cat saga, volume 1

Okay, ether was unsuccessful, mostly due to difficulties cornering the
cat in an area where the ether could work. So I decided to take a page
out of my boyscout handbook, and set up a trap. The market sells a
variety of dried fish, ranging from minnows to more substantial perch;
the smaller sized ones are called kapenta, and for about 3 bucks you can
get a grocery sack full of it. The kittens have been hanging around
outside the nursing college, next to the malnutrition ward of the
hospital, so I went with my sack of kapenta to win the cat's trust.
It's a little cat with big ears, mostly orange and black, and it seemed
pretty friendly.
I hadn't counted on the kids from the malnutrition ward coming wanting
to eat the kapenta, so I had to give some away, and try to reconcile
with scattering food on the ground outside the malnutrition ward. We do
provide food for all of our patients, with special supplements for the
nutrition ward, so I didn't feel too bad.
After about 30 minutes squatting even closer to the kittens as they ate
the fish, I then went in search of a box on the wards, which I propped
up with a stick. Unfortunately, I couldn't find any string, which is
tough to come by at times. Fortunately, the girls at the nursing school
had recently re-done their hair and there were synthetic hair extensions
in the trash, so I made a string out of hair, sat back and waited, and
-- voila! -- I caught the kitten!
After a careful transfer with various pieces of cardboard, I brought the
kitten back home, where I put it in my shed in the back, which is a
pretty reasonably secure area. I didn't carefully inspect the roof
line, however, and it got out through the crack between the wall and the
ceiling. So tomorrow I will return to the nursing college, armed with
fish and box and stick and hair. We'll see if I can be more successful
tomorrow.

baths on the beach

Mukinge was built in between two hills to take advantage of the natural
springs here and ensure enough water in the dry season. We get a little
inundated during the rainy season, though, and the water pumps and
filters have trouble keeping up a little bit. When that happens, we get
some 'friends' in the bathwater, so that after I finish my bath, the
water looks like I came home from the beach and brought a load of black
sand with me. At least that's what I tell myself, because I hope that
I'm not carrying around that much dirt on myself before I get in the
bath. I have developed a pattern of filling it with extra hot water
(the hot water heater tends to collect the dirt) and letting the dirt
settle out and cool off a bit. You can't totally avoid the dirt, though
-- when we scrub for surgery and rinse off the soap, there's usually
some pieces of dirt stuck on our arms from the rinsewater. People seem
to do okay, though.

communication issues

Well, the aftermath of the buying trip to Ndola was less successful than
I hoped. I purchased the wrong type of tape, and several parts of the
order were missing, despite the multiple checks at every level. We have
a lot of packing tape, but no masking tape, unfortunately. These sort
of things seem unavoidable, but are still frustrating. Never having
thought of myself as having a real strong accent, I've had a lot of
people frustrated with me this week as they haven't understood what I'm
trying to say, the colloquialisms/slang/accent getting in the way, I
guess. Of course, I take solace from other people's similar struggles
-- the Indian shopkeeper from whom we ordered a lot of bleach -- 'JIK'
-- who didn't have enough and sent his shop boy to the store down the
road to buy more to fill the order. The shop boy returns with a pile of
soap -- 'CHIK'. (try saying the two with your best Indian accent, and
you'll see what I mean).

the local walmart

There is no such thing around here, however, we do have some interesting
combinations of stores -- my favorite is the shop that provides arc
welding, haircuts, and car washes. I mean, what else do you really
need? The BOMA is bustling these days with several new stores,
restaurants, and all the local produce. I've been buying tomatoes by
the bucketful, especially since now I don't have to carry them all the
way home on my back or in a flimsy plastic sack. Now I pile them all in
my plastic carton on the back of my scooter and rush back home -- what
used to take 2 hours for shopping now takes me 30 minutes.
We tried eating out for the first time the other week -- Ghanian feast,
to be exact. Not bad, although a bit pricey for what I expected.
Certainly no Chinese Peking Duck feast or anything like that. I think I
saw a new restaurant open up last week, though, so maybe I'll check that
out.

names

A few of my favorites:
Blabby
Fatness
Skinny

Can't wait for the first kid to be named after me, although I think I
may be waiting awhile. Fortunately, I have a leg up because one of our
nurses' last name is Matthews, which I am going to shamelessly count as
my own name if someone is named Matthews. In fact, Matthews seems to be
a much more common name here: I'm not sure if that's because Jan's been
around for so long or if it's a trick of Kikaonde pronunciation. But
it's the book of Matthews in the Bible, and most people are named
Matthews, not Matthew. Most people think that my name is Matthews as
well when I introduce myself, so I think I'm perfectly justified in
claiming any newborn Matthews while I'm working on maternity.

business in Zambia

Well, my trip to Ndola was eye-opening, to say the least. (it looks
like my pictures didn't make it through, either -- bummer) Here's a
example of me trying to buy some cloth to make some OR drapes:

Go into store, where there are about 9-10 men standing behind various
counters. No one makes eye contact.
Go up to man, ask where the heavy-weight calico is, get vague gesture
towards cloth bolts across the room
Go over to other side of room, begin looking at cloth, none of which is
labelled
Ask second man where the heavy-weight calico is, get vague gesture that
intersects the line of the other man's gesture about halfway
Look around in general area, find some canvas and silk.
Ask third man to take me and show me the calico
He takes me over to a bolt of cloth standing literally 1 foot away from
where the 1st man was
I ask how much the cloth costs
I am told 14,000/meter. I frown. I am told 13,000/meter. I frown. I
am told 12,000/meter.
I say I would like to buy some cloth, and ask how much is on the bolt.
He says around 30 meters.
I say okay, I would like to buy the bolt. He takes the bolt over to the
table, and begins stripping it off the bolt, measuring it in a vague way
by arm widths.
I am told there is 40 meters. I say I would still like to buy it. We
then proceed to roll up the bolt and now measure it again using a ruler.
I am told there are 49 meters. I say I would still like to buy it.
They begin folding up the cloth.
I say I would like the cloth to be put back on the roll. They recruit
three other men to help them roll it up, foot by foot. I am told the
price will be 14,000/meter.
I frown. I say they agreed on 12,000/meter. The boss comes over and
agrees to give it for 12,000/meter.

Pretty much everything I buy works the same way. Tiring, to say the least.

photos a-comin'

Think I may have figured out how to email photos to the blog. Let me know if there's some pics....

On the way to Ndola

Got out and took a road-trip today to Ndola, a town in the copperbelt
region of Zambia. It was my first time on the road out of Kasempa, the
town where Mukinge is located, and it's always good to see the
countryside from the window of a car instead of flying over it. I am
going on the trip to buy supplies for the hospital. We don't have any
sort of supply mechanism to ensure regular deliveries of our medical
supplies or maintenance needs, so someone from the hospital (usually our
pharmacist, Tamar) goes on these buying trips to purchase what we need
about once a month. We were due to gather supplies from about 5
different pharmacists along the way; they have names like "Chemopharm",
"Pharmaking", "Briking", "Biochem", and "Netpharm", and are all run by
expat Indian shopkeepers. The first place we stopped wasn't expecting us
until the next day and hadn't prepared anything; the second one we
couldn't find, when we called for directions he would not give them but
rather wanted to come meet us where we were, and after an hour wait he
arrived and told us that he wasn't ready and we needed to return later.
I was a little irritated that we had now been travelling 6 hours and had
nothing to show for our efforts so far. The places in Ndola, however,
have been more prepared.
We can only fill the back of one Land Rover, so that limits what we can
buy. I am responsible for about 8 million kwacha of the hospital's
money in addition to various checks for at least that much. Needless to
say, carrying around a stack of cash around 4 inches thick makes me a
little nervous, especially since our hospital executive director had his
car stolen and money robbed waiting at the gate of the guesthouse where
we are staying just last fall. I feel a bit like George on Seinfeld
when I try to stuff all that cash in my wallet and sit down -- not too
comfortable.
But it's good to have a few more of the comforts of life; we ate at an
Indian restaurant called Country Fried Chicken tonight when I had good
Chicken Tandoori; I haven't eaten out at a restaurant since I made it to
Mukinge. Tomorrow I will try to use the high speed internet and perhaps
clear away the updates for my antivirus program and windows which
continually remind me that I haven't updated now for three months. We
have a TV in our room at the guesthouse, and I watched the news for the
first time for awhile. Zambian TV news is luridly shocking; they will
regularly show pictures of half-charred corpses and
death/destruction/mayhem. The lead story tonight was about a woman who
was murdered and had her 'private parts' cut away. I can't say I miss
not seeing that on a daily basis. On the more positive side, I enjoyed
my first shower in Zambia today; think I must have used my entire
allotment of hot water for the week at once. Can't wait to do it again
tomorrow.

book burning

Had my atavistic fill today when I went through and got rid of the
out-of-date textbooks in our medical library. The library is kept on
several white wooden shelves in the doctor's office; it's a mixture of
books from various eras (leprosy surgery from 1930, HIV brochures from
last month), spiderwebs, and old mud burrows from the wasps and
termites. So I went through and swept away the old dirt and culled out
some of the outdated and redundant books that we had around. I'm told
that the last time they were sorted through they used them as ballast at
the end of a lightning rod grounding -- today I had more fun as we took
them out to the dump pit and burned them. It's surprisingly difficult
to burn books, especially without kerosene to douse them with. I think
given how many times I've heard about book-burnings that it would be easier.
The procession out to the dump was entertaining: although it's just a
few hundred yards, we arrived with only about half of the books that we
set out with after being stopped by various people along the way. The
local policemen really wanted both the copies of the PDR (a
pharmaceutical compendium put out every year -- quite massive) from both
1998 and 2000, so if they want to prescribe some viagra, I think they
will be covered. Also escaping the Fahrenheit 451 were two copies of
the Christian Doctor Quarterly from 1992, which one of the guys from the
workshop (his name is Diamond) wanted to have for reading. One of the
local villagers wanted to leaf through Manson's tropical diseases. When
I was in the village I was struck by how people would take anything to
read if it was available. But apparently I underestimated the
entertainment value of new techniques for gallbladder surgery. I will
make sure to check around a bit more before burning any more books.

you're too good to me

Just wanted to put out a public thank you to all of those who have sent
me stuff already, I feel so loved and supported with oodles and oodles
of spices, shoes, books, etc. You are all too good to me.

The river is here

Our daily runs (actually I've become quite lazy over the past two weeks,
not getting out nearly as often since my running shoes were drenched by
the cleaning woman) were abruptly curtailed this week as the bridge was
flooded away. This apparently is a yearly, if not more frequent,
occurrence as I was informed by the man I met crossing the river in a
canoe that he had made from half of a tree's bark, peeled away like a
tamale wrapper and good for about three crossings over the water, I
would estimate (maybe he could stretch it to 4 and get back to the side
he started from). The bridge is usually kind of a miracle of sticks
and logs and tree branches held together with bark rope; it's always an
adventure when we are running in the morning whether it will hold at
all. We occasionally get crocs and hippos when the river is really
high, like it is now, but so far, we haven't seen hide nor hair of them.
The rains, after rotting my garlic, are beginning to show signs of a
little bit of a break; I'm told I will miss them when April rolls around
and I'm shivering in the cold weather (no fireplace at my abode, unlike
most of the places out here). For right now, though, I could do with a
change of pace with the weather.

I fought the law and the law won

Was out joyriding on the motorbike I am planning to buy today when I got
pulled over by the cops for not wearing my helmet. Actually, I wasn't
really sure they were the cops, since they weren't wearing any uniforms,
and I nearly just drove on by, which I'm guessing would have made things
much worse. But they pulled me over and began to harrass me.
Eventually they 'impounded' the bike, which consisted of me hauling it
up into the flatbed of their pickup truck and driving to the police
station, where I commenced to have an interview with the local traffic
officer. I must be becoming more African because I was able to talk him
into dismissing one of the charges, rescue the bike from the impound,
and even drive it back home without my helmet. I am now a proud owner
of a ticket for 'cycling on a motor cycle without a crushed helmet'....

not for the faint of stomach

I know that some of you don't like hearing about the gross medical
stuff, so those of weaker stomachs should probably skip onto the next
entry. The hospital has undergone some big changes recently, with the
arrival of a generalist from New Zealand who feels comfortable in the
theater and a second surgeon from the states who is here for a little
while to help us all get training better in our surgical experience. So
all of us have been trying to spend some time in the theater to improve
our skills, and my big case this week was an interesting woman who I had
seen earlier in my time here with a baby and a large extra-uterine mass,
which was easily the size of the uterus, if not larger. At the time
that I saw her before, she was too early to do much about the mass, but
now with surgical backup we elected to do a C-section and then remove
the mass. Her stomach was so huge that she could only get up by rolling
to the edge of the bed, swinging her legs over the edge, and then
pulling herself up to a sitting position from the side.
Fortunately, the baby did well, and I managed to scoop out a huge tumor
from her left ovary that was the size of two basketballs and filled with
greenish-brown fluid, as I discovered to my dismay when one of the cysts
popped and spilled all over my shoes. Amazingly, there doesn't seem to
be any spread of this thing to anywhere else, and her post-op course has
been fairly smooth, so maybe we were able to help her. And the baby was
named after the RN who did the anesthesia, too!

What you need

I hear over and over in your emails to me about how hearing about needs
in Africa puts a perspective on our own troubles and tribulations. I am
glad that we each take the time to examine ourselves and think about how
we are provided for, but I think it is a difficult and dangerous thing
to compare 'needs' or to try to rank them, one against another. As was
pointed out by a friend of mine, our ability to live out the
opportunities we have been given to the fullest is the measure of
happiness and fulfillment for many of us, and need is felt more in the
lack of what we know we could be than the lack of what we know we
can't. "To him to whom was was given, much will be expected."
I think Caedmon's Call put it well on their album "Share the Well":
I did not catch her name I did not catch her tears
It hit me like a train when her story hit my ears
Mother of 8 sons father off to war
Got no home address just bricks on a dirt floor
She said "Jesus is all I need"
Tiny plot of land corn stored up in piles
The years it doesn't rain just stay hungry for awhile
No fatted calf to kill she made a feast of qui and corn
Said who else knew my name before the day that I was born
She said "Jesus is all I need, Jesus is all I need"
She bragged about her boys how they're growing into men
How they learned to praise the Lord -- old-style, Ecuadorian
To buy the new guitar they had to sell the swine
Said my boys go to school on a foreign angel's dime
This world calls me poor I bore my babies on this floor
He always provides sure as the sun will rise
So I sing him songs of praise because I know he keeps me in his gaze
Rain fell from the sky, we raced back to the van
Tears in the eyes of this poor, forgetful man
Mother of 8 sons, she knows the peace of God
Lord, help me learn to lean on thy staff and thy rod
Jesus is all I need, Jesus is all I need.

a quick plug

Can't say enough for Mark Bittman's How to Cook Everything, which has
been my constant companion in the kitchen and has plenty of chatty
things to say about nearly everything related to cooking. If you like
to cook, or think you might like to cook, or hate cooking but have to do
it anyway, it's awesome. I have followed his advice on everything from
eggplant curry to quiche to frosting and every time it comes out great.
Okay, that's the last you'll hear from me about that.

The toll of working at Mukinge

As my last post intimated, it's pretty easy for me to get in over my
head here in Africa. Currently I'm juggling a lot of hospital
responsibilities, educational responsibilities, and various projects,
etc which keep me up at night. I was struck by how many of the
long-term missionaries here suffer from chronic, stress related
illnesses -- 3 people with chronic migraines, another 3 with insomnia,
several others with depression -- and I can't help but feel that that is
a direct result of working and living in a setting where resources are
scarce, information is sketchy, and communication with the outside world
is poor. Certainly as I push myself past what I've been trained to do
-- ultrasound for malignancy staging; surgical techniques for which my
training is limited at best, non-existent at worst; pediatric
chemotherapy; gastroscopic endoscopy -- I find myself rather than
becoming more confident, becoming more hesitant, because I never get to
do the things that I'm good at anymore -- ER resuscitation, diagnosis,
etc. Fortunately, my fingernails are still long and my aphthous ulcers
have remained quiescent, so I guess I'm currently being protected
against the ravages of stress myself.

laundry daze

Today was laundry day, which always carries a fair amount of risk with
it. Vegas has nothing on the science of predicting the chances of rain
at any given hour, and success or failure is often measured in seconds,
with cloudbursts appearing from the chronically grey sky with little or
no warning. Today I lost the gamble in a big way, with my laundry
ending up with not just one, but three extra rinses, which was in some
ways good, since it all got splattered with mud after the first
'rinse'. In general we've hit the middle of the rainy season with a
vengeance, with my front yard more often than not having an inch or more
of standing water in it.
Laundry also carries the general risks of bleach spots -- note, black
socks and bleach don't mix well -- various other stains not being
removed, and today we had a new twist, with my household worker deciding
that my shoes were too dirty and washing all of them. I now have very
clean but very wet shoes, which usually take about a week to dry (at
least they did last time) with no sun to dry them during the day. I
would have never thought to ask her not to wash my shoes. I'll add it
to the list.

trials in the OR

This week has been a bit of a stretch for me as I take over the hospital
administrator position from Curtis. Fortunately, we now have excellent
surgical backup which saved me from near disaster from a lady with a
c-section. A combination of factors made it into a bloody mess, but
thank God that he has brought two surgeons here currently that were able
to give me a hand.
I'm struck as I go about rounds about how much less sure of myself I am
here than in the states -- part of it is working so far out of your
comfort zone, part of it is the lack of information and working in the
dark, and part of it is being so newly out of residency and not working
in the specialty that you trained in. It was nice to get some
educational materials from home and listen to what was news in the ER
world in the states, at least in November. I'm sure that I will
continue to get more comfortable about trusting my judgment as time goes
on, but it is hard at times right now.