Merry Christmas!

Finally got back on email and had all these wonderful Christmas
greetings awaiting me. Thank you all! I made homemade eggnog, and
sweet potatoes are still awesome all the world over, and Christmas is
way more fun when you're an adopted uncle. Thinking of all of you for
the holidays.

Love,
Matt

Ants in my pants

Quite literally today, the ants crawled up my pants, as I am visiting
one of the elderly missionaries on the station who's been a bit ill and
wondering how I can suavely smush the ants beneath my scrubs without
seeming like a strung-out meth addict. The fecundity of African bugs
requires a second sense to avoid breathing them, bathing with them, or
drinking them in your water. The bugs range from the beautiful --
moths, preying mantises -- to the large -- some crazy jumping
rhino-looking beetle and of course the palmetto bugs, near and dear to
the heart of anyone who's lived in Houston -- to the organized --
termites, army ants. I'm reminded of Pilgrim on Tinker Creek, when
Dillard describes the water bug eating the frog, and the sheer volume of
life that the bugs represent. The amount of alteration that the
termites put on the landscape is a testament to their numbers and their
impact.
Occasionally you will get a stream of ants migrating from one place to
another, and the only recourse is to get out of the way. Apparently you
can control the flow with ashes, a practice which reminds me of building
dams in the street gutters when I was a kid. And it leads to
fascinating voodoo-like rituals of ash circles around your bed and
doorsills to try to keep them out. I sprayed my doorway to get rid of
the regular ants (this practice is strongly discouraged with the
migrating ants, as it tends to send them into a swarming frenzy) and was
pleased to have a little pile of dead ants in front of my door for at
least 2 weeks. Apparently the Raid here is a big stronger than the US
-- probably DDT or something. I have fortunately been free of the
marching version of the ants in my house to date, and have lived in
harmony with the bugs, although something has recently broken the truce
(did they hear about the ant pile-up in front of the door?) and is
giving me bites on my arms and legs that appear when I wake up. Today I
had to share my dining room chair with a praying mantis who had perched
on top of it and was reluctant to move. I am starting to feel more
sympathy for those homeless folks I used to see in the ER in Denver with
their 'bug problems'....

end of the road

The road literally ends at the hospital -- this is one of those times I
wish I could show you a picture -- and about 100 yards from my door.
The amount of witty phrases this brings to mind seems to have no end,
but its primary impact (other than cutting the commute to the nearest
airport down to about 10 hours) is that my front yard essentially
becomes the bus stop, market, and main thoroughfare for the surrounding
towns. Every day there's a group of about 15-20 people hanging out
waiting for the bus to come, some of whom I've gotten to know a bit. It
makes the rural area seem less rural, as there's a fair amount of
traffic with the buses and trucks and vans picking up people or dropping
them off here at the end of the road.
I've been hanging out with some of these passers-through when I get a
chance, but finding out people's stories is a little more difficult than
I'd hoped given the language barrier -- it's hard to make small talk
through an interpreter, or even broken English. But I've been trying to
make sure I get out and do at least one authentic cultural event a week,
if not more. So I've been to weddings and funerals, eaten caterpillars,
visited a friend preaching at a local church (seeing them dance the
Bible and him up to the altar was one of the funnier things I've seen in
a church), and this week I went to a local soccer game that my neighbor
was playing in. Actually, that wasn't so much a cultural shock,
although a few things were a bit unusual -- having to slash the grass on
the field down before you can play, the dog running out in the middle of
the players, the fans rushing the field several times during the play of
the game to celebrate a point or argue about a call (the game was
delayed for 30 minutes while they argued about whether a goal counted
that went off the goalpost and barely crossed the line of the goal), and
yours truly as the 'big man' being entrusted with the prize money to
award at the end, all with a dramatic lightning-filled backdrop and the
wind and rain. It was the first time I have actually been cold in
Africa (the top of Kilimanjaro doesn't count). The home team (my
neighbor's team) won by the margin of the disputed goal, and as the
visiting official, I got to award the cash money, about $20. Perhaps
they will be able to purchase a real soccer ball with the winnings, I'm
not sure if they have a plan.
Culture shock is hitting with a bit of a vengeance, as I find myself
getting frustrated with things that I probably wouldn't have cared about
a few weeks ago. I'm still learning sensitivity as to what I should
work to change and what I should accept. I'm right on schedule with
what most books I've read seem to mention, and knowing that makes it a
bit easier and more manageable -- not just me being a miserable person,
but a normal reaction to a stressful situation. Keep praying for me for
that.

life in Mukinge

Still haven't given you a great picture of what things are like here, so
I thought I'd try to remedy that. In attempt to feel like less of a fat
American compared with the 2% body fat of most African people you meet
(and that's the healthy ones) I've taken up running every other day,
unless it's pouring rain, which it rarely is in the mornings. So I and
my Canadian counterpart Curtis hit the red mud trails around the big
hill that lies to the left of the hospital, waving at the people hoeing
in the fields and occasionally stopping to say hi to someone we know. I
haven't had to fight off the packs of dogs which occasionally roam the
trails, although other fellow runners have. Then it's back home to my
bathtub (no shower for the Brits that built these places) and breakfast,
usually followed by a bit of guitar practice. I have to roll into work
around 9am (I know, you feel sorry for me) because the nurses aren't
done rounding until then, and they get peevish if you interrupt. We
have so many doctors right now that I only have to be responsible for
the men's ward, which is pretty light duty, so I usually wander around
looking for people to practice scanning, helping out in the OR
(theater), or working in the outpatient department. Then it's off for
lunch for two hours, and back to the grind from 3-5. On call on the
weekends has been quite busy, but during the week usually is fairly
slow. We usually get a bolus of admissions around 4 pm, so you may end
up staying a bit late to tie a few things up, but mostly it's easy work.

My free time is consumed with a variety of things -- good cooking is a
bit of work, but fortunately I have trusty Mark Bittman to ease the
transition. I've been experimenting in the kitchen, trying to read up
on some medical info, swimming in our pool, and playing roulette with
the laundry dryness versus the chance of an afternoon rainstorm. So far
I have gambled for that bit of extra dryness and lost several times, but
it was satisfying when it paid off. The rain is quite fun, much more
like Texas rain with its sudden downpours and thunder and lightning.
The mud is quite manageable, too. I will try to get some of my seeds in
the ground this weekend -- nothing like planting tomatoes for Christmas,
eh? I have a fantastic shovel that I bought in town that I am quite
proud of and am looking forward to getting some use out of.

Our new Zambian doctor arrived yesterday, and I had he and his wife over
for dinner tonight. I served fried okra, pork chops, and rice in a
vague attempt to approximate something that Zambian doctors might like
that I like as well. I think they were perhaps more shell-shocked by
the experience than I was, but were game to try new things and gracious
about my clumsy attempts at hospitality. Entertaining consists of
trying to get together enough flat surfaces and fork-like utensils to
feed four people -- few things match, but I haven't exactly been pining
over the lack of wedding china. If I have to have the president over
for dinner, then we'll see about getting some nicer stuff.

WIRN vol 3

Actually, my reading these days has been confined to medical texts and
old Dorothy Sayers murder mystery short stories. Every day I find
myself faced with another medical question which I feel I should know
the answer to -- how thick should the endometrial stripe be on
ultrasound after a miscarriage, which side the vagus nerve twists around
the esophagus when it crosses under the diaphragm, how many days you
should treat for a course for PCP pneumonia -- but I have forgotten and
have to look them up again. Medicine has been a curious mix of
improvisation, high-tech solutions, and old school answers to
questions. It's hard to build a library to answer all of these
questions -- for example, the section on removing sequestra for
osteomyelitis states 'this disease does not affect patients in the US
today and so will not be covered here.' Thanks for that helpful bit.
It does leave lots of room for organizing continuing medical education
for the staff, however, which can be fun, and trying to get protocols
and systems that dovetail with what we have here. And I enjoy the
challenge of trying to fill in nooks and crannies of knowledge which I
have touched on in brief, but now must practice in reality.

The holly and the ivy...and the avocado

Christmas below the equator is always a funny experience for us North
Americans, I think. (BTW, I've been trying to figure out which way the
drain goes down, but for some reason this seems to be more difficult
than I expected. More updates to come.) Last Saturday I walked into
town listening to Karen Carpenter sing I'll Be Home For Christmas while
getting a massive sunburn on my neck. This week we had Christmas carols
during our Friday night potluck (I made samosas, which turned out pretty
good), but it's hard to feel much sympathy for good King Wencelas
tramping through the snow while you're sweating against the couch.
Poinsettia plants are replaced by poinsettia trees, snow-shoeing is
replaced with swimming in the pool, and Christmas trees are replaced by
fake ones, or nothing at all. And of course, your family is a long way
away. But that being said, what Christmas here really brings home is
the message of what the Episcopal church calls Advent -- appreciating
Jesus coming in the past, and wishing he'd come back soon. Suffering
deserves to end.

the perils of blogging unseen -- the author's aside

After my last success at accessing the internet (hurrah! -- to be
pronounced with a British accent -- hur-aah) and re-reading my posts, I
realize that I come across as a bit whiny, with multiple comments on the
power, internet, etc. And also a poor speller/grammatician (see, I
think even that's misspelled). Please rest assured that your prayers
have carried me through with a cheerful heart and patience for the
issues as they arise. Mostly I meant to convey that I was trying
desperately to keep my loyal readers posted on what was up, and even if
not communicating well, was thinking of each of you. With that out of
the way, back to less complaining things.....

beaten by a coffin

One of my first medical successes was a man admitted 4 days ago to the
wards. One of the local superstitions/customs is to throw a traditional
'medicine' on the coffin of recently deceased people; the coffin then
acts like a Ouiji board and seeks out the person who was responsible for
the person's death. That person is usually attacked, often fatally, by
the coffin and the men carrying it. In effect, every death is
accompanied by an act of assault and often murder, making the scene
doubly tragic and also perpetuating a vicious cycle of death, with the
victims often being the elderly that cannot flee quickly. On Monday, a
70 year old man was the victim of this, presented agitated and bleeding
from his right ear, and eventually lapsed into coma. After medical
treatment and prayer, however, he came around 3 days later, and is now
awake and talking and eating.

It's often hard to know what to do, and I had debated to drill holes in
his skull to relieve the pressure, but as he never localized I decided
not to, and in retrospect am glad that I didn't. Interestingly, the
police were involved, but very little action gets taken in these
situations. Several of the long-term missionaries are convinced this is
demonic possession; even if not, the retributive murder of innocent
people is obviously something to speak out against, and something to
pray about as well.

Act I, Scene II

Bieppe from Mukinge!

The country was on fire as I flew out from Lusaka, must of been 100
brush fires burning in the bush in the surrounding lands around the
city, with the termite mounds standing up like burned out chimneys in
the middle. After the pilot's amusing struggle with the aircraft
controller's accent in order to get off the ground (it's a good thing
Lusaka International isn't that busy) we did make it out here with
little incident, and as you get closer the fires gave way to the green
of the game park and the area of Mukinge. They built the hospital here
because of the abundance of water in the area. As you fly in, you
approach two low green hills, and then a patch of white as the hospital
peeks out between the trees. In the dry season, the trees that were
planted around the hospital flower, so as you hike you can always pick
out the station by the blaze of color amidst the green.

I settled in with the requisite words of wisdom from the staff who has
been here longer -- beat the grass for snakes at night, unplug your
computer when the lightning storms come, enjoy the mangoes while they
are in season -- has been easier than expected. My accommodations,
while not large, are plenty sufficient for me, and the hospital is
surprisingly roomy after my experience in Rwanda. I have a lovely
grenadilla vine growing up my screen door, but the fight against the
daddy-longlegs seems to be never ending. I did suffer the
disappointment of my fan breaking as soon as I got to Mukinge, but the
beginning of the rainy season is really a good time for that to happen,
not too hot, in the 80's. Other than that, life in Africa has been as
expected -- the phone lines are down, there's a gas shortage so my stove
doesn't work, and there's no electricty for three days after the most
recent storm. Hopefully the power will be back on today. I'm hiking
into town (about an hour) to go to the local phone company office to see
if I can get on my dial-up there.

Send recipes and eggplant seeds.

Care Packages

Not that I'm begging, especially since I still haven't even made it
through my package of Gobstoppers that I bought in the airport, but
after spending over 1,500,000 on groceries, I did realize there were a
few things that were unavailable, which I can picture myself enjoying
and feeling deprived about in the months to come:

guitar strings
seeds
spices (you can get MSG, salt, pepper, cinnamon, paprika, and nutmeg
here, but that's it, unless you grow it)
music
nuts (peanuts are all that I've seen)
recipes. If you've got a good one, say how to make sweet potato fries,
or sweet potato pie, or sweet potato fritters (actually, there's a good
variety of stuff to be had in the supermarket here, I'm just saying....)

That's all for now. There's a link on the side to postage rates from
the USPS. There's nothing better than logging on the internet and
having a inbox full of well-wishes, thanks to you all. Sorry I can't
log on to my blog yet to respond in kind to your comments, but rest
assured they get to me via email.

vicissitudes of medical work

Thought I'd give you a brief picture of what medical life is like here.
Overall, it's been pretty much what I expected. The doctor's day is
less packed, and it seems much less busy as things which seem like they
should be less difficult (suturing a wound, putting in a suprapubic
catheter, casting a fracture) end up taking quite a bit of time, so that
you don't feel that you're getting that much done. We are hamstrung by
supply shortages, despite a recent container sent to us by Samaritan's
Purse. One of the frustrating things about relying upon donated
supplies is that there's no supply and demand ordering, so that you end
up with excesses of certain supplies and deficits of others. So we have
boxes with open heart supplies, laparoscopy equipment, expired lunch
meat (no kidding!), and laminectomy sets, all of which are essentially
useless to us due to manpower, expertise, or equipment lack, while on
the other hand what we need are things like gloves, tape, ECG
electrodes, IV fluids, and medications like potassium, all of which are
much less expensive than what we got, but infinitely more useful to us.

I got a promotion when I got here -- I'm the head of radiology, and also
the direction of continuing medical eduation. Since I'm the only one
with any significant ultrasound experience, I spend some part of my day
doing scans. We have a curvilinear probe and a vaginal probe for a
Sonosite Titan machine, which is good, since I'm fairly familiar with
it. I'm definitely stretched past what I was trained on -- my training
for recognizing ectopics is only somewhat transferrable to diagnosing
pelvic masses, but you do you best. Unfortunately, my only reference
text out here is a OB/GYN ultrasound book from 1985, when they had
barely invented the technology, so it is of limited use. You do the
best you can and try to keep improving with practice.

As for my patients, I'll save that for the next installment.

I'll do my best to keep the blog updated (I'm sending these posts sight
unseen, hopefully you're still reading them) but between phone service
being down several times a week, power outages, dial-up internet with
speeds around 7-20 kbps, and limited access to a phone line in the first
place it may be a bit sporadic at first. Thankfully, we are getting
wireless satellite email setup sometime in the next month or two, God
willing and funds available, so at that point I should be a bit more
reliable. In the meantime, don't give up on me.

what's going on out there?

Gentle reader, you may be wondering why no posts for two weeks, then all
of a sudden, multiple posts at the same time. An explanation awaits the
patient mind. Life in Africa, although surprisingly connected, is
unsurprisingly inconsistent. This week was marked by a loss of
electricity for three days, the loss of the telephone service for the
past week and a half, and the countrywide lack of natural gas, so that
trying to cook, bathe, or boil water for drinking became a bit of a
chore. On the good side, dinner by candlelight is always fun, my
computer has a relatively new battery that still holds its charge well,
and my entertainment is relatively power-free anyway (guitar, dominoes,
cards, dinner with friends). And we emerged on the far side unscathed.

So, I'm writing posts as the mood strikes, and I figure I'll post them
when the opportunity arises. I hope that your thirst has been slaked,
for a time at least. And salvation awaits in the guise of a Dutch man
who is going to wire us for wireless satellite internet at some point in
the next several months. Hopefully my ability to show you pictures will
increase at that time.