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!
Sunday, 19 August 2012
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.
Wednesday, 25 July 2012
Proper explanation of what we are doing, where and why!!
What are you doing and why do you have this blog?
Short version - My husband (Geoff) and I are going to work in a hospital in the middle of nowhere in Zambia (more specifically - Katete in Eastern Province). He will be doing all things surgical (quite literally) and I will be helping to run the hospital and doing anything non-medical that needs doing. My primary motivation is to see if I can have some sort of impact (however slight) on the lives of some of the people out there, as well as to get a deeper understanding of Africa, the people and the animals. I look forward to coming back with a different perspective on life and exactly as pastey white as when I leaveWhat's the hospital like?
The hospital (St Francis' Hospital, Hospital website) is a charitable organisation that survives partly on donations (of time, money and kit). Geoff and I are doing the time bit but if you wanted to help on the other fronts that would be very much appreciated by the hospital and its patients (http://www.justgiving.com/CharlotteisinZambia). We intend to keep this blog whilst we are out there so you will be able to see the impact of your donation and the general standard of the hospital! I would recommend you spend a few seconds looking at the photos on their website to get a feel for it
It is a large and busy Church Administered Hospital focusing on providing treatment, especially to the most vulnerable in society (typically local farmers) and providing training for health professionals. The hospital serves the local district, Katete, which has a population of 220,000. It has 360 beds (60 of which are for children under 5 - the age of maximal illness) and about 400 staff. It is also a second level referral hospital for the Eastern Province, total population of 1.2 million, in conjunction with Chipata Hospital (Government run). The area is about the size of mainland Scotland.
The hospital doesn't have too much time for collecting statistics but to give you an idea, I have included an extract from their newsletter. In 2010 we had 93,038 Outpatient attendances (that’s 255 per day) and 22,608 Admissions (62 per day!). The hospital electricity bill was 420 Million Kwacha (£53,846) and we used 35 tonnes of maize to feed the patients. 5,148,000 tablets of Septrin were dispensed in 2010 - Septrin or more accurately Cotrimoxazole is a prophylactic drug given to patients with HIV.
What will you and Geoff be doing?
Geoff and I will be living in accommodation provided by the hospital (in the grounds) and will be working in the hospital every day (at least when we aren't in the local game reserve, which we hope to be for occasional weekends!). Geoff will be providing support to the resident medical staff - this will include but not be limited to assisting with Caesarean sections, amputations (mostly of limbs after snake bites) and 'acute abdominal emergencies' - quite! I will be an assistant in 'Administration and the Workshop' - if they think that I will be that helpful in the workshop then I'm afraid they might be deeply disappointed but I will do my best!
What will you do outside of working?
We won't have any need to leave the hospital grounds as our accommodation is there. We can also eat very cheaply (but not very excitingly) in the hospital canteen. The local shops are a reasonable walk away and the closest place you can pay by credit card or get pasta is a little over 100km…. as I said - middle of nowhere. Being so close to the equator it gets dark early, and the electricity supply isn't always perfect so there will be long dark evenings to fill. I think that will leave plenty of time for reading and, if Geoff gets his way, playing games! We should have internet access (perhaps intermittently) and will hope to write a blog covering our exploits. In addition, we will have homework - by collecting data on surgery and its outcomes, we hope to be able to feed in to an ongoing study run from the UK that seeks to understand the cost and lifetime value of surgery in developing countries. This information is then compared to the outcomes of other interventions - e.g. mass immunisation, provision of free mosquito nets etc - to see whether aid is being channelled in the most efficient manner.Did you say that I could help?
I have set up a justgiving page to make it easier for you to donate money if you want to. I have set the target at enough money to fund one hospital bed for one year and buy 5 Oximeters. Oximeters are used to measure the oxygen levels in the blood of sedated patients - both during operations and in intensive care - and they are a key patient safety tool. The WHO says that no operations should be undertaken without one.(http://www.justgiving.com/CharlotteisinZambia).
Tuesday, 24 July 2012
Preparations!
The preparations are now in full flow (although I have so far failed to link the explanatory text I have written to this page about what exactly we are doing!), which is probably a good thing given that it's only 3 weeks until we fly. Am pretty sure that was 4 weeks only a day ago - time seems to be moving very quickly. Am sure it will speed up!! And the day will be upon us........ more than likely before Geoff has located the mosquito net that he claims we own!!
In the meantime - here's a map of where we are going to! [aka middle of nowhere]
In the meantime - here's a map of where we are going to! [aka middle of nowhere]
And here is the entrance to the Maternity Ward (I think I prefer the heading above the door - I wonder if it's still there!)
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