Charlotte has had to entertain herself for a few days - I have been rather busy! Monday was my first on call, arranged so I would cover surgery and an obstetrician was covering his side of things, but would call me in to help and teach me the ropes. We had an epic operating day, including two laparotomies, two open fractures for external fixation, some hernias and biopsies.
At the end of the list, I then popped onto the ward to see the new admissions.
There is no emergency department here. During the day, all new arrivals are seen by the clinical officers in the outpatients department. If we have a surgical outpatients clinic happening, surgical patients get sent to see us. If not, they just get sent to the ward. We then pick them up at the end of the day. At night, the same thing happens with the coverage nurse assessing the patient and calling us if they have concerns.
So, at 6pm on Monday (or 18 hours, as it is known here) I discovered a chap who had sat on the ward all day with a tension pneumothorax. With a beautiful X-ray showing it. In the UK, it is said you should never see a tension pneumothorax on chest X-ray, as it is an emergency, is diagnosed clinically and should be drained sooner than you can do the X-ray. On ER, it is what they are talking about when they shout "TENSION. Chest drain stat!" Anyway, I quickly got him to theatre and drained it and was feeling suitably pleased with myself to drop by the labour ward on the way home to make sure everything was OK.
This yielded an emergency Caesarean section, who turned out to have undiagnosed twins - all very exciting!
This then left only five patients to be seen on the surgical wards. Four were straightforward, the fifth being a 3 day old baby admitted with bilateral cleft lip and palate, for our attention! These are all dealt with by the plastic surgeon, who comes up every three months - his next clinic is in November. It was however obvious this child was a little more complicated - high fevers, and clearly a very peculiar syndrome, causing the cleft, exophthalmos and a plagiocephaly [essentially he had a very abnormally shaped skull]. Indeed, I wonder if he has a cloverleaf skull. Anyway, I called the paediatrics on call to come and sort him out, was marching out the door, when I hear "there's one more doc...."
She was an old lady with an incarcerated femoral hernia and obvious small bowel obstruction who wasn't looking too rosy. She had been admitted at noon, but no one had informed us! So I called the theatre team in, nipped home for a spot of dinner while they prepared, then operated on her. She had necrotic bowel, and needed a laparotomy, so I had to call the Professor in as well. We ended up resecting two segments of dead bowel. She unfortunately died the next morning - I suspect electrolyte disturbances, but our lab does not test for them, so we can never know!
By the end of all the operating, it was 0230 and I had been operating nearly constantly for 18 hours! The obstetrician was however just arriving for another section - he suggested I went to bed, so I left him to it.
I have today spoken to the anaesthetic licentiates about our pulse oximeters from Lifebox - they were very excited by the prospect. Currently, there is minimal monitoring of anaesthetised patients - they only knew one of my laparotomies on Monday was hypoxic because the blood coming out was too dark. I hope we can get to a point where there is a pulse oximeter not only in every theatre (which will happen from Friday), but also several in recovery. This is currently a minimally observed corridor, where anything could happen and no one know. I think there is a big difference that can be made in perioperative monitoring and care, with really very little effort.
Wednesday, 29 August 2012
Trainee surgeons and death
It might seem trivial to say but death is one of the first things junior doctors have to learn about. What it looks like, what it feels like, how you break the news to a family. It's one of the first things that they need support with.
When training to be a Surgeon there are two types of death - deaths that could be your fault and deaths that weren't your fault (failure to save). Being able to differentiate between them is critical because it allows you to filter some of the negative emotions associated with the latter type of death. The patient would have died anyway, you did no harm.
In Western hospitals mortality rates are generally quite low and, with time, the 'failure to saves' relatively easy to identify. It is slowly dawning on me (watching and listening to Geoff) that things are very different out here. A great many of his patients (including several he operated on late on Monday night) have died shortly after surgery. These people would not have died in the UK. But what type of death are they? The first sort (Geoff's doing procedures he's not familiar with, in less than ideal conditions) or the second sort?
I spent an hour or so in Theatres this afternoon but didn't see very much operating (I will go back). I left with Geoff who'd been called to the ward to see a patient from the morning list. She's 12 and presented yesterday having fallen from a tree. She'd damaged her spleen 24 hours earlier but Geoff and the Prof were hopeful that it wouldn't need operating on (it had stopped bleeding of its own accord). Unfortunately, and unusually, over night she started to bleed again and they removed the spleen this morning. But here she was on the ward looking distinctly unwell. Her spleen had been inflamed (suggesting that she was fighting infection) but so damaged that it needed to be removed. Now, without the spleen to help out, she is very septic. It's not clear of the cause and Geoff is not hopeful.
He asked advice of one of the medics (there is a strange wailing sound coming from his ward when we find him). He teaches Geoff how to treat for malaria and which antibiotics he would give (although we are still short of the most useful one). The wailing? That's the families of two patients that had just died. Both came in over night - one with renal failure, the other meningitis. How long will they wail for? Until the body is removed. How long might that be? Up to an hour.
When training to be a Surgeon there are two types of death - deaths that could be your fault and deaths that weren't your fault (failure to save). Being able to differentiate between them is critical because it allows you to filter some of the negative emotions associated with the latter type of death. The patient would have died anyway, you did no harm.
In Western hospitals mortality rates are generally quite low and, with time, the 'failure to saves' relatively easy to identify. It is slowly dawning on me (watching and listening to Geoff) that things are very different out here. A great many of his patients (including several he operated on late on Monday night) have died shortly after surgery. These people would not have died in the UK. But what type of death are they? The first sort (Geoff's doing procedures he's not familiar with, in less than ideal conditions) or the second sort?
I spent an hour or so in Theatres this afternoon but didn't see very much operating (I will go back). I left with Geoff who'd been called to the ward to see a patient from the morning list. She's 12 and presented yesterday having fallen from a tree. She'd damaged her spleen 24 hours earlier but Geoff and the Prof were hopeful that it wouldn't need operating on (it had stopped bleeding of its own accord). Unfortunately, and unusually, over night she started to bleed again and they removed the spleen this morning. But here she was on the ward looking distinctly unwell. Her spleen had been inflamed (suggesting that she was fighting infection) but so damaged that it needed to be removed. Now, without the spleen to help out, she is very septic. It's not clear of the cause and Geoff is not hopeful.
He asked advice of one of the medics (there is a strange wailing sound coming from his ward when we find him). He teaches Geoff how to treat for malaria and which antibiotics he would give (although we are still short of the most useful one). The wailing? That's the families of two patients that had just died. Both came in over night - one with renal failure, the other meningitis. How long will they wail for? Until the body is removed. How long might that be? Up to an hour.
Pictures of the hospital
Pictures have been slightly lacking (owing to some laziness on my part) but I'm making amends. Have just added some to the Kalumba Ceremony post that hopefully bring it a bit more to life!
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| This is the outside of the house we are staying in. It is massive! (in SFH terms anyway) |
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| The front of the hospital (SFH) |
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| Shop in the hospital |
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| Outpatients during the day with a massive queue! |
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| Outpatients in the evening |
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| Black cats are lucky?? |
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| Sunset over the hospital buildings |
Tuesday, 28 August 2012
Things are hotting up!
Geoff was expecting to be on call on Friday this week but suddenly found himself on call last night (Monday). At least, I hope it was suddenly because the first I heard of it was when I decided to go to dinner (he hadn't come back by just after 6.30pm) to be told by the others not to expect him any time soon. As is standard practice, I plated up his meal and Amy generously gave him 3 portions of pudding. By the time everyone left the mess there was still no sign so a kind medical student helped me carry it all home...
I'd had an 'interesting' day. Last week I'd identified that perhaps the chap in charge of greeting people and organising accommodation needed a hand. I don't know why, perhaps it's because no one was expecting us and we'd been housed in a filthy flea pit. Then they weren't aware of Fiona and Rory coming and their house preparations were rushed (the new cement around the loo was still wet and there was no fridge). I had offered assistance towards the end of the week but been sent away with a flea in my ear. Everything was fine, the man had a spreadsheet with everyone on and he knew exactly what was going on. I withdrew. How could I have got it so wrong?
Separately, Geoff had discovered that the medical student rotations could do with a little more structure. It would be useful for them and the departments to know how many students were coming, for how long, and when. It's no use having a student for 2 weeks at a time because you just spend your time training them. I mention this in my useful chat with the Medical Superintendent (boss of the hospital). He agrees and suggests Geoff should do this. I head to the administration office to see if I can get the list of names.
'No organisation needs doing, the students say in advance what they want to do and they have an orientation on day one and choose specialty then. Why would you want to organise anything any further in advance?' Um, I don't know! Perhaps because lives and the rota are at stake. Why on earth would you think beyond tomorrow? You might be dead - especially if you were sent to a hospital with no I/V antibiotics - oh hang on, that was here!! Eventually, after a brief exchange where he asked me if I had a job back home, [I am putting myself forward for an award - I managed not to say a single provocative thing at that point.] he prints me a copy of the aforementioned spreadsheet.
Inside I am laughing. This thing is a joke. For a start I point out that 3 medical students have arrived today - where are they on the list? Two were expected on the 27th of Sept, the third 'Peter' is not on the list at all. At this point the nice man tells me I'm wrong and there is no Peter here but a guy whose surname is Yin. I can assure you now that the medical student I showed round the hospital an hour earlier did not have the surname Yin! Geoff and I are on the list twice (how nice!) but both as expected on the 21st - which goes some way to explaining the confusion and mould...
This list is useless - it only goes to the end of September, I can see gaps in the data and the data that is there is patently untrustworthy. I think back to work and my junior teams - not once (thankfully) have I seen anything as shambolic as this. But, I'm not at work, I'm not being paid and this man does 'not need any help'. I thank him and ask what he thinks the weather will be like tomorrow? 'The weather? It will be the same'. I feel a little better for he has inadvertently joined in on a private family joke. My father enjoys telling stories of his time in Malawi and his travelling with a chap named Jim. Every day Jim would open the curtains and say 'Nice day for it' safe in the knowledge that the weather is pretty much always nice and always the same...
I had hoped that Geoff would take over now and tell you what he was doing last night. He ate his dinner (no pudding) quickly at 10pm and came back at 2.30am. We got up just before 7am and he went to the 7.30am clinical meeting. This is a long way of telling you that right now (9.10pm) Geoff is sat next to me asleep on the chair. Perhaps tomorrow he can tell you about his 'fun' in theatre with his improvised chest drain (hospital has run out), lack of gowns (hospital has run out), multiple patients admitted to the ward at lunchtime needing urgent care but not flagged to the surgeons (standard) and the myriad of animals that inhabit theatres at night including: rats (which eat the body parts the surgeons cut off (ugh!) and the image intensifier), cockroaches, ants and a large spider. It sounded glorious! Wish I was there!!!
I'd had an 'interesting' day. Last week I'd identified that perhaps the chap in charge of greeting people and organising accommodation needed a hand. I don't know why, perhaps it's because no one was expecting us and we'd been housed in a filthy flea pit. Then they weren't aware of Fiona and Rory coming and their house preparations were rushed (the new cement around the loo was still wet and there was no fridge). I had offered assistance towards the end of the week but been sent away with a flea in my ear. Everything was fine, the man had a spreadsheet with everyone on and he knew exactly what was going on. I withdrew. How could I have got it so wrong?
Separately, Geoff had discovered that the medical student rotations could do with a little more structure. It would be useful for them and the departments to know how many students were coming, for how long, and when. It's no use having a student for 2 weeks at a time because you just spend your time training them. I mention this in my useful chat with the Medical Superintendent (boss of the hospital). He agrees and suggests Geoff should do this. I head to the administration office to see if I can get the list of names.
'No organisation needs doing, the students say in advance what they want to do and they have an orientation on day one and choose specialty then. Why would you want to organise anything any further in advance?' Um, I don't know! Perhaps because lives and the rota are at stake. Why on earth would you think beyond tomorrow? You might be dead - especially if you were sent to a hospital with no I/V antibiotics - oh hang on, that was here!! Eventually, after a brief exchange where he asked me if I had a job back home, [I am putting myself forward for an award - I managed not to say a single provocative thing at that point.] he prints me a copy of the aforementioned spreadsheet.
Inside I am laughing. This thing is a joke. For a start I point out that 3 medical students have arrived today - where are they on the list? Two were expected on the 27th of Sept, the third 'Peter' is not on the list at all. At this point the nice man tells me I'm wrong and there is no Peter here but a guy whose surname is Yin. I can assure you now that the medical student I showed round the hospital an hour earlier did not have the surname Yin! Geoff and I are on the list twice (how nice!) but both as expected on the 21st - which goes some way to explaining the confusion and mould...
This list is useless - it only goes to the end of September, I can see gaps in the data and the data that is there is patently untrustworthy. I think back to work and my junior teams - not once (thankfully) have I seen anything as shambolic as this. But, I'm not at work, I'm not being paid and this man does 'not need any help'. I thank him and ask what he thinks the weather will be like tomorrow? 'The weather? It will be the same'. I feel a little better for he has inadvertently joined in on a private family joke. My father enjoys telling stories of his time in Malawi and his travelling with a chap named Jim. Every day Jim would open the curtains and say 'Nice day for it' safe in the knowledge that the weather is pretty much always nice and always the same...
I had hoped that Geoff would take over now and tell you what he was doing last night. He ate his dinner (no pudding) quickly at 10pm and came back at 2.30am. We got up just before 7am and he went to the 7.30am clinical meeting. This is a long way of telling you that right now (9.10pm) Geoff is sat next to me asleep on the chair. Perhaps tomorrow he can tell you about his 'fun' in theatre with his improvised chest drain (hospital has run out), lack of gowns (hospital has run out), multiple patients admitted to the ward at lunchtime needing urgent care but not flagged to the surgeons (standard) and the myriad of animals that inhabit theatres at night including: rats (which eat the body parts the surgeons cut off (ugh!) and the image intensifier), cockroaches, ants and a large spider. It sounded glorious! Wish I was there!!!
Monday, 27 August 2012
A dose of culture and learning!
I would have posted this earlier this morning but we've been somewhat without electricity. Whilst that has returned, the usual lack of water is in full swing. This gives me a good reason for postponing the washing up! But does make other things more tricky - I quite fancy a glass of squash but not sure I want it quite enough to go in search of a functioning tap outside yet
This weekend we were lucky enough to visit the annual Kulamba Ceremony. This celebrates the freedom and culture of the Chewa people - the tribe is spread across eastern Zambia, Malawi and Mozambique. Thousands of people travelled from all over to be there. We were told that if we went then we'd be ushered into a VIP area (just because we are white). So we planned to visit on our way to Chipata.
The location was somewhere just the other side of Katete - we were told we couldn't miss it. As we got into Katete we realised how many more people there were than usual. Anyone with a flat bed truck was doing a sterling job of ferrying people out of town. I have never seen so many people on the back of a truck or rammed in a car before. No one seemed bothered if their bodywork was rubbing on the tyres - the smell though was quite something. Occasionally I did wonder what these guys mum's would think if they could see this - then I realised the mums were probably on the truck too!
On the walk up to the event (the directions were accurate, you couldn't miss it) we passed hundreds of stalls selling everything from flip flops to dried fish (it stinks!) to radios to clothes pegs. Also, large quantities of clothing shipped from Europe. My brother likes to think he got bargain jeans in Primark (I think they cost £2.50) - he was ripped off. The guys here were offering them for less than 50p. Admittedly slightly holey but still... There were also a great many bags with 'London' and a picture of Tower Bridge at night on them - in all the dust and heat it was odd to think I'd been stood looking at that view barely a week and a half earlier! It also made me think about the complaints that the Olympics had become too commercial - this appears to be standard practice at all large events globally!
The main event was in a purpose built 'arena'. There was a raised circular stage topped in mud, surrounded by stands (essentially concrete platforms with sun shades). The army (or similar) was controlling the crowds trying to get close enough to see through the stands. We found a clear area between two of the stands. Will, desperate to get close enough to take photos, marched forwards. After a few seconds the rest of us, not wanting to be separated, walked forward awkwardly. We couldn't just walk in, could we? It turned out quite rapidly that this space was only free because it was the main entrance for performers. One of the army guys came over and told us to move. Will had already made a dash for the group of photographers in the centre. The 5 of us were ushered to the Zesco sponsored stand (thank you Zesco but I would thank you more if you could keep the electricity on...) and given chairs.
Now, it's hard to understand what's going on when you don't speak the language. Geoff and I were making good guesses and, whilst I know the guys sat around us could understand what we were saying, no one seemed bothered enough to fill us in. Broadly, each of the sub-tribes was represented by its traditional dancers - these were all covered in mud with feathers or tassels at the knee, elbow and neck and wearing masks. The masks were quite scary and either human or animal. There was also a large chicken outfit (that guy must have been boiling) and some other weird creatures. The dancing was amazing and I had to keep pinching myself to remind me that this wasn't some contrived show for tourists, this was for the Chewa people.
A lot of the performers and audience were wearing specially printed clothing (tunics, chitengas etc) with a man's face on. All of a sudden everyone stood up, we stood up. A huge procession came in. I admit I was slightly distracted by the sound of the crowd behind us complaining that we were blocking their view - the two army guys were having a bit of trouble stopping a riot from starting. Anyway, the guy in the picture (wearing a white hat) was brought to the stand close to us. This is the King of the Chewa people. He was settled on an armchair (faded and like something out of a nursing home) surrounded by elephant tusks, a lion skin and a leopard skin. He had his own guards dressed in red and like Masai, with bows and arrows.
Amongst other events there was a session where people brought the King gifts. It was almost unbelievable and he was going to need several lorries to take it all home. One wonders how many mattresses one man needs, and stoves. There was even an entire bedstead with hard wood headboard, cupboards and dressing table with mirror!
After getting in the way some more and managing to get between the proper VIP stand and the stage we decide to head off to Chipata. 6 cheeseburgers and 5 swims later we are ready to hit the supermarket. I think I was the cleanest at that point that I have been since leaving the UK! Just as I'm lining up to take a photo of a sign that says 'Fatti's and Moni's' the lights go out. Immediately the security guys throw the doors shut. Then start searching the aisles for shoplifters. Eventually they decide it might be nice to turn on the back up generator. Clearly the rest of us had nothing better to be doing with our time.
However, this adventure and some faffing means that we don't set off back before 5.30pm. This is bad news. Very bad news. Sunset is at 5.45. It goes pitch black at 6pm. The one thing you never do around here is drive at night. Not only are we driving along the main east west road - don't be thinking it's a motorway - it's single carriageway, has pedestrians/cyclists/dogs all over it, is unlit, is used by massive lorries all the time and has pot holes and mostly unmarked speed bumps. But it's the end of the Kulamba ceremony and half of Malawi is heading for the border. We are the only car for miles going West... Nat's 'smile' mix had been keeping us entertained but soon the tension in the car starts to increase. I'm wedged in the boot (on a proper fold down chair with a 3 point seatbelt - fear not) with all the shopping, which doesn't really increase comfort but I'm happily singing along to the songs. If they didn't go so slowly, I was tempted to tell us to tuck up behind the one lorry we find going our way, at least then if someone strays over towards us they'll meet the lorry first. The back seat drivers are silenced eventually and we plough on. It was with a mixture of relief and renewed concern that we reach the Kulamba turning. We are nearly home but we are now surrounded by drunk people. Mostly on vehicles or walking but some driving.
The pace slowed. We count over 50 people on the back of one truck. If it had an accident that would fill an entire ward at the hospital. There aren't enough doctors (even with us back) to deal with any significant accident tonight. As we pull into the driveway there is a deep sigh of relief. Note to us - next time we will leave the pool earlier - driving in the dark is for idiots...
This weekend we were lucky enough to visit the annual Kulamba Ceremony. This celebrates the freedom and culture of the Chewa people - the tribe is spread across eastern Zambia, Malawi and Mozambique. Thousands of people travelled from all over to be there. We were told that if we went then we'd be ushered into a VIP area (just because we are white). So we planned to visit on our way to Chipata.
The location was somewhere just the other side of Katete - we were told we couldn't miss it. As we got into Katete we realised how many more people there were than usual. Anyone with a flat bed truck was doing a sterling job of ferrying people out of town. I have never seen so many people on the back of a truck or rammed in a car before. No one seemed bothered if their bodywork was rubbing on the tyres - the smell though was quite something. Occasionally I did wonder what these guys mum's would think if they could see this - then I realised the mums were probably on the truck too!
On the walk up to the event (the directions were accurate, you couldn't miss it) we passed hundreds of stalls selling everything from flip flops to dried fish (it stinks!) to radios to clothes pegs. Also, large quantities of clothing shipped from Europe. My brother likes to think he got bargain jeans in Primark (I think they cost £2.50) - he was ripped off. The guys here were offering them for less than 50p. Admittedly slightly holey but still... There were also a great many bags with 'London' and a picture of Tower Bridge at night on them - in all the dust and heat it was odd to think I'd been stood looking at that view barely a week and a half earlier! It also made me think about the complaints that the Olympics had become too commercial - this appears to be standard practice at all large events globally!
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| Fish anyone? |
The main event was in a purpose built 'arena'. There was a raised circular stage topped in mud, surrounded by stands (essentially concrete platforms with sun shades). The army (or similar) was controlling the crowds trying to get close enough to see through the stands. We found a clear area between two of the stands. Will, desperate to get close enough to take photos, marched forwards. After a few seconds the rest of us, not wanting to be separated, walked forward awkwardly. We couldn't just walk in, could we? It turned out quite rapidly that this space was only free because it was the main entrance for performers. One of the army guys came over and told us to move. Will had already made a dash for the group of photographers in the centre. The 5 of us were ushered to the Zesco sponsored stand (thank you Zesco but I would thank you more if you could keep the electricity on...) and given chairs.
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| Fi and Nat boldly stride forward.... |
Now, it's hard to understand what's going on when you don't speak the language. Geoff and I were making good guesses and, whilst I know the guys sat around us could understand what we were saying, no one seemed bothered enough to fill us in. Broadly, each of the sub-tribes was represented by its traditional dancers - these were all covered in mud with feathers or tassels at the knee, elbow and neck and wearing masks. The masks were quite scary and either human or animal. There was also a large chicken outfit (that guy must have been boiling) and some other weird creatures. The dancing was amazing and I had to keep pinching myself to remind me that this wasn't some contrived show for tourists, this was for the Chewa people.
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| Will using his much better camera! |
A lot of the performers and audience were wearing specially printed clothing (tunics, chitengas etc) with a man's face on. All of a sudden everyone stood up, we stood up. A huge procession came in. I admit I was slightly distracted by the sound of the crowd behind us complaining that we were blocking their view - the two army guys were having a bit of trouble stopping a riot from starting. Anyway, the guy in the picture (wearing a white hat) was brought to the stand close to us. This is the King of the Chewa people. He was settled on an armchair (faded and like something out of a nursing home) surrounded by elephant tusks, a lion skin and a leopard skin. He had his own guards dressed in red and like Masai, with bows and arrows.
Amongst other events there was a session where people brought the King gifts. It was almost unbelievable and he was going to need several lorries to take it all home. One wonders how many mattresses one man needs, and stoves. There was even an entire bedstead with hard wood headboard, cupboards and dressing table with mirror!
After getting in the way some more and managing to get between the proper VIP stand and the stage we decide to head off to Chipata. 6 cheeseburgers and 5 swims later we are ready to hit the supermarket. I think I was the cleanest at that point that I have been since leaving the UK! Just as I'm lining up to take a photo of a sign that says 'Fatti's and Moni's' the lights go out. Immediately the security guys throw the doors shut. Then start searching the aisles for shoplifters. Eventually they decide it might be nice to turn on the back up generator. Clearly the rest of us had nothing better to be doing with our time.
However, this adventure and some faffing means that we don't set off back before 5.30pm. This is bad news. Very bad news. Sunset is at 5.45. It goes pitch black at 6pm. The one thing you never do around here is drive at night. Not only are we driving along the main east west road - don't be thinking it's a motorway - it's single carriageway, has pedestrians/cyclists/dogs all over it, is unlit, is used by massive lorries all the time and has pot holes and mostly unmarked speed bumps. But it's the end of the Kulamba ceremony and half of Malawi is heading for the border. We are the only car for miles going West... Nat's 'smile' mix had been keeping us entertained but soon the tension in the car starts to increase. I'm wedged in the boot (on a proper fold down chair with a 3 point seatbelt - fear not) with all the shopping, which doesn't really increase comfort but I'm happily singing along to the songs. If they didn't go so slowly, I was tempted to tell us to tuck up behind the one lorry we find going our way, at least then if someone strays over towards us they'll meet the lorry first. The back seat drivers are silenced eventually and we plough on. It was with a mixture of relief and renewed concern that we reach the Kulamba turning. We are nearly home but we are now surrounded by drunk people. Mostly on vehicles or walking but some driving.
The pace slowed. We count over 50 people on the back of one truck. If it had an accident that would fill an entire ward at the hospital. There aren't enough doctors (even with us back) to deal with any significant accident tonight. As we pull into the driveway there is a deep sigh of relief. Note to us - next time we will leave the pool earlier - driving in the dark is for idiots...
Saturday, 25 August 2012
The first week at work
This week has been somewhat busy, getting settled in, getting accustomed to the hospital and learning the local pathology. We operate Mondays, Wednesdays and Fridays, with OPD Tuesdays and Thursdays. The day starts at 0730, and finishes when all is dealt with. There is normally a rush at the end of OPD, and ward problems to sort every evening as well.
The operations vary, with a lot of work being trauma related, either orthopaedic or wound management. I will write a bit more as the weeks go on, but to start on the orthopaedic side, we mainly deal with road traffic accidents and paediatric injuries. The image intensifier is currently broken, so we are doing MUAs, K-wires and ORIFs by eye, which is challenging. There are several people with major open fractures, who have external fixation, but we have to wait until their wounds heal on their own - there is no advanced plastic surgery to apply flaps. Most of the paediatric injuries are supra condylar elbow fractures, but we have had a spate of toddlers with femoral shaft fractures, all now in a row in Gallows traction.
The two most challenging things so far have been knowing the limits of what we can do - referral is possible (to Lusaka) but few patients can afford it, so working out if we should operate or not is tricky - and dealing with deaths which would not happen back home. We have had two toddlers die with burns of about 30%, a survivable injury with modern intensive care and burns therapy. We have only IV fluids, some blood and skin grafting. It is not possible to check the electrolytes even, which makes fluid balance near impossible.
Next week I go onto the on call rota, initially shadowing someone so I can pick up the ropes on the obstetric side. I'm looking forward to it, but with a degree of trepidation!
The operations vary, with a lot of work being trauma related, either orthopaedic or wound management. I will write a bit more as the weeks go on, but to start on the orthopaedic side, we mainly deal with road traffic accidents and paediatric injuries. The image intensifier is currently broken, so we are doing MUAs, K-wires and ORIFs by eye, which is challenging. There are several people with major open fractures, who have external fixation, but we have to wait until their wounds heal on their own - there is no advanced plastic surgery to apply flaps. Most of the paediatric injuries are supra condylar elbow fractures, but we have had a spate of toddlers with femoral shaft fractures, all now in a row in Gallows traction.
The two most challenging things so far have been knowing the limits of what we can do - referral is possible (to Lusaka) but few patients can afford it, so working out if we should operate or not is tricky - and dealing with deaths which would not happen back home. We have had two toddlers die with burns of about 30%, a survivable injury with modern intensive care and burns therapy. We have only IV fluids, some blood and skin grafting. It is not possible to check the electrolytes even, which makes fluid balance near impossible.
Next week I go onto the on call rota, initially shadowing someone so I can pick up the ropes on the obstetric side. I'm looking forward to it, but with a degree of trepidation!
Thursday, 23 August 2012
Starting to feel settled!
We are both getting into a nice routine. Mine perhaps slightly more comfortable than Geoff's because I'm still identifying projects and meeting new people. I have now read the majority of the papers I need to on Cost Effectiveness Analysis (and am in touch with our UK contact) but still have time to find myself reading my book occasionally.
I haven't yet explained who Nat and Will are and, as we have two new doctors this week, I think it's a good time. Nat is a GP trainee who is out here for a year - her husband Will is a professional wildlife photographer. He used to be an auditor for a company called PwC, who knew. Whilst Nat is attempting to save lives, Will has mostly been sorting his 12,000 photos of Ethiopian Wolves, or so he claims. Between times he's also managed to kidnap a chameleon to be his pet, photograph said chameleon and eat most of the muffins that Nat baked today.
Tomorrow he and I have a project. Separately we'd been thinking that what we really needed was a bucket shower. That way we are in control of the temperature and flow of water at all times. Sometimes the old methods are the best. Nat was pleased when she discovered I'd thought the same 'So we might get one soon? Because you are a do'er'. Sure enough the do'er has found the workshop foreman, got approval that they can make the things and found out where to find the stuff. Now all Will has to do is drive us to the shops... I think he got the easy part :) That said, neither of us has quite worked out how we'll rig up the frame we need to hang the thing off - one thing at a time, right?
The new doctors are Fiona and Rory. Both medics but Fiona has done ST2 and Rory F2. They are here for 6 months and will be doing the medical stuff (as opposed to surgical or obs and gynae). I managed to sneak on their tour of the hospital today so I've got a better grasp of where everything is. I'm summoning up the courage to be taken to the delivery ward and watch a delivery..... perhaps in a month. Apparently it's silent because the midwives don't let them make noise and there's no analgesia... but more of that when I've seen it.
Slightly confused this afternoon to find a little boy using my outside tap to fill about 100 bottles a) because I'm pretty sure that's theft and b) how was he going to carry them? Two hours later, as we left for dinner the answer presented itself - the rest of his family was going to pitch up and join in! I think I might have to intervene if they come back frequently!
This weekend we have planned another trip (aka sneaked ourselves onto Nat and Will's trip - they have the car) to Chipata where there's the supermarket and hotel with nice food. Nat insists that 'we' will actually go swimming this time because the weather has got much warmer. I'm not so sure about the increase in temperature! Although I did nearly get burnt today as I stood nattering / finding out all the politics with a volunteer on the building side - didn't quite have the courage to ask to relocate our conversation to the shade...
Next week there are 2 new doctors coming and 2 large groups of people. I am watching with interest how they might be accommodated. The 'new' houses I was shown at the weekend (due to be finished Monday) are exactly as they were and, according to John, exactly as they have been since last year...
I haven't yet explained who Nat and Will are and, as we have two new doctors this week, I think it's a good time. Nat is a GP trainee who is out here for a year - her husband Will is a professional wildlife photographer. He used to be an auditor for a company called PwC, who knew. Whilst Nat is attempting to save lives, Will has mostly been sorting his 12,000 photos of Ethiopian Wolves, or so he claims. Between times he's also managed to kidnap a chameleon to be his pet, photograph said chameleon and eat most of the muffins that Nat baked today.
Tomorrow he and I have a project. Separately we'd been thinking that what we really needed was a bucket shower. That way we are in control of the temperature and flow of water at all times. Sometimes the old methods are the best. Nat was pleased when she discovered I'd thought the same 'So we might get one soon? Because you are a do'er'. Sure enough the do'er has found the workshop foreman, got approval that they can make the things and found out where to find the stuff. Now all Will has to do is drive us to the shops... I think he got the easy part :) That said, neither of us has quite worked out how we'll rig up the frame we need to hang the thing off - one thing at a time, right?
The new doctors are Fiona and Rory. Both medics but Fiona has done ST2 and Rory F2. They are here for 6 months and will be doing the medical stuff (as opposed to surgical or obs and gynae). I managed to sneak on their tour of the hospital today so I've got a better grasp of where everything is. I'm summoning up the courage to be taken to the delivery ward and watch a delivery..... perhaps in a month. Apparently it's silent because the midwives don't let them make noise and there's no analgesia... but more of that when I've seen it.
Slightly confused this afternoon to find a little boy using my outside tap to fill about 100 bottles a) because I'm pretty sure that's theft and b) how was he going to carry them? Two hours later, as we left for dinner the answer presented itself - the rest of his family was going to pitch up and join in! I think I might have to intervene if they come back frequently!
This weekend we have planned another trip (aka sneaked ourselves onto Nat and Will's trip - they have the car) to Chipata where there's the supermarket and hotel with nice food. Nat insists that 'we' will actually go swimming this time because the weather has got much warmer. I'm not so sure about the increase in temperature! Although I did nearly get burnt today as I stood nattering / finding out all the politics with a volunteer on the building side - didn't quite have the courage to ask to relocate our conversation to the shade...
Next week there are 2 new doctors coming and 2 large groups of people. I am watching with interest how they might be accommodated. The 'new' houses I was shown at the weekend (due to be finished Monday) are exactly as they were and, according to John, exactly as they have been since last year...
Tuesday, 21 August 2012
And so we begin work....
It's at this point in particular that our experiences and working days diverge a little. Geoff (who will take over in a minute) has slotted straight in to the routine of Surgery with its ward rounds, Outpatient clinics (in the OPD) and operating lists.
Whilst he's off doing these things, I have slightly different tasks. I know of some areas where my help is needed or Geoff and I want to do some work but these are all reliant on other people. I either need them to explain things to me or help me get data or just give me permission to assist and make suggestions.
I have been told to work slowly and build relationships slowly. So on Monday I set myself 3 tasks
I try to find someone at the mess that can sort out the hot water (they seem to sort the accommodation) but I am directed to Mr Patrick who then says that another lady is in charge. She's currently away getting curtains made. Can I wait in the house for her? I can, but there's no indication of whether I might be waiting 10 minutes (unlikely), one hour (still unlikely) or half a day (highly probable). I settle down with a book under a tree. After a while I get bored of this and decide to search for Mr Mwale.
Located in his office I explain what I do back home and that I'm here to help in whichever way he feels would be most helpful. He says he'll think about what I can do and perhaps we can discuss tomorrow [tomorrow comes and goes but I don't go back to his office - pretty sure it can wait another day]. In there I also meet the man in charge of accommodation proper. We have a nice chat about where we'd like to move to and when. Casually I ask where he's going to put the couple that's arriving in a few days...... what couple? Aaaahhh, I sense that perhaps I might need to up the pace of my relationship building rapidly! Unless huge amounts of mould are to greet all new visitors [Note: it's actually highly unusual, we were just unlucky!]
At lunch a lady finds me and tells me she will come to look at the hot water at 14 hours (2pm). For a second at 14.02 I worry that I might miss her! Then I remember that I'm in Africa and settle myself under a tree. After 25 minutes she comes. Takes one look at the system and decides it's broken and she needs a man from the workshop. I think this is the equivalent of ringing the IT helpdesk and them telling you to turn it off and on again. I don't bother to mention that I have a Masters in Engineering and am able to identify a broken immersion heater!
After an hour (of intermittent labour) it's fixed (in theory). We can't check if it's really fixed because the water pressure isn't high enough to get the water into the feeder tank (about 5m off the ground) to feed the hot water tank. Perhaps in the evening we will have hot water!
Now I'm not sure what to do on Tuesday - I don't want to hassle people! The hot water wasn't very hot - I climb up to fix it myself - and then realise this is pointless because the pressure is not going to be enough at any point in the next two months to fill the feeder tank fast enough. I must accept we don't have hot water in this house (all the more reason to move!)
I start to read the WHO paper on Cost Effectiveness Analysis in developing countries. This is not a holiday - it's actually quite complicated - discount this, annualise that, use the life expectancy by age, convert costs from domestic to international prices... it's going to take me a while to get this work right! Thankfully I get a call from Geoff that we've been invited for coffee at the Professor's house. He and his wife are lovely! I feel even more at ease!
At the end of the day I've read over 70 pages, some Private Eye, cleaned some more, sent some emails and sat in the sun for a while. Happy times!
While Charlotte has been sunning herself, I've had an exciting couple of days. It is fair to say that theatres here are the most efficient in terms of patients per list that I have ever seen. On Monday, we had just finished doing an abdominal biopsy when the paediatrician arrived with a baby just born with a Gastroschisis (all the bowel outside of the abdomen through a defect in the umbilicus). Following some anaesthetic difficulties, we managed to reduce this - the baby is now on the Special Care Baby Unit (SCBU) and we have our fingers crossed. The rest of the list consisted of some paediatric hernias, fixation of a fracture and a laparotomy for bowel obstruction. All finished by half past five!
Tuesday is a ward round day (OPD doesn't start until 11am), so I took some time getting to know what was going on on my ward (Mukasa, the female surgical ward) which I am to look after with the other Geoffrey, who is one of the Clinical Officers. Again, there are lots of fractures, but this also houses the paediatric burns unit. These are mostly hot water scalds, but the children receive little or no first aid, so the scalds are deeper than seen in the UK. There is one two year old who has just received a horrible pan-facial scald - I'm going to tidy up her blisters in theatre tomorrow and we'll be able to judge how bad things are, and whether she has any ocular involvement.
The rest of Tuesday was spent in Surgical OPD. There is no appointment system - patients turn up every day of the week to be seen, and just wait in line. We have one room, with two doctors sharing a table, a translator and an examination couch. There is no privacy for the patients! Every history includes a question about HIV status, as it is ubiquitous and impacts on a lot of our surgical pathology. Clinic is however somewhat "quick-fire" - a patient with a fractured limb appears, you check the injury, look at the X-ray then send over for a plaster, or admit for MUA, all in 5 minutes. I think I saw in the region of 50 patients today, the final one was an 8 year old who fell out of a tree and had a stunning supra-condylar fracture of his humerus and no blood supply to his forearm. We called the theatre team in and manipulated it under anaesthetic, with partial success. It then turned out we needed to put a difficult catheter in under anaesthetic, then site a chest drain for a poly-trauma patient. So a late night, but another interesting day!
Tomorrow, we have 24 cases booked on two operating lists and have just added an exploratory laparotomy to the start of the list. I'll be amazed if we get it all done, but we'll just have to see!
Whilst he's off doing these things, I have slightly different tasks. I know of some areas where my help is needed or Geoff and I want to do some work but these are all reliant on other people. I either need them to explain things to me or help me get data or just give me permission to assist and make suggestions.
I have been told to work slowly and build relationships slowly. So on Monday I set myself 3 tasks
- Find and introduce myself to Dr Chisi - he is the Medical Superintendent and overall boss
- Find and introduce myself to Mr Mwale - he is the Manager Administration
- Get the hot water fixed
I try to find someone at the mess that can sort out the hot water (they seem to sort the accommodation) but I am directed to Mr Patrick who then says that another lady is in charge. She's currently away getting curtains made. Can I wait in the house for her? I can, but there's no indication of whether I might be waiting 10 minutes (unlikely), one hour (still unlikely) or half a day (highly probable). I settle down with a book under a tree. After a while I get bored of this and decide to search for Mr Mwale.
Located in his office I explain what I do back home and that I'm here to help in whichever way he feels would be most helpful. He says he'll think about what I can do and perhaps we can discuss tomorrow [tomorrow comes and goes but I don't go back to his office - pretty sure it can wait another day]. In there I also meet the man in charge of accommodation proper. We have a nice chat about where we'd like to move to and when. Casually I ask where he's going to put the couple that's arriving in a few days...... what couple? Aaaahhh, I sense that perhaps I might need to up the pace of my relationship building rapidly! Unless huge amounts of mould are to greet all new visitors [Note: it's actually highly unusual, we were just unlucky!]
At lunch a lady finds me and tells me she will come to look at the hot water at 14 hours (2pm). For a second at 14.02 I worry that I might miss her! Then I remember that I'm in Africa and settle myself under a tree. After 25 minutes she comes. Takes one look at the system and decides it's broken and she needs a man from the workshop. I think this is the equivalent of ringing the IT helpdesk and them telling you to turn it off and on again. I don't bother to mention that I have a Masters in Engineering and am able to identify a broken immersion heater!
After an hour (of intermittent labour) it's fixed (in theory). We can't check if it's really fixed because the water pressure isn't high enough to get the water into the feeder tank (about 5m off the ground) to feed the hot water tank. Perhaps in the evening we will have hot water!
Now I'm not sure what to do on Tuesday - I don't want to hassle people! The hot water wasn't very hot - I climb up to fix it myself - and then realise this is pointless because the pressure is not going to be enough at any point in the next two months to fill the feeder tank fast enough. I must accept we don't have hot water in this house (all the more reason to move!)
I start to read the WHO paper on Cost Effectiveness Analysis in developing countries. This is not a holiday - it's actually quite complicated - discount this, annualise that, use the life expectancy by age, convert costs from domestic to international prices... it's going to take me a while to get this work right! Thankfully I get a call from Geoff that we've been invited for coffee at the Professor's house. He and his wife are lovely! I feel even more at ease!
At the end of the day I've read over 70 pages, some Private Eye, cleaned some more, sent some emails and sat in the sun for a while. Happy times!
While Charlotte has been sunning herself, I've had an exciting couple of days. It is fair to say that theatres here are the most efficient in terms of patients per list that I have ever seen. On Monday, we had just finished doing an abdominal biopsy when the paediatrician arrived with a baby just born with a Gastroschisis (all the bowel outside of the abdomen through a defect in the umbilicus). Following some anaesthetic difficulties, we managed to reduce this - the baby is now on the Special Care Baby Unit (SCBU) and we have our fingers crossed. The rest of the list consisted of some paediatric hernias, fixation of a fracture and a laparotomy for bowel obstruction. All finished by half past five!
Tuesday is a ward round day (OPD doesn't start until 11am), so I took some time getting to know what was going on on my ward (Mukasa, the female surgical ward) which I am to look after with the other Geoffrey, who is one of the Clinical Officers. Again, there are lots of fractures, but this also houses the paediatric burns unit. These are mostly hot water scalds, but the children receive little or no first aid, so the scalds are deeper than seen in the UK. There is one two year old who has just received a horrible pan-facial scald - I'm going to tidy up her blisters in theatre tomorrow and we'll be able to judge how bad things are, and whether she has any ocular involvement.
The rest of Tuesday was spent in Surgical OPD. There is no appointment system - patients turn up every day of the week to be seen, and just wait in line. We have one room, with two doctors sharing a table, a translator and an examination couch. There is no privacy for the patients! Every history includes a question about HIV status, as it is ubiquitous and impacts on a lot of our surgical pathology. Clinic is however somewhat "quick-fire" - a patient with a fractured limb appears, you check the injury, look at the X-ray then send over for a plaster, or admit for MUA, all in 5 minutes. I think I saw in the region of 50 patients today, the final one was an 8 year old who fell out of a tree and had a stunning supra-condylar fracture of his humerus and no blood supply to his forearm. We called the theatre team in and manipulated it under anaesthetic, with partial success. It then turned out we needed to put a difficult catheter in under anaesthetic, then site a chest drain for a poly-trauma patient. So a late night, but another interesting day!
Tomorrow, we have 24 cases booked on two operating lists and have just added an exploratory laparotomy to the start of the list. I'll be amazed if we get it all done, but we'll just have to see!
Monday, 20 August 2012
You wanted photos, right?
With thanks to Will for explaining to the dummy how to make her photos small enough to blog :) [He doesn't know it yet but soon he'll be giving lessons in how to take good photos!]
Andrew's Motel
The accommodation before...
... and after!
If you are interested, the rock is actually keeping the hot tap turned off.... Well, I say hot tap, we don't actually have any hot water but I'm assured that if we did, it would come from there :)
Sunday, 19 August 2012
Starting on the wards
Following a final day of sorting ourselves out with some kitchen stuff and a nice lunch in Chipata, I thought some clinical bits and pieces might be interesting...
I'm just about getting my head around the male surgical ward, which accommodates somewhere between thirty and forty patients (the number of beds, and precise number of patients, is irrelevant, as there are a variable number on mattresses on the floor!) most of our patients are currently orthopaedic, with femoral, tibial, humeral or forearm fractures in various states of recovery from open repair or in traction.
There is really little that can be done in terms of post op care, so oxygen, antibiotics and fluids are the mainstay (and the limit!) of managing everything from fever (likely to be malaria) to chest pain and in between. There are a few peri op abdominal cases as well, mostly hernias, typhoid perforations and appendicectomies.
One major trauma (with stunning surgical emphysema from the waist up, pneumothorax and pneumomediastinum) has got a chest drain in, which I spent a bit of time sorting out this morning. There is no advanced imaging and no endoscopy, so we have no idea what he has injured and are very much hoping for the best...
My project for the six months is going to be sorting out the burns unit. This is a four bed side ward, which at the moment is full with patients with epilepsy and sizeable, ungrafted burns. One patient has his tibia exposed from knee to ankle. Looking at what is currently done here (minimal grafting with a Watson knife, no adrenaline infiltration and variable dressings) there is significant room for improvement. I'm quite excited that in six months things could be a lot better!
Tomorrow is my first day in theatre, with a mix of wound management, hernias, manipulation of fractures and a laparotomy for large bowel obstruction on the cards. How much we will achieve is yet to be decided - no one has a haemoglobin of greater than 8 and the blood bank is currently empty! We are now off for roast dinner in the mess!
There is really little that can be done in terms of post op care, so oxygen, antibiotics and fluids are the mainstay (and the limit!) of managing everything from fever (likely to be malaria) to chest pain and in between. There are a few peri op abdominal cases as well, mostly hernias, typhoid perforations and appendicectomies.
One major trauma (with stunning surgical emphysema from the waist up, pneumothorax and pneumomediastinum) has got a chest drain in, which I spent a bit of time sorting out this morning. There is no advanced imaging and no endoscopy, so we have no idea what he has injured and are very much hoping for the best...
My project for the six months is going to be sorting out the burns unit. This is a four bed side ward, which at the moment is full with patients with epilepsy and sizeable, ungrafted burns. One patient has his tibia exposed from knee to ankle. Looking at what is currently done here (minimal grafting with a Watson knife, no adrenaline infiltration and variable dressings) there is significant room for improvement. I'm quite excited that in six months things could be a lot better!
Tomorrow is my first day in theatre, with a mix of wound management, hernias, manipulation of fractures and a laparotomy for large bowel obstruction on the cards. How much we will achieve is yet to be decided - no one has a haemoglobin of greater than 8 and the blood bank is currently empty! We are now off for roast dinner in the mess!
What can be achieved with elbow grease...
So things always look better in the sunshine I find but infinite expanses of mildew and general grot appear to disobey the rule. We headed to breakfast quickly yesterday to meet the others and assess the relative dirtiness!
Buoyed by some friendly faces and nice chat over toast we feel emboldened to ask for different accommodation. It turns out that a couple of students only vacated our place on the morning we arrived and had told all the others that it was amazing. We showed them the photos of the bathroom - they looked shocked!
Geoff went to do the ward round with his new boss at 7.30am. He was also given a tour of the hospital. I've been promised a trip (perhaps today) to see but have been warned in advance. I am told to expect a great number of people lying on mattresses on the floor under blankets because there aren't enough beds. In some places there are two people to one mattress. These are friends or family?? No no, these are other patients - there aren't enough mattresses to go round.... oh.
On his return the rest of the morning was spent armed with Ajax. I've developed a new test for fridge interior designers. Once you are done, imagine that students have used the fridge and turned it off with the door shut. This means that every square inch of your beautiful interior is covered in mould (various colours). Further imagine that the person cleaning it has only Ajax and a cloth - can they do it? Many fiddly corners later and an extended period of time in the bathroom and things are looking up. We can at last wash ourselves. But of course, the hot water (not that it was particularly hot) has run out and there isn't enough pressure for a shower - cold bucket bath it is.....
We are shown a new 'house' (really a studio) that is expected to be finished on Monday. I look around - it is small but has the advantage of a total absence of mould - it will not, however, be finished on Monday. The water isn't working, there's no cooker and no fridge. More crucially there are no curtains and the room is overlooked on all 3 sides!! Despite the kind offer, we decline to move in straightaway.
In the afternoon we went for a 'run'. Well, the boys could run but I wasn't anywhere near fit enough. However, this did give me plenty of time to admire the rolling countryside, the hills partially hidden in the haze in the distance and a number of people making bricks. It really is very beautiful!!
In the evening we persuaded the others to go to the local community centre for a drink rather than retire to their respective rooms (at 7.30pm) and settle in for the night. Between us, Geoff, Will, Nat and I are determined to be sociable!! Let's see if it lasts :)
Buoyed by some friendly faces and nice chat over toast we feel emboldened to ask for different accommodation. It turns out that a couple of students only vacated our place on the morning we arrived and had told all the others that it was amazing. We showed them the photos of the bathroom - they looked shocked!
Geoff went to do the ward round with his new boss at 7.30am. He was also given a tour of the hospital. I've been promised a trip (perhaps today) to see but have been warned in advance. I am told to expect a great number of people lying on mattresses on the floor under blankets because there aren't enough beds. In some places there are two people to one mattress. These are friends or family?? No no, these are other patients - there aren't enough mattresses to go round.... oh.
On his return the rest of the morning was spent armed with Ajax. I've developed a new test for fridge interior designers. Once you are done, imagine that students have used the fridge and turned it off with the door shut. This means that every square inch of your beautiful interior is covered in mould (various colours). Further imagine that the person cleaning it has only Ajax and a cloth - can they do it? Many fiddly corners later and an extended period of time in the bathroom and things are looking up. We can at last wash ourselves. But of course, the hot water (not that it was particularly hot) has run out and there isn't enough pressure for a shower - cold bucket bath it is.....
We are shown a new 'house' (really a studio) that is expected to be finished on Monday. I look around - it is small but has the advantage of a total absence of mould - it will not, however, be finished on Monday. The water isn't working, there's no cooker and no fridge. More crucially there are no curtains and the room is overlooked on all 3 sides!! Despite the kind offer, we decline to move in straightaway.
In the afternoon we went for a 'run'. Well, the boys could run but I wasn't anywhere near fit enough. However, this did give me plenty of time to admire the rolling countryside, the hills partially hidden in the haze in the distance and a number of people making bricks. It really is very beautiful!!
In the evening we persuaded the others to go to the local community centre for a drink rather than retire to their respective rooms (at 7.30pm) and settle in for the night. Between us, Geoff, Will, Nat and I are determined to be sociable!! Let's see if it lasts :)
Friday, 17 August 2012
The one with the taxis...
This morning we were up early doors to do some chores before we headed out to the hospital.
First off we wanted to visit the motel that my Dad stayed in over 40 years ago (aptly named Andrew's Motel) so we headed to the taxi rank (cf petrol station forecourt) to find a car. The first man over says that a trip to the motel, stop for 5 mins and return to the Immigration Office (we missed Winnie overnight) would be 200,000 Kwacha (c.£26). I told him that this was unacceptable and he protested that the motel was a very long way away. The day before I'd been told it was 8km away and we finally settled on 70,000.
We went through the centre of town, past the President's Palace (he has a high wall and razor wire, and one of those silly mobile phone masts disguised as a palm tree), the Chinese Embassy, the Japanese Embassy, the Intercontinental, the Immigration Office. Then on past the 60s concrete blocks, over the railway, past the market. And then the buildings got sparser but on we went. After a while I was beginning to wonder if we hadn't been kidnapped, which would have been inconvenient given that it was now 9.30am and we had lots to do! However, a few minutes later we arrived - hopped out, took some photos then headed back to Winnie.
Our friends had managed to negotiate 90 day visas, rather than 10 days and we rather hoped to do the same. Winnie directed us to Catherine (the lady in the white shirt) who had the stamp. In the direction of the hand gesture were 4 ladies in white shirts. Catherine, it turns out, is desk 5. She agreed to give us 60 days and I could feel Geoff summoning up the courage to complain that she had given the others 90 days only yesterday - but I stopped him - a bird in the hand and all that!
And now for a taxi to the shopping centre - surely there are some near the Intercontinental. There we go a handful of blue cars. First driver steps forward and asks for 50kK. I refuse and say this is way too much (we managed to drive for an hour for 70kK, which I'm starting to feel slightly bad about). He says that's the price and I say I will ask another driver - they will all be the same is the response. OK then, I will walk. You can't walk madam!! [He's right but doesn't know it for 2 reasons - 1) I haven't the first idea where I am and 2) I have no idea where I need to go!] We settle on 30 before Geoff does a reverse negotiation up to 40. In the car the driver turns to him and informs him that "Madam clearly doesn't like to pay for taxis. Doesn't she know that taxi drivers don't earn very much money?" Clearly not.
At 13 hours (or 1pm) we were waiting for the transport to the hospital. When the car arrived it had clearly been picking up stocks. Geoff and I looked at the boot of the SUV then at our bags. The driver looked at our bags and then the back of the SUV. 'How long are you staying?' '6 months?' 'Why do you have so much stuff?' Stuff in the car we head off with me and Geoff and Charles in the front and Martha hidden somewhere under the bags and boxes in the boot. For the next 6 hours only occasional shouting and some singing reminded us she was there!
We got on to discussing qualifications. "What did you study?" "Engineering" I say. He laughs and says "aaaaa aaaaa" [broadly translates as yes, yes]. There is a pause. "It's a funny thing for a girl to study, isn't it? ;)" "Yes" he says "that's why I just said aaaaaa. If the car breaks down can you fix it?" Now I laugh loudly, "No, sorry, I can't". "I have a City and Guilds in car mechanics and systems" he says. I laugh more "Then you fix the car!"
So last night I asked what we could possibly need beyond towels and internet capability on arrival. The answer, it transpires, is industrial strength bleach!! The shower and the fridge are clearly being used to culture biological weapons......... I shall thwart the terrorists tomorrow. For now my hair shall stay unwashed!
First off we wanted to visit the motel that my Dad stayed in over 40 years ago (aptly named Andrew's Motel) so we headed to the taxi rank (cf petrol station forecourt) to find a car. The first man over says that a trip to the motel, stop for 5 mins and return to the Immigration Office (we missed Winnie overnight) would be 200,000 Kwacha (c.£26). I told him that this was unacceptable and he protested that the motel was a very long way away. The day before I'd been told it was 8km away and we finally settled on 70,000.
We went through the centre of town, past the President's Palace (he has a high wall and razor wire, and one of those silly mobile phone masts disguised as a palm tree), the Chinese Embassy, the Japanese Embassy, the Intercontinental, the Immigration Office. Then on past the 60s concrete blocks, over the railway, past the market. And then the buildings got sparser but on we went. After a while I was beginning to wonder if we hadn't been kidnapped, which would have been inconvenient given that it was now 9.30am and we had lots to do! However, a few minutes later we arrived - hopped out, took some photos then headed back to Winnie.
Our friends had managed to negotiate 90 day visas, rather than 10 days and we rather hoped to do the same. Winnie directed us to Catherine (the lady in the white shirt) who had the stamp. In the direction of the hand gesture were 4 ladies in white shirts. Catherine, it turns out, is desk 5. She agreed to give us 60 days and I could feel Geoff summoning up the courage to complain that she had given the others 90 days only yesterday - but I stopped him - a bird in the hand and all that!
And now for a taxi to the shopping centre - surely there are some near the Intercontinental. There we go a handful of blue cars. First driver steps forward and asks for 50kK. I refuse and say this is way too much (we managed to drive for an hour for 70kK, which I'm starting to feel slightly bad about). He says that's the price and I say I will ask another driver - they will all be the same is the response. OK then, I will walk. You can't walk madam!! [He's right but doesn't know it for 2 reasons - 1) I haven't the first idea where I am and 2) I have no idea where I need to go!] We settle on 30 before Geoff does a reverse negotiation up to 40. In the car the driver turns to him and informs him that "Madam clearly doesn't like to pay for taxis. Doesn't she know that taxi drivers don't earn very much money?" Clearly not.
At 13 hours (or 1pm) we were waiting for the transport to the hospital. When the car arrived it had clearly been picking up stocks. Geoff and I looked at the boot of the SUV then at our bags. The driver looked at our bags and then the back of the SUV. 'How long are you staying?' '6 months?' 'Why do you have so much stuff?' Stuff in the car we head off with me and Geoff and Charles in the front and Martha hidden somewhere under the bags and boxes in the boot. For the next 6 hours only occasional shouting and some singing reminded us she was there!
We got on to discussing qualifications. "What did you study?" "Engineering" I say. He laughs and says "aaaaa aaaaa" [broadly translates as yes, yes]. There is a pause. "It's a funny thing for a girl to study, isn't it? ;)" "Yes" he says "that's why I just said aaaaaa. If the car breaks down can you fix it?" Now I laugh loudly, "No, sorry, I can't". "I have a City and Guilds in car mechanics and systems" he says. I laugh more "Then you fix the car!"
So last night I asked what we could possibly need beyond towels and internet capability on arrival. The answer, it transpires, is industrial strength bleach!! The shower and the fridge are clearly being used to culture biological weapons......... I shall thwart the terrorists tomorrow. For now my hair shall stay unwashed!
Thursday, 16 August 2012
We have arrived!!!!
Hello our dear readers (I hope at least our mums are reading this!)
It seems that we have been a little lax in blogging over the last 2 weeks - probably because we spent most of our time saying goodbye and sorting things out [Like picking up two more Oximeters]. Thankfully these things have been done and we caught the plane yesterday evening..... so I am now writing this from Zambia. How exciting!
As eventful as ever my godson drove us to the airport and serenaded us with his best rendition of popular songs. The lady at the check in desk did not balk when we said we would like to check in 4 big bags (we had been told in advance we would be charged £11/kg for excess), tagged them up and then asked us if there was anything else..... errr, no!, and if you've forgotten to charge us for our extra 26kg then I'm not about to remind you!!!
Settling myself onto the plane I forgot about the time a few years ago when Geoff decided that watching Blood Diamond on the Oxford Tube on the way to a party was a good idea, and therefore asked him for a film suggestion. I am sure that 'The Best Exotic Marigold Hotel' is an amazing film but perhaps for sensitive types, who are leaving home to live in a developing country, it's not exactly what was needed...... However, I now have two mottos for this trip 1) 'If I can't pronounce it then I don't want to eat it!' and 2) 'Everything will be all right in the end, and if it's not all right then it's clearly not the end'
At immigration we dutifully got in the queue for permit holders. For some reason it was the slowest moving queue and at this point I considered making us move. However I filled the wait with watching the bags on the carousel. Yes, I can see 2 of the 4 bags, not bad, and that looks like a third. Oh now, that person's going to be upset - there's stuff hanging out of their bag. Hang on a second....that looks like our..... And we were at the front of the queue... we explained how we had the receipt for the permit application but so far no permit. This upset the man greatly! "Why are you here early? You cannot come in" Then "Leave me your passports and go and collect your bags and the man meeting you". Thank you! I'm more than happy to leave you a little red book that cost £100 - I'm much more interested in recovering our belongings from the carousel before other people do!!!
We were given permission to stay for 10 days and told to front up to the Immigration Office in Lusaka ASAP. A few hours later (I was hungry and there was the small matter of a letter to be written) we did so. There was no one on reception when we arrived and we managed to spend a good 10 mins finding someone to tell us what the process was - which was, obviously, waiting under the "waiting area" sign and hoping that someone would come...... We were sent to desk 7. No, none of the desks has numbers, why would they! And no one knows which desk number they sit at - why would they? From thence, we were directed to the lovely Winnie (desk 10 if you need her but she only does surnames Q, R and S). Yes, she had Geoff's work permit application but it wouldn't be decided upon until Tuesday. Can we come back next week? Of course we can, we only live 7 hours' drive each way from here, that will be no problem at all!
Thence to the confusing world of the mobile phone operators - I would recommend to others that they don't keep hold of their phones for 10 years or more - it's not that my phone doesn't work, it's that I don't know about all this new fangled technology. We have bought a router (but not the sort I'm used to!) that is wireless in every sense of the word (we are just reliant on electricity...) and data is about the most expensive thing - never again shall I complain about the cost of my broadband :)
Off to the hospital tomorrow - Nat and Will (you will hear lots about these guys) arrived late at night last week to discover that their house had nothing much other than furniture and bedding. Forewarned we will arrive prepared - with towels - oh and internet capability. What more could we possibly need?
Enough from us for now!
Charlotte (and Geoff - who is reading the Daily Mash)
It seems that we have been a little lax in blogging over the last 2 weeks - probably because we spent most of our time saying goodbye and sorting things out [Like picking up two more Oximeters]. Thankfully these things have been done and we caught the plane yesterday evening..... so I am now writing this from Zambia. How exciting!
As eventful as ever my godson drove us to the airport and serenaded us with his best rendition of popular songs. The lady at the check in desk did not balk when we said we would like to check in 4 big bags (we had been told in advance we would be charged £11/kg for excess), tagged them up and then asked us if there was anything else..... errr, no!, and if you've forgotten to charge us for our extra 26kg then I'm not about to remind you!!!
Settling myself onto the plane I forgot about the time a few years ago when Geoff decided that watching Blood Diamond on the Oxford Tube on the way to a party was a good idea, and therefore asked him for a film suggestion. I am sure that 'The Best Exotic Marigold Hotel' is an amazing film but perhaps for sensitive types, who are leaving home to live in a developing country, it's not exactly what was needed...... However, I now have two mottos for this trip 1) 'If I can't pronounce it then I don't want to eat it!' and 2) 'Everything will be all right in the end, and if it's not all right then it's clearly not the end'
At immigration we dutifully got in the queue for permit holders. For some reason it was the slowest moving queue and at this point I considered making us move. However I filled the wait with watching the bags on the carousel. Yes, I can see 2 of the 4 bags, not bad, and that looks like a third. Oh now, that person's going to be upset - there's stuff hanging out of their bag. Hang on a second....that looks like our..... And we were at the front of the queue... we explained how we had the receipt for the permit application but so far no permit. This upset the man greatly! "Why are you here early? You cannot come in" Then "Leave me your passports and go and collect your bags and the man meeting you". Thank you! I'm more than happy to leave you a little red book that cost £100 - I'm much more interested in recovering our belongings from the carousel before other people do!!!
We were given permission to stay for 10 days and told to front up to the Immigration Office in Lusaka ASAP. A few hours later (I was hungry and there was the small matter of a letter to be written) we did so. There was no one on reception when we arrived and we managed to spend a good 10 mins finding someone to tell us what the process was - which was, obviously, waiting under the "waiting area" sign and hoping that someone would come...... We were sent to desk 7. No, none of the desks has numbers, why would they! And no one knows which desk number they sit at - why would they? From thence, we were directed to the lovely Winnie (desk 10 if you need her but she only does surnames Q, R and S). Yes, she had Geoff's work permit application but it wouldn't be decided upon until Tuesday. Can we come back next week? Of course we can, we only live 7 hours' drive each way from here, that will be no problem at all!
Thence to the confusing world of the mobile phone operators - I would recommend to others that they don't keep hold of their phones for 10 years or more - it's not that my phone doesn't work, it's that I don't know about all this new fangled technology. We have bought a router (but not the sort I'm used to!) that is wireless in every sense of the word (we are just reliant on electricity...) and data is about the most expensive thing - never again shall I complain about the cost of my broadband :)
Off to the hospital tomorrow - Nat and Will (you will hear lots about these guys) arrived late at night last week to discover that their house had nothing much other than furniture and bedding. Forewarned we will arrive prepared - with towels - oh and internet capability. What more could we possibly need?
Enough from us for now!
Charlotte (and Geoff - who is reading the Daily Mash)
Wednesday, 1 August 2012
Pulse oximeter
I have just been to collect the pulse oximeter we are taking out for the hospital, courtesy of Lifebox and Smiletrain. This piece of incredibly simple kit (its a small box with a screen and a finger tip probe) will hopefully improve the safety of anaesthesia in St Francis' by monitoring oxygen levels in patients' blood.
Now I have finished work it is all becoming rather close, and the pile of stuff we are taking out is getting larger. I'm in the process of packing up the flat and heading home to Newcastle for a visit, before departure on 15th August.
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