So long, sucker

So long, sucker, originally uploaded by mattcotham.

This has been my temporary bridge to sanity for the past two months as I

have given up on my phone ever working properly and the vagaries of

dial-up internet. This pint-size package plugs into my computer and

allows me to talk to all of you, at least briefly and with a minimum of

pictures.

BUT.....The awaited promised day is soon to arrive, where I can call

home using Skype, and get pictures, and watch edited Lost episodes on

abc.com -- the VSAT! The satellite dish has been delivered, the

installation team has been scheduled to arrive on Thursday, and

hopefully by next Monday, without too many snafus, we'll be in

business. Updates to follow....

African yard sale

I had the opportunity to participate in my first yard sale in Africa
this weekend. Two of the missionaries who have been here for a few
years are moving back to New Zealand in a month, so this weekend was the
cleaning out of their house and selling off of all those useful things
which aren't worth the cost of shipping -- furniture, sheets, dishes, etc.
Muzungu yard sales are a much anticipated tradition here at Mukinge,
mostly because shopping experiences are so limited so it's a chance to
get some stuff that's different from the usual things you can buy.
There are tales of sales of people climbing over fences to get in early,
clawing through bushes, and hiring bouncers for crowd control at
previous events. It's more like opening day for tickets for Star Wards
than a yard sale.
This weekend was a tamer version, however, with people lining up only 2
hours before the event, and only about half the hospital staff skipping
out of work to come. Despite that, the stuff was mostly gone in 30
minutes, and by the end of the sale everything was completely gone
except for a few videos left behind; a striking difference to my yard
sale in Denver where the men came by to steal my golf clubs in the early
morning hours but I still had over half my things leftover after two
days of sale. Total raised for the local orphanage from the sale
yesterday: around 3 million Kwacha, which roughly translates into around
$750.
I will admit to not being immune to the pleasures of the yard sale; my
purchases were a lavender shower curtain to go with the pink and peach
ones that I already own, a waste basket (been looking for 2 months for
one), and a sprinkler to replace the one that got stolen last week. Not
a bad haul.

experimental chemotherapy

I've got a man on the ward these days who presented with a large growth
on his testes; like most people here, he waited until it got really big
and started bleeding until he came into to see us. There's a few
elements of community education that I'd really like to see emphasized,
but one of them would definitely be the idea that presenting earlier for
unexplained masses is a really good idea. Like the guy in the bed next
to him, who has a mass that's at least 8 inches across eroding through
the skin, pushing his cheek out and his ear closed. Or the guy in the
bed next to him, who's got a big fleshy mass in the back of his throat
which is gradually cutting off his windpipe.
We do have limited chemotherapy, and our reading said that this could
likely be Burkitt's lymphoma in his groin, so we decided to give
chemotherapy a go. Chemo is really specialized at home, with good
reason, as these drugs are pretty evil -- one turns you so toxic that
you have to even wipe their nose with gloves for 24 hours (that one's a
derivative of mustard gas from WWI) and when you pull them up in
syringes they are thick and have these weirdly beautiful and
deadly-looking oranges and reds, so it feels like injecting some strange
type of jello into his veins.
So I put on my gloves, and pulled up my array of orange and red-filled
syringes, and ran through with him about how he'd lose his hair. I
transferred the guy three beds down to the TB ward so he could cough
over there while we were waiting to determine if he had TB or not. So
we gave the meds, and now we wait and see if there will be any shrinkage
of the tumor. This is fairly experimental, however, because we don't
really know what we're treating (the chemo doctors at home won't treat
anything until it's been examined by a pathologist); so we weigh the
options and take our best guess. We'll see how he does.

Emailing: tennis partners

Emailing: tennis partners, originally uploaded by mattcotham.

These are the Griffiths, my tennis partners. You can see the somewhat

rehabilitated tennis court in the background. Construction is still

ongoing....

Transport trouble

One of the constant demands and problems for people here is transport --
with distances that range up to 70 kilometers and no regular public
transportation, even no people with a car that live out that direction,
people have to cobble together whatever means of transport they can find
-- bicycles, finding a ride with the mining trucks, various people going
around or good samaritans willing to give them a ride. Today we had a
case that highlighted that for me: we are the referral hospital for two
district hospitals that don't have a surgeon or higher care. An HIV
woman was admitted to one of these hospitals with severe diarrhea a week
ago; they decided that they needed us to treat her more aggressively, so
they wanted to send her on. They have been having troubles with their
ambulance, so they sent her on a Bethlehem-like journey on the back of a
bicycle for a three-day journey to arrive here today, weak, dehydrated,
and very ill. Now this is mostly just plain negligence to transport a
very sick person that way, but it also highlights the difficult
decisions that they have to make without a working ambulance and without
other options.

Our welcome sign

Our welcome sign, originally uploaded by mattcotham.

I think this speaks for itself. I especially like the phoenix-like

depiction of the chicken on the left being transformed into the serving

platter.

My email spot

My email spot, originally uploaded by mattcotham.

I currently am emailing using a 'cell-phone modem', which is basically a

cell-phone that plugs into my computer and allows me to connect to the

internet. I don't get good cell coverage in my apartment, so my current

system is to go outside and sit in my pink lawn chair (also known as a

'lazy-man chair') with my laptop on my knees, my hoodie on, and the cat

gnawing at my toes while I watch the sunset or contemplate the mass of

lettuce that I'm about to harvest from my garden next week (what I'm

going to do with 35 heads of lettuce, I'm not quite sure; gotta work on

having my gardener space out the planting a bit). Occasionally I get

treated to sunsets like this (taken by one of the visiting docs) or the

incredible night sky filled with billions and billions of stars, to

quote Carl Sagan. Next photo project -- picture of the stars.



One downside from having so much natural exposure is the fact that my

malaria risk has gone up immensely as I sit outside at dusk while

emailing and get bit by the mosquitos. That should tail off here as the

rainy seasons have ended. I think it's a good trade-off anyway.

Success!

Success!, originally uploaded by mattcotham.

This man came in after he had tried to commit suicide by slashing open

his throat. Psychiatric care is one of the things that I really

struggle with here in Zambia, partially because my language skills are

still rudimentary, partially because we have only basic medications to

treat people with, and partially because the follow-up is done by

untrained personnel, if at all. Who knows if this man will do okay at

his house or not. When he arrived on early Sunday morning a week ago,

he had cut most of the way across his windpipe, so that he was breathing

out of the hole in his throat. I was called out of bed to see someone

who 'had a cut on his neck"; I asked if it could wait until I was to

come in to the hospital a few hours later and they said I should come

see him now, and we went to the OR where I put a breathing tube down the

hole and tried to sew up his trachea around it. He unfortunately had

cut through the larynx, above the vocal cords, so he kept draining

saliva down through the wound; however, as the wound healed up this got

to be less, and we finally took him back to the theater where we put a

tube down his throat from above and sewed up the external hole. And he

is doing great, able to talk, swallow his saliva, and looks much

better. We've been praying pretty hard for him here, and the surgeon

says that people he worked with say that they've never had a patient

with a tracheostomy survive in Africa, so he's a testament to the grace

of God. I'll put the follow-up picture next.

Plastic surgery extravaganza

Plastic surgery extravaganza, originally uploaded by mattcotham.

This past week we had a marathon plastic surgery clinic. Generally once

or twice a year a visiting Serbian plastic surgeon flies out to see us.

To prepare, we send out letters about 1-2 months in advance asking

people to come to the hospital to see him; we generally get about 60-70%

of people to actually come. These people start coming to the hospital

on Wednesday, where they get admitted, and the surgeon flies in on

Thursday, operates Thursday and Friday, and then leaves on Saturday. We

generally finish operating at around 8-9pm on Thursday and Friday, so

it's a long day for the staff.

This kid, Goodson, was scheduled to have a bilateral cleft lip and

palate repair; he got there on Thursday and was scheduled for surgery on

Friday but started running a fever and having bloody diarrhea. We had

to cancel his surgery on Friday because he was too sick to go under

anesthesia, and we prayed for him at prayer meeting in the morning (we

have daily prayers at 10:15 every day). Sure enough, the next day his

fever was gone, his diarrhea had gotten better, and we squeezed in his

surgery before the surgeon had to go. This is how he looked today!

Next week we do the same thing with a visiting orthopedic surgeon. This

is pretty much the only way to get surgical sub-specialty care out here,

and we still feel the need for urology and ENT follow-up for patients

that right now have nowhere to go.

Speaking of surgeons, our current surgeon is scheduled to leave in

January of next year and no replacement has been found; if you know

someone who might be willing to come, let us know!

Tracheostomy part 2

Tracheostomy part 2, originally uploaded by mattcotham.

Looking good!

legends of the fall

May has begun to bring about some change in Zambia.  After 5 months of hot, sticky, wet weather and rain, we've entered the fall, with cooling temps (down to the 50's at night) and beautiful, sunny days.  The grass is starting to turn brown after 3 weeks of dry weather.  I'm now the proud owner of a somewhat crooked shower and a 2 month old cat with really bad breath.  I also enjoy a large amount of pink furniture, with a pink lawn chair and shower curtain.  And after only 6 months here, it is starting to feel more and more like home. 

The hospital continues on much as usual.  Our fortunate budgets for the past few months have ended, so we had to make some hard choices this month at the finance meeting and still budgeted over 5,000,000 Kwacha (about 1,250 USD) more than what we expect to receive.  Our usual budget is around 17,000 USD/month, from which we pay the salaries of around 150 employees, buy drugs, lab reagents, postage and paper, IV fluids, gloves, tape, plaster of paris, etc.  We're trusting that the additional funds will come from somewhere.  It's a bit of a step for me to do that sort of thing, being the son of two accountants, but it's been a good experience for me.  I've personally settled in a bit better to my role as the manager of clinical services, with the educational responsibilities and meetings that that entails.  I've still been covering the pediatrics and TB wards, with a little help out in the radiology and anesthesia realms.  It keeps me interested, and I even had a few cases that were vaguely ER related this past month -- heart block, a man who cut through his windpipe with a sickle, insecticide poisoning -- which helped me feel somewhat competent, as opposed to all those malnutrition cases that I see on pediatrics.

I had a much more traditional 'missionary' month, with preaching in the local church two Sundays ago, various Easter responsibilities, and leading worship for the SIM retreat.  All were somewhat stretching experiences for me but went on reasonably well.  Our missionary staff has grown closer here on the station, and we thank you for your prayers.  We still will likely need some docs starting in February 2008, so you can starting asking your friends and neighbors if they want to come out!  At the same time that I was a more traditional missionary, I also enjoyed my first taste of tourist Zambia, with a 2 day stop-over at a nice hotel coming back from retreat, and a few purchases at the local curio shop.  We've also resurrected the local tennis court here at the station, and although it could use a little work, the only points I win are when the ball takes a funny hop off the cracks, so I'm not pushing too hard to get it fixed.

I've enjoyed hearing from each of you.  Communication has improved immensely since I bought a cell-phone modem which uses cellular technology to get on the internet.  You should check out the blog if you haven't recently -- it's a veritable multimedia experience (www.mattcotham.blogspot.com).  It's been good to be in better touch, although it still routinely takes me around an hour a day to download my messages, so don't expect 24/7 responses.  Next step: satellite internet, supposedly coming for the second stage of set-up in 2 weeks.

A few pieces of news which may be of interest to you donors back home:  thanks to the hard work of one of my college friends, Leslie Park, we are in the process of creating a non-profit organization in the states which will forward all funds directly to the hospital, with a small fee taken out to support the local church (2.5%).  Hopefully for anyone who's not donated through the usual SIM channels because of high administration fees, this will be a vehicle to ensure that your funds get straight to the hospital where they can help the most.  We expect to have this up and running by the next month or two.

Also, after some discussion with the management of the hospital, we are also contemplating converting one of the wards into a more intensive-care area, where sicker patients could get closer nursing care.  This will involve remodelling part of a ward, installing an oxygen system, buying some equipment, and so forth.   I'm therefore going to send all my donations made to my account at WMM to this purpose, unless you specifically ask me to send it somewhere else.  We're hoping to raise around 30,000 USD to get this done.  We're already making good progress towards the goal, thank you for all your contributions!

Miss all of you.  Would love to hear about your travels (especially those who have made it to Africa since I've been out here!) life events (lots of new babies out there) and other things going on.  I am relaxing the email restriction on photos sent to me since I've got a better connection these days, so a few cute pictures of babies or other things wouldn't be amiss.

Talk to you all soon,

Matt

illustration2

illustration2, originally uploaded by mattcotham.

illustration

illustration, originally uploaded by mattcotham.

Thought this might illustrate my previous blog on child safety. This is

Linus, who fell in the fire after a seizure and burned the right side of

her face. She's a beautiful girl.

grocery shopping

grocery shopping, originally uploaded by mattcotham.

This is the local grocery store; there's a bigger collection about 3

miles away, in case you're out of luck at this one. Fortunately, this

one stocks a good supply of the basics -- candy, flour, and toilet paper

-- so in an emergency you can get fixed up.

Look out Roger Federer

The inaugural tennis match of 2007 came off without a hitch as we found
the tennis net buried in the back of the musty housing container,
nestled between two wasps nests and a hopelessly tangled amount of
clothes hangers. We even found some cans of tennis balls that were
still pressurized from the 1990's; there must have been some serious
tennis players here in the past. After blatantly ignoring the
instructions taped to the cable, we managed to get it strung up and had
our first (sort of) game of tennis, where I lost 3-1. The tennis was a
true African experience, starting off with about 8 people on the court,
wildly swinging rackets and hitting the balls into the surrounding
brush. We still need to fix the fences at the ends of the court, but
fortunately several of the crowd of children stuck around to help
retrieve balls in between their time dribbling the basketball around me
while I tried to hit the ball back to John. Today I must have been
asked by 15 people if I played tennis; I guess news travels fast here at
Mukinge. Next up: wash off the court so you can see the lines well; I'm
currently looking for a hose long enough to stretch from the nearest
house. After that, I think we need to build one of those high chairs so
we can have a proper line judge -- you all know how competitive I am.

child safety

I must admit, I've made a little fun of the over proliferation of child
safety restraints and laws in the US -- I can still remember sliding
around the backseat of our old yellow Buick when I was a kid and the lap
belts were too big to hold me down. And yet I managed to escape serious
head injuries. However, I'm hit by the amount of negligence/accidental
injuries suffered by children here -- hot porridge burns down their
front, crush injuries from putting their fingers in the maize pounder,
broken arms from picking fruit from trees. Obviously children are
expected to grow up faster here -- marriage in the teens, working the
fields when 7-8 years old -- but there's also some room for the
regulations which keep kids safe. On the other hand, it's nice the
freedom that kids have to be kids here as well. I'm sure there's
probably a middle ground somewhere.

poor choices

poor choices, originally uploaded by mattcotham.

This was attempt number three at climbing to the top of the screen door

-- I let him find his own way down this time. He hasn't climbed up

again....