planted up with seeds harvested from the abundance of vegetables available for pennies at the chadda, the market outside the hospital. Amongst the hopefuls are watermelon, pumpkin, cucumber, aubergine, groundnut (peanut), lemon, orange, papaya, mango and avocado. Some are starting to sprout, others are growing only a nice film of mould. I’ve been experimenting with baking using ingredients available at the chadda – banana loaf and pumpkin cake have both proved successful and the surgical team has started to complain that they are all getting fat as a result. Tidiness has never been my particular strong point, and although the Sahara is a very long way away from Zambia it seems to be making its best efforts to set up shop in my living room. Sweeping up the sand is an endless task, especially when half of the dust pile crawls away when my back is turned.

Kizito (male surgical) ward

Towards the end of my second week at St Francis’ I succumbed to the almost inevitable d+v which lurks in the wings waiting for susceptible foreigners with naïve stomachs. I was treated to the luxury of ‘hospital at home’ by my kind medical colleagues and made a full recovery, sped up by a few bags of IV fluid strung up to my mosquito net. Once back at work I have been able to get fully stuck in to life in the surgical department. With three theatre lists a week there is plenty of opportunity to operate – I tend to work in theatre 3 where we do minor procedures – lesion removals, lipomas, insertion of suprapubic catheters, sequestrectomies for osteomyelitis, desloughing of dirty wounds and lots and lots of incision and drainage of abscesses. The word ‘mufima’ meaning pus was one of the first I learnt!

A standard theatre 3 case - this one was a very dense sebaceous cyst

On a theme of pus: we have a patient on the ward at the moment who came in with ‘toothache’ which ended up being a bit of an understatement – he had a huge dental abscess which tracked down under his chin to his chest wall. Despite the heaviest duty antibiotics we have here he ended up with gas gangrene and necrosis of most of his anterior chest wall, leaving him with all his muscles exposed and a tracheal fistula which bubbles pus every time he takes a breath. Fortunately he seems to have turned a corner and the spread of infection has halted, but it will take a long time for everything to heal and he will require extensive skin grafting. An extreme example of the dangers of poor dental hygiene.

Purple market

Red market

 We hold twice weekly surgical outpatient clinics where we see a whole assortment of cases, some straightforward, some more complex. Over the last few weeks we have seen patients who have been bitten by an assortment of creatures, varying from dogs to crocodiles, snakes and on occasion their own wives. We have also had a recent flurry of patients falling from motorbikes when trying (and failing) to avoid a pig. A significant number of the casualties from road traffic accidents have been driving when intoxicated, and although they often deny it the overpowering stench of Shakeshake, the local maize beer, gives the game away. We also see a fair number of injuries as a result of ox carts – either people being mowed down by bolting oxen trundling the hefty sized carts behind them, or passengers falling out of the cart. A couple of weeks ago (and before I’d seen any ox cart related injuries) a group of us took an ox cart to a nearby village to watch a traditional women’s dance – a lovely evening and all survived the journey, although I’m not sure I’d be so keen to go again having seen so many injuries in recent weeks!

Experiencing one of the less safe modes of Zambian transport

One patient in particular has begun to tug at the heart strings of the surgical team – a 9 year old boy who has been in hospital for the past 8 weeks, originally with a bowel perforation secondary to typhoid and a string of subsequent problems with a faecal abdominal collection which discharges through four separate openings in his abdominal wall. He is horribly malnourished, weighing just 18kg, some of which is oedema from protein malnutrition. He is too weak to stand and can barely even hold his head off the pillow. The staple food, inshima and rape, is very low in protein and not particularly calorific and the hospital kitchen only provides meat once a week. His family cannot afford to buy meat or beans to supplement his diet and the only hospital nutritional supplement in stock, F100, a high protein milk-based drink is not enough to fulfil his requirements. As a team we have taken to bringing in extra bits of food for him, saving meat from dinner in the mess, baking calorific cakes and buying him full fat yoghurts and nutty chocolate bars. Over the past few weeks we have begun to see a gradual change in him, his mood seems brighter and his ribs are not looking quite so prominent. He is still very unwell but we remain hopeful that with a focus on his nutrition he will become stronger and some of his wounds will heal, aiming to provide reconstructive bowel surgery in 6 months time.

Look at me, my eyes move independently from one another!

Last weekend four of the students and I travelled to Lake Malawi for a relaxing few days. As we had been assured it was well worth the long (16+ hours) bus journey and we spent the weekend snorkelling in the crystal clear water, enjoying non-hospital food and drink and generally enjoying ourselves. We attempted to paddle dug-out canoes which are the standard boats for local fishermen – it turns out they make it look much easier than it is and there were many, many capsizes. We enjoyed some live ‘leggae leggae’ music at a local ‘crub’ – after initial confusion we worked out the interchangeability of the letters L and R. We returned refreshed and very well fed (and feeling a need to up the pace of evening runs to offset the overindulgence!).

Snorkelling, good food and drink, this view...not a bad holiday all told

Thank you to everyone who has been in touch, I really enjoy hearing your news. Apologies it has taken a while to update the blog, I’ll try and do another before too long.