7/7/7

An auspicious day for a 16 hour bus ride, if any day could be an
auspicious day to sit on a bus for so long. When you travel via bus to
Lusaka, you get up at 3:30 to catch the 4am bus to the nearby city,
Solwezi. This is the same bus I took back in March, which has to be the
most maddening bus ever because it picks you up at 4, but doesn't leave
until 6. You may ask, 'Matt, why don't you just catch it at 6, then',
but it drives 5km away and sits there for the 2 hours, so that it's not
really practical to go find it at 6am. Anyway, I made it onto Mark's
Motors (pronounced Max Motors, don't ask me why) at 8:30, managed to
score the seat on the back row that faced the aisle so I could stretch
out my legs, and settled in with my iPod for the trip.
Travelling by bus is one of the best ways to get a sense of the country;
you see Africa 1st-hand, sometimes really close-up, like when I was
holding the baby of the woman sitting next to me, or reading about the
uncle who wanted to marry his niece on my next-door neighbor's paper
(the lead article for the day). But nevertheless, I was ready for a
break from Africa at the end of all that time, so I was glad to see the
smog and lights of Lusaka in the distance.
Now I'm back at the first place I saw when I came to Zambia. It's not
quite full circle, but it is an opportunity for reflection, remembering
the days of sweating and swatting mosquitoes. Hard to remember all
those too hot days when it's 40 degrees outside now and I've got only
two sweaters to my name. I nearly was down to one after a woman in the
hospital got pretty angry with me this week when I declined to give the
one I was wearing to her. I feel much more comfortable and more
uncomfortable than I did 6 months ago; just having some Zambian Kwacha
and a basic grasp of the language goes a long way to feeling
comfortable. I don't feel nearly as much out of place as I did, and
there are few places that I could go where I wouldn't know anyone
around. On the other hand, I get more uncomfortable with the limits of
what I can provide for the patients at the hospital, more uncomfortable
with the sense of entitlement that I get from some Zambians, and
uncomfortable with how some of the ex-pats have responded to their
Zambian brothers and sisters.
Although there's no more marathon bus rides in the future, I guess my
journey in Zambia still has a long way to go.

vacation time

I left for vacation yesterday for 10 days to clear my head and get away
from Mukinge. As such a small place, it's good to take a break every
now and then; the life gets a bit claustrophobic at times. We had an
extended weekend last weekend; I asked one of the Zambian nurses what
she did for the weekend and she somewhat grumpily replied 'there's
nothing to do here'. Certainly there's more opportunities for
entertainment for me with DVD's and the computer age and the advent of
the internet these days. But it's still good to take a break from
personalities and the grind of work and the depressing nature of the
patients that you can't do much for and don't get better.
At the same time, vacation feels a little bit guilty, just because you
spend a fair amount on yourself. This is magnified by the opportunity
to come to Lusaka where there are well-stocked stores; I've been
accumulating a list of things to get for the past 6 months, so you end
up doing 6 months worth of shopping in one day, which makes me feel
frivolous and like I'm spending too much on myself. It's a lot easier
to buy things here and there; the psychological impact of all that money
that you spend on yourself is lessened and you don't feel nearly as
guilty about it all. And all the stuff is not essentials -- you can buy
flour and cabbage and corn at home -- but the little extras that make
things nice; a mixing bowl so that I don't have to use my stewpot, or
some olive oil, or toys for the cat so he doesn't shred my ironing
board. My biggest guilty pleasure will be a mattress if I can figure
out how to arrange it. It's a tough balance between being comfortable
and being a good steward of your money, especially when there are needs
for people to go to school, or to buy blankets for their kids when it's
cold, or requests for loans to put a door on their house.

burning days/burning haze

Hello to all my friends and supporters out there!

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

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.

So long, sucker

So long, sucker, originally uploaded by mattcotham.

This has been my temporary bridge to sanity for the past two months as I

have given up on my phone ever working properly and the vagaries of

dial-up internet. This pint-size package plugs into my computer and

allows me to talk to all of you, at least briefly and with a minimum of

pictures.

BUT.....The awaited promised day is soon to arrive, where I can call

home using Skype, and get pictures, and watch edited Lost episodes on

abc.com -- the VSAT! The satellite dish has been delivered, the

installation team has been scheduled to arrive on Thursday, and

hopefully by next Monday, without too many snafus, we'll be in

business. Updates to follow....

African yard sale

I had the opportunity to participate in my first yard sale in Africa
this weekend. Two of the missionaries who have been here for a few
years are moving back to New Zealand in a month, so this weekend was the
cleaning out of their house and selling off of all those useful things
which aren't worth the cost of shipping -- furniture, sheets, dishes, etc.
Muzungu yard sales are a much anticipated tradition here at Mukinge,
mostly because shopping experiences are so limited so it's a chance to
get some stuff that's different from the usual things you can buy.
There are tales of sales of people climbing over fences to get in early,
clawing through bushes, and hiring bouncers for crowd control at
previous events. It's more like opening day for tickets for Star Wards
than a yard sale.
This weekend was a tamer version, however, with people lining up only 2
hours before the event, and only about half the hospital staff skipping
out of work to come. Despite that, the stuff was mostly gone in 30
minutes, and by the end of the sale everything was completely gone
except for a few videos left behind; a striking difference to my yard
sale in Denver where the men came by to steal my golf clubs in the early
morning hours but I still had over half my things leftover after two
days of sale. Total raised for the local orphanage from the sale
yesterday: around 3 million Kwacha, which roughly translates into around
$750.
I will admit to not being immune to the pleasures of the yard sale; my
purchases were a lavender shower curtain to go with the pink and peach
ones that I already own, a waste basket (been looking for 2 months for
one), and a sprinkler to replace the one that got stolen last week. Not
a bad haul.

experimental chemotherapy

I've got a man on the ward these days who presented with a large growth
on his testes; like most people here, he waited until it got really big
and started bleeding until he came into to see us. There's a few
elements of community education that I'd really like to see emphasized,
but one of them would definitely be the idea that presenting earlier for
unexplained masses is a really good idea. Like the guy in the bed next
to him, who has a mass that's at least 8 inches across eroding through
the skin, pushing his cheek out and his ear closed. Or the guy in the
bed next to him, who's got a big fleshy mass in the back of his throat
which is gradually cutting off his windpipe.
We do have limited chemotherapy, and our reading said that this could
likely be Burkitt's lymphoma in his groin, so we decided to give
chemotherapy a go. Chemo is really specialized at home, with good
reason, as these drugs are pretty evil -- one turns you so toxic that
you have to even wipe their nose with gloves for 24 hours (that one's a
derivative of mustard gas from WWI) and when you pull them up in
syringes they are thick and have these weirdly beautiful and
deadly-looking oranges and reds, so it feels like injecting some strange
type of jello into his veins.
So I put on my gloves, and pulled up my array of orange and red-filled
syringes, and ran through with him about how he'd lose his hair. I
transferred the guy three beds down to the TB ward so he could cough
over there while we were waiting to determine if he had TB or not. So
we gave the meds, and now we wait and see if there will be any shrinkage
of the tumor. This is fairly experimental, however, because we don't
really know what we're treating (the chemo doctors at home won't treat
anything until it's been examined by a pathologist); so we weigh the
options and take our best guess. We'll see how he does.

Emailing: tennis partners

Emailing: tennis partners, originally uploaded by mattcotham.

These are the Griffiths, my tennis partners. You can see the somewhat

rehabilitated tennis court in the background. Construction is still

ongoing....

Transport trouble

One of the constant demands and problems for people here is transport --
with distances that range up to 70 kilometers and no regular public
transportation, even no people with a car that live out that direction,
people have to cobble together whatever means of transport they can find
-- bicycles, finding a ride with the mining trucks, various people going
around or good samaritans willing to give them a ride. Today we had a
case that highlighted that for me: we are the referral hospital for two
district hospitals that don't have a surgeon or higher care. An HIV
woman was admitted to one of these hospitals with severe diarrhea a week
ago; they decided that they needed us to treat her more aggressively, so
they wanted to send her on. They have been having troubles with their
ambulance, so they sent her on a Bethlehem-like journey on the back of a
bicycle for a three-day journey to arrive here today, weak, dehydrated,
and very ill. Now this is mostly just plain negligence to transport a
very sick person that way, but it also highlights the difficult
decisions that they have to make without a working ambulance and without
other options.

Our welcome sign

Our welcome sign, originally uploaded by mattcotham.

I think this speaks for itself. I especially like the phoenix-like

depiction of the chicken on the left being transformed into the serving

platter.

My email spot

My email spot, originally uploaded by mattcotham.

I currently am emailing using a 'cell-phone modem', which is basically a

cell-phone that plugs into my computer and allows me to connect to the

internet. I don't get good cell coverage in my apartment, so my current

system is to go outside and sit in my pink lawn chair (also known as a

'lazy-man chair') with my laptop on my knees, my hoodie on, and the cat

gnawing at my toes while I watch the sunset or contemplate the mass of

lettuce that I'm about to harvest from my garden next week (what I'm

going to do with 35 heads of lettuce, I'm not quite sure; gotta work on

having my gardener space out the planting a bit). Occasionally I get

treated to sunsets like this (taken by one of the visiting docs) or the

incredible night sky filled with billions and billions of stars, to

quote Carl Sagan. Next photo project -- picture of the stars.



One downside from having so much natural exposure is the fact that my

malaria risk has gone up immensely as I sit outside at dusk while

emailing and get bit by the mosquitos. That should tail off here as the

rainy seasons have ended. I think it's a good trade-off anyway.

Success!

Success!, originally uploaded by mattcotham.

This man came in after he had tried to commit suicide by slashing open

his throat. Psychiatric care is one of the things that I really

struggle with here in Zambia, partially because my language skills are

still rudimentary, partially because we have only basic medications to

treat people with, and partially because the follow-up is done by

untrained personnel, if at all. Who knows if this man will do okay at

his house or not. When he arrived on early Sunday morning a week ago,

he had cut most of the way across his windpipe, so that he was breathing

out of the hole in his throat. I was called out of bed to see someone

who 'had a cut on his neck"; I asked if it could wait until I was to

come in to the hospital a few hours later and they said I should come

see him now, and we went to the OR where I put a breathing tube down the

hole and tried to sew up his trachea around it. He unfortunately had

cut through the larynx, above the vocal cords, so he kept draining

saliva down through the wound; however, as the wound healed up this got

to be less, and we finally took him back to the theater where we put a

tube down his throat from above and sewed up the external hole. And he

is doing great, able to talk, swallow his saliva, and looks much

better. We've been praying pretty hard for him here, and the surgeon

says that people he worked with say that they've never had a patient

with a tracheostomy survive in Africa, so he's a testament to the grace

of God. I'll put the follow-up picture next.

Plastic surgery extravaganza

Plastic surgery extravaganza, originally uploaded by mattcotham.

This past week we had a marathon plastic surgery clinic. Generally once

or twice a year a visiting Serbian plastic surgeon flies out to see us.

To prepare, we send out letters about 1-2 months in advance asking

people to come to the hospital to see him; we generally get about 60-70%

of people to actually come. These people start coming to the hospital

on Wednesday, where they get admitted, and the surgeon flies in on

Thursday, operates Thursday and Friday, and then leaves on Saturday. We

generally finish operating at around 8-9pm on Thursday and Friday, so

it's a long day for the staff.

This kid, Goodson, was scheduled to have a bilateral cleft lip and

palate repair; he got there on Thursday and was scheduled for surgery on

Friday but started running a fever and having bloody diarrhea. We had

to cancel his surgery on Friday because he was too sick to go under

anesthesia, and we prayed for him at prayer meeting in the morning (we

have daily prayers at 10:15 every day). Sure enough, the next day his

fever was gone, his diarrhea had gotten better, and we squeezed in his

surgery before the surgeon had to go. This is how he looked today!

Next week we do the same thing with a visiting orthopedic surgeon. This

is pretty much the only way to get surgical sub-specialty care out here,

and we still feel the need for urology and ENT follow-up for patients

that right now have nowhere to go.

Speaking of surgeons, our current surgeon is scheduled to leave in

January of next year and no replacement has been found; if you know

someone who might be willing to come, let us know!

Tracheostomy part 2

Tracheostomy part 2, originally uploaded by mattcotham.

Looking good!

legends of the fall

May has begun to bring about some change in Zambia.  After 5 months of hot, sticky, wet weather and rain, we've entered the fall, with cooling temps (down to the 50's at night) and beautiful, sunny days.  The grass is starting to turn brown after 3 weeks of dry weather.  I'm now the proud owner of a somewhat crooked shower and a 2 month old cat with really bad breath.  I also enjoy a large amount of pink furniture, with a pink lawn chair and shower curtain.  And after only 6 months here, it is starting to feel more and more like home. 

The hospital continues on much as usual.  Our fortunate budgets for the past few months have ended, so we had to make some hard choices this month at the finance meeting and still budgeted over 5,000,000 Kwacha (about 1,250 USD) more than what we expect to receive.  Our usual budget is around 17,000 USD/month, from which we pay the salaries of around 150 employees, buy drugs, lab reagents, postage and paper, IV fluids, gloves, tape, plaster of paris, etc.  We're trusting that the additional funds will come from somewhere.  It's a bit of a step for me to do that sort of thing, being the son of two accountants, but it's been a good experience for me.  I've personally settled in a bit better to my role as the manager of clinical services, with the educational responsibilities and meetings that that entails.  I've still been covering the pediatrics and TB wards, with a little help out in the radiology and anesthesia realms.  It keeps me interested, and I even had a few cases that were vaguely ER related this past month -- heart block, a man who cut through his windpipe with a sickle, insecticide poisoning -- which helped me feel somewhat competent, as opposed to all those malnutrition cases that I see on pediatrics.

I had a much more traditional 'missionary' month, with preaching in the local church two Sundays ago, various Easter responsibilities, and leading worship for the SIM retreat.  All were somewhat stretching experiences for me but went on reasonably well.  Our missionary staff has grown closer here on the station, and we thank you for your prayers.  We still will likely need some docs starting in February 2008, so you can starting asking your friends and neighbors if they want to come out!  At the same time that I was a more traditional missionary, I also enjoyed my first taste of tourist Zambia, with a 2 day stop-over at a nice hotel coming back from retreat, and a few purchases at the local curio shop.  We've also resurrected the local tennis court here at the station, and although it could use a little work, the only points I win are when the ball takes a funny hop off the cracks, so I'm not pushing too hard to get it fixed.

I've enjoyed hearing from each of you.  Communication has improved immensely since I bought a cell-phone modem which uses cellular technology to get on the internet.  You should check out the blog if you haven't recently -- it's a veritable multimedia experience (www.mattcotham.blogspot.com).  It's been good to be in better touch, although it still routinely takes me around an hour a day to download my messages, so don't expect 24/7 responses.  Next step: satellite internet, supposedly coming for the second stage of set-up in 2 weeks.

A few pieces of news which may be of interest to you donors back home:  thanks to the hard work of one of my college friends, Leslie Park, we are in the process of creating a non-profit organization in the states which will forward all funds directly to the hospital, with a small fee taken out to support the local church (2.5%).  Hopefully for anyone who's not donated through the usual SIM channels because of high administration fees, this will be a vehicle to ensure that your funds get straight to the hospital where they can help the most.  We expect to have this up and running by the next month or two.

Also, after some discussion with the management of the hospital, we are also contemplating converting one of the wards into a more intensive-care area, where sicker patients could get closer nursing care.  This will involve remodelling part of a ward, installing an oxygen system, buying some equipment, and so forth.   I'm therefore going to send all my donations made to my account at WMM to this purpose, unless you specifically ask me to send it somewhere else.  We're hoping to raise around 30,000 USD to get this done.  We're already making good progress towards the goal, thank you for all your contributions!

Miss all of you.  Would love to hear about your travels (especially those who have made it to Africa since I've been out here!) life events (lots of new babies out there) and other things going on.  I am relaxing the email restriction on photos sent to me since I've got a better connection these days, so a few cute pictures of babies or other things wouldn't be amiss.

Talk to you all soon,

Matt

illustration2

illustration2, originally uploaded by mattcotham.

illustration

illustration, originally uploaded by mattcotham.

Thought this might illustrate my previous blog on child safety. This is

Linus, who fell in the fire after a seizure and burned the right side of

her face. She's a beautiful girl.

grocery shopping

grocery shopping, originally uploaded by mattcotham.

This is the local grocery store; there's a bigger collection about 3

miles away, in case you're out of luck at this one. Fortunately, this

one stocks a good supply of the basics -- candy, flour, and toilet paper

-- so in an emergency you can get fixed up.

Look out Roger Federer

The inaugural tennis match of 2007 came off without a hitch as we found
the tennis net buried in the back of the musty housing container,
nestled between two wasps nests and a hopelessly tangled amount of
clothes hangers. We even found some cans of tennis balls that were
still pressurized from the 1990's; there must have been some serious
tennis players here in the past. After blatantly ignoring the
instructions taped to the cable, we managed to get it strung up and had
our first (sort of) game of tennis, where I lost 3-1. The tennis was a
true African experience, starting off with about 8 people on the court,
wildly swinging rackets and hitting the balls into the surrounding
brush. We still need to fix the fences at the ends of the court, but
fortunately several of the crowd of children stuck around to help
retrieve balls in between their time dribbling the basketball around me
while I tried to hit the ball back to John. Today I must have been
asked by 15 people if I played tennis; I guess news travels fast here at
Mukinge. Next up: wash off the court so you can see the lines well; I'm
currently looking for a hose long enough to stretch from the nearest
house. After that, I think we need to build one of those high chairs so
we can have a proper line judge -- you all know how competitive I am.