travelling mercies

A lot of our management team was away this week, so I had the privilege of attending the organizational meeting for the local measles vaccination campaign that will happen next month.  It was an interesting meeting as we try to sort through logistics of getting vaccines that need to be refrigerated out to rural health clinics without power, much less refrigerators, often 40-50 miles away down roads that take several hours to traverse.  We also have to try to recruit staff for the administration of the vaccine, even when we don't have staff to run the hospital or local clinics.
Anyway, as many Zambian meetings do, this one started an hour late and ran over into the lunch hour.  I am still without my motorbike and so was walking back the 3 miles from town back to the hospital, and was a little hungry.  As I walked through the charred stubble that is most of our fields, trying to avoid the clouds of dust that get whipped around by our cold season winds, with my stomach rumbling a bit, I couldn't help but think again about all of our patients who often have to walk or bike those miles when sick, or in labor, or anemic, or with HIV wasting.  Many of our HIV patients are around 60-80lbs.  A few months ago, I took care of a woman who had been referred to us by Mufumbwe hospital, a local district hospital even more rural than us without a doctor that works there.  She was too sick for them to take care of, so they wanted to send her to us.  However, they didn't have transport available, so she was discharged from the hospital, placed on the back of a bicycle, and forced to cycle for three days to reach us with her family.  Keep in mind that this was a woman who was too sick to stay there.  Anyway, they made it to us, and eventually recovered.  That's in contrast to the women who our student nurses took care of at a local clinic, pregnant and with malaria, but there was no malaria medications at the clinic, the ambulance was broken down, and she died before it could be fixed and come and get her.  In keeping with local custom, the husband cut out the baby from the dead woman so that it could be buried separately. 

Tom

Tom, originally uploaded by mattcotham.

This is a picture of Tom, who I blogged about on Monday

cancer-causing ARV's -- the rumor mill strikes again

We had a set back in the treatment of HIV in Zambia this week when
rumors got out that a batch of drugs from the Netherlands was
contaminated and people were getting sick. In many people's minds,
there is still a undercurrent of belief that HIV was a disease
deliberately introduced by the west to kill Africans; rumors like this
pop up from time to time that play on those beliefs and fears. Well,
this time the government did independent testing of the batch of drugs
and found that they were 'contaminated'; at this point the rumor changed
to the fact that these drugs were causing cancer in the people who took
them, something that I think would be highly unlikely given the
time-course of cancer and the nature of most carcinogens. At this point
the government issued a statement that this batch of ARV's might cause
cancer; in translation to the local language this became simply
'anti-HIV drugs can cause cancer'. Yesterday we were beset with at
least a dozen people wanting to stop their drugs; who knows how many
more have simply stopped taking them at home, leaving us wide-open for
the development of resistance of the HIV virus to standard treatment in
the area. I have a feeling that this dealt a serious blow to trust for
years to come. Our Zambian doctor on staff, Dr. Mutimushi, contacted
the ministry yesterday asking for a new statement to be released to
clarify, but I think the damage has already been done.

rumor mill part 1

Had an interesting lesson about the power of the rumor mill at Mukinge
this week. I had lent out my motorbike to one of the local teachers to
go into the BOMA for a meeting; he came back with a flat tire. So he's
very apologetic and says that he will get the tire fixed; I don't hear
anything more from him but one day I come home to find my motorbike
missing. Well, my gardener comes by and I go out to say hello; he's
surprised to see me since my bike wasn't out front and he figured I was
gone. I say that it seems to be missing, and I wasn't sure where it was
right then. The next day I get about 10 people coming by or calling to
say how sorry they were that my motorbike was stolen; word even gets to
surrounding cities like Solwezi, and I find out the next day that it's
in the workshop dismantled for want of a innertube. Apparently my
gardener told the houseworker of the Griffiths who told the Mutimushis
who told the business office, etc. I even had a two page letter written
home about my bike by one of the Griffiths boys. I guess I need to be
more careful about how I phrase things....

cases from Mukinge

One of my patients now has been hard for me -- a 19 year old boy who
presented with high fevers and paralysis/numbness of his lower
extremities. He can't move either of his legs and can't feel anything
below the belt. We took some X-rays of his spine and thought we might
be able to see a paravertebral abscess, so we did exploratory surgery on
Friday but didn't find anything to drain, so we're back at square one,
except he still can't move. It's difficult because he's very young and
I feel like there's likely a treatable condition if I could just figure
out what it was; as it is, he's not responding to antibiotics, TB
medicine, or steroids, and the prognosis looks very grim. You can pray
for healing for him.

islamic moon

Hey everyone --
sorry the blogging has been less than adequate recently. We are now
sort of linked with the satellite email system; however, the promised
in-house connections have yet to materialize, so the only place to get
on is sitting outside the airplane hanger where the satellite dish is.
Now that the temperatures are dipping into the 40's at night, it isn't
quite as much fun to sit out there and email you all. Tonight there's
some planet sitting next to the moon making a picture of the islamic
flag in the sky. I have also been trying to research the southern
cross, which I think I managed to spy last night. And I looked us up on
Google Earth, which is pretty fun; you can see the hospital and airstrip
to the south of town when you look at Kasempa, Zambia. I even managed
to order Simpsons season 9 via amazon; I'll be curious as to when it
will arrive.

days of smoke and dust

days of smoke and dust, originally uploaded by mattcotham.

The dust has started to reach epidemic proportions at times; one of the

local roads literally has a foot of dust with hard packed mud

underneath; riding on my motorbike the dust is over the foot pegs. I've

developed covers for all my electronic equipment, and have to wipe off

my desk daily to get the dust off. On the plus side, it gives some

great sunsets.

king for a day

If you want to get rapid job advancement, you should come to Africa,
where I was made the head of radiology the day that I showed up and 6
months into my stay am now the temporary executive director of the
hospital. Fortunately, the real guys get back tomorrow from their
various excursions, so my reign was brief; I had my only true leadership
test this afternoon where the chief was waiting for his X-ray, the X-ray
tech couldn't be found, and at the same time a woman needed a C-section,
the doctors were having a meeting, and two people with broken arms
showed up. Fortunately, the chief was good-humored about the delay, the
C-section went on okay, and everyone got their casts on before 6
o'clock. I still rely on my Zambian brothers to handle the protocol
side of things with VIP's, so with most of the senior staff gone I worry
that I was going to make some huge cultural blunder. However, things
seemed to get on okay.

Our tribute

Our tribute, originally uploaded by mattcotham.

This is our tribute to the Millenium bridge there in Denver, spanning

the lovely South Platte. This poor guy was with us for almost a month

after he got his leg straightened out by our visiting orthopedist; he

has an external fixator on the outside which we've covered in plaster so

that it can't be messed with. His English was pretty much limited to 'I

go home now today?', which I guess was a useful phrase while in the

hospital, although one that didn't produce the desired results until

today, when he got to go with an interesting looking cast that

incorporated all that plaster you see there. You can see my erstwhile

surgical colleagues peering in on the next patient in the background.

the dry season

the dry season, originally uploaded by mattcotham.

With the advent of the dry season, the extra dust and smoke from burning

off the fields makes for some beautiful sunsets. Pretty much every day

ends like this at the hospital....

card playing....shhhh

I haven't read anything prohibiting me from playing cards on the
station, although I have restrained my urges to try to swindle people
out of money by gambling. :) Nevertheless, a simple game of gin rummy
with one of my Zambian brothers last night was pretty amusing. Our
western ideas of taking turns and waiting in line are not common here in
Zambia. When you go to the grocery store, while they are totalling up
your amount, they will often attend to several other customers who barge
in with their purchases, whether a big order or just a child wanting to
buy 5 pieces of candy. Needless to say, trying to play a card game
without the concept of turns becomes a tricky prospect. I'd discard a
queen (or a Q, to a Zambian) , and he'd take the card whether it was his
turn or not. He'd then proceed to take another turn, because that
didn't count as a turn. This was the natural and right way to do
things, and although we took several breaks to explain the concept of
turns, it never really sank in. It's funny the different emotions you
go through, but you eventually end up laughing at the absurdity of it
all, and it becomes a license to have a free-for-all playing the game.
It challenges a very basic cultural assumption of my concepts of
fairness and respect and fun.
I've noticed the same thing when trying to teach people to play tennis
here; tennis in Zambia is mostly a game of hitting the ball as hard as
you can if it will go over the net. Hitting the ball within the lines,
or serving the ball, or keeping score become very secondary goals and
not usually adhered to by the kids or even the adults that play.

hope deferred

As some of you know, this weekend was supposed to be the launching of
the new satellite internet here at Mukinge. Well, the team arrived on
Thursday, but was not the team we expected. The team that came arrived
in order to survey the local people outside Mukinge what they thought of
the internet, but they forgot to actually bring the parts that would
allow the internet to be functioning here. Likewise, they didn't bring
the technical people to help set it up. So after surveying people, they
flew back to Lusaka and brought back the parts required; however, they
forgot the software to install the run the server. So we're still back
where we began, although maybe we'll have another flight next week that
will help clear this up a bit. After waiting six months after when they
said it would be installed, I guess another week or two won't make that
much difference. Don't call me on Skype quite yet, though.