blooming season

My bluebonnets are turning out even better than I hoped they would, and
September, despite the ever increasing temperatures, is an amazing time
where most of the trees burst into bloom. It's actually quite amazing,
considering that there has been not a single drop of rain for 5 months
now, but the trees know to expect the rains in a few months and are
preparing for another season of flowering and growth. It is really
beautiful, especially the jacaranda trees which look like giant purple
afros, the flame trees with their masses of red blooms, and the
beautiful white and yellow tree out in front of my place, which
basically looks like it has grown wedding bouquets at the end of a
hundred dried sticks. I'm proud that the bluebonnets picked now to
bloom as well; it's a testament to American solidarity with the African
plant life.

Kaonde lessons

I've been trying to have a little bit of improvement in my Kaonde by
studying in a nearby village once weekly for the past two months. I
really think that language learning is such a great tool to helping
patients feel comfortable and welcomed when they come to the hospital.
I think learning the language is a great way to get insight into the
culture and ways of thinking of the people that you are working with as
well. For instance, last week I learned that Kaonde doesn't have a way
to express "I have to" -- ie, I have to go now, or I have to write a
blog entry since I have not written one in almost two weeks. You can
say "I should" or "I want to", but the idea that you are at the mercy of
time constraints or external pressure just doesn't exist. Everyone is
seen to have a choice about the way they spend their time and energy,
and circumstances are relegated to a secondary role.

updates

For those who I haven't let know personally, I will be managing to come
home for about 10 days this October to take my oral boards and attempt
to get some early Christmas shopping done for the folks here at
Mukinge. If any of you have a little time in Chicago or Texas during
Oct 12-22, let me know and we'll see if we can get together!

long overdue -- ER days

Well, if anyone is still reading after such a long hiatus, I'm still
here. It's been a busy few weeks with various people out of the
hospital on trips, so I've been playing a few roles: OPD officer,
occasional anesthetist, surgeon, and so forth. But I actually got a
chance to be an ER doc a week ago Monday when we had a motor vehicle
accident appear with 14 passengers at around 4pm. The nature of all
transport in Zambia is that in any one accident there are lots of
victims; all cars or trucks are pretty much filled to bursting wherever
they go because there is no other way to get around. Even at the trauma
hospital where I trained, if 14 patients showed up to the ER
simultaneously it would cause a bit of a stir; here it nearly overwhelms
us every time that it happens. We default to our 'emergency plan' which
I revised a few months ago.

We were finishing up a case in the theater when we got word that they
were arriving; I scrubbed out and went to the female ward. We had to
stage a little traffic direction to bring everyone to a place where we
could triage them -- sort out who was the sickest, the next sick, and so
forth. Unfortunately, one man had bypassed the queue and gone straight
to the theater, and although he was pretty sick, there were two people
who needed to go to the OR more; one with a bilateral broken legs, and
one with a head injury.

The man with the broken legs had lost so much blood en route to the
hospital that by the time he reached the theater he died. We started
CPR and started four IV's and transfused him, and he came back for about
30 minutes, but we were unable to get enough blood into him and he died
again; this time not to recover. The second man with the brain injury
died the next day. The rest are still mostly here 10 days later,
recovering from their various orthopedic injuries as they try to figure
out ways to get transport back to where they were originally supposed to
be going.

With the arrival of the paved road to Mukinge a few years ago, things
like this will become even more common, but the protective things that
shield people from serious injuries in car accidents at home -- seat
belts, sturdy seats, air bags, antilock brakes, decent tires -- are
still a long way off. Most of these accidents come not from two people
hitting each other, but from the vehicle breaking down en route -- blown
tires, failed steering, and so forth. It's sad, because the things to
take good care of trauma patients are pretty basic: availability of
someone with surgical skill, ample blood supply, and decent transport of
accident victims to the hospital.