Who's who II

The second installment of the who's who for the hospital: mostly our
nursing staff here.

Liz Bennett -- usually introduces herself as 'they call me bossy
Bennett' for reasons that I don't quite understand; not actually that
bossy at all. Has a love/hate relationship with her computer which I
have become embroiled in, and has a huge heart for our nursing students
here at the hospital. Also has a HUGE cat named Tinker who I think
could probably eat my cat in one gulp if he wanted to.

Jan Matthews -- described as a 'real pot of gold' by one of the visiting
doctors, she's approaching the retirement age but still manages to
giggle like she's 16. She has the ability to put on a semi-miraculous
spread of food at her house with seemingly no effort and is the
instigator of many of the cakes that we eat during tea time. She's been
in Zambia for almost as long as Zambia has been a country. A real
prayer warrior with who knows how many notebooks filled with prayer
requests that go back years.

Michelle Proctor -- everyone's favorite pediatric nurse, with a
fantastically happy black lab named Bouncer because he shares a
Tigger-like enthusiasm for chasing such delicacies as small rocks and
pebbles. Amazing gifts of hospitality. Comes from the land of Beatrix
Potter, who's biography we were (forced) to watch one Friday evening.
She braves the spider-filled cavern of our storage area more than anyone
else. Despite being an excellent nurse and friend, I think she'd quit
the whole shebang to open up a Starbucks branch in Kasempa, if the
opportunity were to arise.

Ruth Green -- assumed the role of youngest medical staff ex-pat from me
when she arrived this summer; from Northern Ireland yet is brave enough
to at least consider going to a Catholic church for services every now
and then. Has an unfortunate lack of knowledge for cooking Irish
delicacies, however, so we're having to remedy that little by little
(taught by non-Irish folks). Willing to help me out by putting feminine
hygiene products that I was asked to buy into her own shopping basket.

Kate Stimson -- a Londoner transplanted to rural Africa; spent the last
two years as a nanny in England while taking a break from her nursing
duties. A good source of British slang like 'brilliant' and 'mental'.
The primary tutor for Ruth's Irish baking deficiencies. Also just
arrived this summer.

Alfonsina Tembo -- one of our dedicated locals who's passing up fame and
fortune to work at a place like Mukinge. Full of sensible ideas and
willing to call you out if you're doing something wrong (ie, drinking
your Coke before you eat your meal). My neighbor and fellow gardener,
along with her duplex-mate Susan. A brilliant laugh.

I could continue to go on for the pharmacy staff, lab staff, business
office, maintenance staff, ZEN's, and so forth, but I'm getting tired.
I think you get the picture that it's very much a team effort here.
Even now as we are putting together this planning document for the
coming year we've had so many different people with different expertise
lend a hand. As John said, it's a good feeling when you're able to
pitch in and help out a bit, even in places that aren't your
'responsibility'. Without everyone, we wouldn't be able to do what we
do on a day-to-day basis.

control freak

One of the interesting things I've noticed about myself is that as I get
more involved with the management at the hospital, I find myself feeling
that things which I used to just shrug off now bother me a bit more. I
think this is because of the illusion of control that doing stuff with
management gives me. For instance, when the power went off for three
days when I first arrived, it didn't bother me very much. We've had a
lot of problems with the power recently as they try to fix some of the
power grid infrastructure, but there's an illusion that I can do
something about it by deciding to run the generator, or call the power
company. Even now that I'm in the communication loop so that I hear
that the power will be switched off and back on at a certain time, when
it goes three hours later, I find myself getting frustrated, when I
think if I didn't know anything I would care less. It's an strange
phenomenon, and I need to learn to let go of things that I have the
illusion of control over, but actually have the exact same amount of
control over that I had in January.

the devil you know

I've got a patient right now with a big white spot on his lung, coughing
up blood, and losing weight. He's been gradually getting worse over the
past few weeks. We are having fairly regular doctors' rounds every
Friday where we discuss cases that we're not sure what to do; one of the
things that we find is that we often make decisions not on necessarily
what we think is going on, but what we think we can treat. So the man
with the spot on his Xray; could be cancer, could be TB, but we can
treat the latter and not the former, so we give him a diagnosis of TB
and treat him as such. Same with the woman with the swollen lymph nodes
in her leg. Or the man with blood in his CSF -- could be a bleed, or
could be encephalitis, but we can only treat the second one.
This obviously leads to overuse of some resources on patients that don't
have the diseases that we are treating them for, and skews our success
rates for treatment of certain diseases. It also makes explaining
prognosis to patients and families difficult (e.g. "I'm going to start
you on some medicine, but I don't really think it will help, since I
don't think you actually have TB"). I struggle with the right way to
approach these patients, however, because I think that false hope and
wastage of resources aren't really good things, but missed diagnosis of
treatable disease is also a bad thing. So we usually err on the side of
treating them.

who's who part 1

As people here at Mukinge get on the internet and take a peek at this
blog, I'm reminded of how often I don't mention the people that I work
with. Part of that is intentional, because I always found it to be very
boring hearing stories about people I'd never met and would likely never
meet. However, it does a disservice to the amount of work everyone puts
in and makes it seem like I'm working in a vacuum, which I assure you
that I'm not. So, at the risk of causing trouble with my brief
portraits of the people that I work with, here's the brief bios of the
admin people and doctors I work with:
Jairos Fumpa: the man in charge, although he refuses to be called the
man in charge, but rather the 'acting' man in charge. That probably
gives you an idea of the kind of man he is: humble, hard-working. He's
been here for a long time now, and is the glue that holds the place
together, the man with the memory of why we decided to do things that
way from 10 years ago. Be careful, though, or he'll whisk that cataract
out of your eye before you can blink. Has about the most outgoing 5
year old son you could ever imagine, who loves his bright yellow
Nigerian outfit.
Kingsley Kuwema: the man trying to keep up with the onslaught of HIV in
the area -- a race against time and before the west gets tired of
funding the effort here in Africa. He runs a math course for adult
education on the side of his house. If you think your building project
was bad, he has been building a house now for ten years in a nearby town
and still hasn't finished -- but he's a man with vision like that. Good
thing for our HIV program, too.
Lynn Hacker: our jack-of-all-trades administrator, nursing supervisor,
OR coordinator, and anesthetist. She's from Wisconsin but her accent
places her someplace between Norway and New Zealand after living out
here for so long. Makes her own bread and seems to have a miraculous
supply of things like decaf coffee which she shares liberally. She
hosts a rather rag-tag group of us every Friday for videos which range
the gamut from a little cheesy to very moving. I'm not sure exactly
where Spy Game fits on that spectrum, though.
David Friend: more African medical experience than the rest of the
doctor staff put together (including our Zambian doctor!). A man with
the ability to make the word 'hmmm" express a thousand different
emotions. Gets big and strong by eating nshima (Zambian corn meal mush)
every day. Somewhat of a health nut (of course, by my standards running
50 feet is a health nut) by getting up around 5:30 every day to go
running in the 40 degree weather. He's the deputy pool director while
he's here.
Edgar Mutimushi: my closest match in terms of experience and medical
training; finished his medical internship last year and reported here in
January out of that. Always with a chuckle and a smile, and a maniac
UNO player (okay, perhaps I exaggerate a bit). Has a very sweet wife
who shares my love for How To Cook Everything.
John Griffiths: you won't see a pair of bushier eyebrows around, but I
should speak softly lest he trounce me even more thoroughly than normal
on the tennis court. I was toying with the idea of making a John
Griffiths day of the week calendar featuring a different button missing
on his shirt daily; the practice of getting them all buttoned in the
morning is difficult for him. Easily the most analytical of us and
well-read; always tracking down answers and challenging you (in a
friendly way) to defend your decisions. Perhaps has a little bit of
poor judgment, however, as he engaged in a American poetry trivia
contest with me, an American and English major. Adopted 2 children from
Russia for a total of 5.

Next week: part 2: the RN's and other folks around the area.

VIP treatment

We had the national police commissioner in the hospital this week after
he arrived after a stroke on Monday. Like most places in the world,
stroke care here is never very satisfying, once the deficits have begun
there's little that you can do, except make sure that it doesn't get
worse. Certainly the lack of CAT scanning makes neurological medicine
feel like you're trying to use an axe to remove a splinter; the tools
you've got just aren't sophisticated enough for the detail that you need
to treat properly.

Certainly we see a fair amount of neurological issues -- right now I've
got 4 women on female ward with various neurological complaints -- one
with high fevers and left arm/leg weakness who we suspect may have a
brain abscess, one with pleasant dementia, not talking, and left leg
weakness who we think may have PML, and two with garden-variety strokes
due to poorly controlled blood pressure. One particularly difficult
situation is the mother whose daughter and mother are both in the
hospital, lying in beds next to each other, one with the suspected brain
abscess and one with a stroke. Her life will change dramatically as she
struggles to care for two invalids at home.

But what was remarkable about the police commissioner was the amount of
people that came by to visit, call, text message, or otherwise inquire
about his status. I'm constantly amazed at the power systems and the
deference given to people of position; from a western perspective it
sometimes seems like toadying, but it's really a different flavor and
emphasis than having a bunch of people come by to see the boss in the
hospital would have at home. It's hard to define, but it's a more
relational concern, and merely marks the co-mingling in so many African
relationships of business and friendship to a degree that we don't have
at home.

Fortunately for me, I survived the onslaught of attention from the
government offices checking up on us (at least I hope that I acquitted
us okay) and he was transferred back to the capital two days ago, where
I hope he arrived well. I'm sure I will hear more follow-up in the days
to come.

the $200,000 patient

Sometimes working in the hospital is like pulling a string out from my
grandmother's crocheted afghan (which I'm missing with the cold weather
right now): you think you're just picking out a loose thread and all of
a sudden whole sections are coming unraveled. Part of the problem of
constantly being underbudgeted (our budget for all the drugs, lab
supplies, X-ray films, and medical stores like IV's, tape, gauze etc. is
$500 this month) is that things are deferred until they can't wait
anymore and then are patched together with whatever solution you can
afford. But later when you try to solve problems, you find that the
problem was actually part of a solution to another problem, so then you
have to fix that one as well, etc.

Case in point: we have trouble keeping our oxygen concentrators working
properly (if anyone knows of a biomedical servicing company that would
be willing to come or that we could send someone to train at, the info
would be appreciated), so back in February I tried to buy three more for
the hospital. One of the nurses that works here, Liz, got her church to
donate another one and pay for the transport. Unfortunately, the
customs clearing house here has a backlog of around two years of
packages that had been sent to the hospital, the local girls school, and
the now-defunct services department, all of which were lumped together
in the same boxes and we owed them around 360 pounds (there's a way to
do the fancy pound sign but I don't know it). So we had to sort out the
different things people owed, much like sorting out a restaurant check
with a bunch of cheapskates who are divving out their 10% for the waitress.

At the same time, we had to get the hospital truck working again so
that we could pick up the boxes; it has two bad tires so we created a
income-generating project to use the truck to raise money for the
tires. At the same time, the battery has gone dead for the truck so
that was borrowed from the generator, but we've had power outages
because the local grass fires have been burning some of the electrical
line poles, so we've needed to use the generator some recently. And of
course, you can't run an oxygen concentrator without electricity, so
we've made it full circle in trying to get the oxygen concentrators here.

Tracing through those threads is difficult even when you've been part of
the decisions to make them; trying to trace through someone else's
decision-making process is nearly impossible. Needless to say, trying
to take care of a small need for one patient often ends up costing much
more and taking a lot longer than you hoped -- I ordered the
concentrators in February, and we will hopefully get them this weekend.

hungry hungry hippos

I took the initiative to expand my language training this week by
scheduling regular meetings with one of the local elders who has taught
several previous 'muzungus' to speak better Kaonde. Steve and Heather,
our local Peace Corps workers, think that it may be effort better spent
elsewhere as there are almost always translators available, and learning
Kikaonde is like learning Icelandic, or Latin -- you're unlikely to ever
find someone to speak with outside of the local area. Even in Zambia,
when I travel to Lusaka I can't really communicate very well. But you
notice a big difference in the way patients see you when you learn the
language; even a few words provokes laughter throughout the ward
(good-natured laughter that you're speaking Kaonde, not laughing because
it's so bad) and smiles and a torrent of information that you just don't
get when you use the translators.

Anyway, I started meeting with Mr. Kapanza this week, and enjoyed my
time immensely. One of the things he's struggling with this year is a
very poor maize crop; although he worked really hard and planted a lot
of maize, about February 3 hippos came and stayed for a week in his
fields, eating all of his hard work, so that he only ended up with maybe
1/10 of what his crop would have been. It's illegal to kill hippos,
although the game wardens are supposed to do it for you if a situation
like that happens. Unfortunately, the wardens didn't show up until even
a week after the hippos had left, obviously at which time the damage had
been done. The hippos returned again 2 weeks ago, a fact which amazes
me since our river isn't that big (maybe 15-20 feet across at the
widest), but the harvest had been finished at that time. The game
wardens once again arrived to late to chase the hippos, so they are
still roaming at large. Maybe they'll show up again if they get hungry
enough....

Holiday time

Hello again to all of you out there in America and far-flung parts of the world!

I realize it's only been a month since I last wrote, and I hope that these emails aren't becoming annoying.  I've been sitting around eating bon-bons this month as I elected to have a vacation and see some of the sights of Zambia with two friends of mine that came out to visit from Denver.  It's holiday season in Zambia as this Friday marks the end of school for 6 weeks until September.  Taking a holiday from work was a good thing just to get a break from the grind of suffering and sickness.  We had our breath taken away by several scenes in the game park and at Victoria Falls, but I won't try to overburden the email server with too many pictures in this email.  Zambia (and Botswana) can be incredibly beautiful, sometimes something you forget when the hospital trash pit smells like burning rubber and you've seen another leg covered in warts, or pus, or burned down to the bone.

That being said, I've been glad to be back at the hospital.  I had missed seeing several of the young teenagers who I had been caring for the past few weeks, and managed to get a few good pictures before they flew the coop.  Hospital life continues to have its share of frustrations -- our water pumps (2 of 3) have broken, so that part of the compound has no water at all, and the rest of us are on water restrictions.  We're trying to get these problems fixed but when things have to come from Lusaka, it moves slowly.  Meanwhile, the people you work with are having trouble even cooking or taking a bath.  I find it difficult to know what the proper response should be -- should I invite 20 people over to my house every day to take a shower?  I think I probably don't end up doing enough for my co-workers.

One of the difficult (maybe the most difficult) part of becoming a government hospital is our requirement to be landlords and provide free housing for all the government staff that work at the hospital, around 100 or so workers.  I feel like I spend a lot of my time trying to solve community living problems rather than medical problems and a lot of our funds are spent on problems like the water pump or fixing toilets, instead of on medicines, etc.  On the other hand, if we are going to make a difference here in Kasempa, one of the major impacts will be how we treat the people that work at the hospital and show them love, provide jobs, allow for fulfilling vocations, and so forth.  You shouldn't run a hospital without first taking care of your nurses, lab technicians, radiographers, doctors, etc, so things like housing are important as well.  But it's a problem that western hospitals don't have to face, and it's frustrating for us, because we don't have the funds to treat all of our workers the way we think they should be treated and we'd like to be treated ourselves.

I've decompressed my clinical workload so that I have more time to spend learning some surgical techniques and so forth.  I'm okay now with skin grafting and closed orthopedic things.  I still need lots of practice with hernias and hydrocoeles, and obviously anything bigger than that is still a little ways off.  But I'm becoming more of a jack-of-all-trades doctor (a 'bush' doctor, as they like to be called) in addition to just becoming a jack-of-all-trades person -- learning some more Kaonde, figuring out the nuts and bolts of computer networks, tinkering with some motorcycle maintenance, doing a bit of gardening, figuring out how to de-worm the cat, learning some African-style hymns to play on piano, and so forth.  I find it difficult to always want to be flexible -- it's nice to be able to define your job and say 'this is what I do', so that you don't get overwhelmed with requests to do other things -- but that approach doesn't work here and you have to be cheerful when something unexpected comes your way (like it does almost every day).

Thanks for your prayers and support.  We are still working on the Friends of Mukinge non-profit donation conduit, thanks to all of you who've been asking.  I will be sure to send out an update when that comes online.  Keep praying for our patients; we have so many for whom we can only do very little. 

I'll close with my GQ shot of me leaning against the frame of the picture with our newly purchased bags of maize.  We are buying up all of our maize for the coming year right now; our cups overflow with corn!  (note the Chuck Taylors)

Love,
Matt