It's been some time since I last wrote; since then the days have gotten shorter and colder (it gets down to 40 degrees at night!) and now that the rains have been finished for about 3 months the burning season has begun. Burning season is marked by the advent of small children running around with flaming sticks and setting the grass and fields on fire. Ostensibly this is to prepare the fields for next year, but as I remember from my days as a Boy Scout where we burned down part of someone's ranch, small boys need little excuse to go around burning things. This season has its good and bad points -- beautiful sunsets at the hospital, but accompanied by the smell of burning rubber.
Work has continued to be a source of challenge and satisfaction for me out here. As you may well imagine, with limited entertainment and diversionary activities, I spend a fair amount of time obsessing about various cases and what to do, with some successes and failures. We've diagnosed a case of leprosy, which was good since we can treat it, and lots of cases of cancer, which are challenging because people often present to the hospital so late that we could do little for them even if we had the treatment. Tragically, in the era of AIDS, many of these cases occur in young men and women who are 30 or below -- lymphoma, parotid tumors, cervical cancer, KS -- and there is a lot of life left to be lived for many of them. As one of the doctors here says, "There's not many fairy-tale endings in Africa", which is very true for most of our patients, despite the lucky few who we can diagnose with a problem that we can fix.
We continue to try to shake things up clinically, so I've been back in charge of the male and female wards and the TB ward, which for the most part I've enjoyed. I've also had a few stints as the acting executive director since the current ED has been away on trips out of the country; it's given me the chance to meet with some of my counterparts at the district and provincial levels, which has been eye-opening for me and also a good source of contacts and information for things that could help out our patients. The meetings themselves are intensely frustrating for me on a personal level, as it seems that very little actually gets accomplished despite a lot of people talking, and also some of the attitudes of the Zambians in charge can be disheartening (the last meeting I was at one mentioned that he'd like to get a scholarship to do some training overseas, so that 'he could get some rest and maybe come home with a car".) That's in contrast, however, with the people that I work with who go very much beyond what is reasonable in dedication to their projects and patients, spending time away from their families, spending personal resources, and extra time on the job here to get things done.
We're at the beginning of planning for the coming year, which is a unique time and I'm glad that I can be a part of that, although who knows whether the promised funding from the government will come through. Finances, as usual, are an issue at the hospital, but fund-raising efforts from home continue to go well and my charitable organization should be off the ground soon. Thanks for all your generous support! We're still progressing towards our goal of around $30,000 for capital projects here at the hospital. We are continuing in need of manpower, especially nurses, a laboratory supervisor, and soon to come, a pharmacist.
I'll cut it short there. If you want more thoughts, etc, don't forget the blog at www.mattcotham.blogspot.com. It's got pictures now. You can also see an aerial view of the hospital on google earth if you look up Kasempa -- we're just a few km south where the airstrip makes a big 'X'. The satellite email system is here, but in a limited capacity; hopefully to be expanded soon.
Talk to you all soon. I'll end with a picture of David, our surgeon, and a man who we constructed a prosthesis for after he got an amputation when he was involved in a motor vehicle crash. It's maybe not that pretty, but he was very happy.
Matt
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