Chitoko-tastic!

We thought you'd like to see some of the highlights of the past month or so - we hope you enjoy these pictures! I am very proud of the fact that I have managed to resize and upload these BY MYSELF! It's so funny that it has taken a year in the bush to make me update some of my IT skills!

We had a visit to Hillwood to see Christine and the other children there. I love this photo! She is so precious. We have had some amazing news about her. She was tested for HIV soon after she was born and the result was positive. This result cannot be relied upon as babies can still have their mothers antibodies. So we send off a test called a PCR to Solwezi. The results normally take 3 or 4 months. The result of this test has just come back as NEGATIVE! Although we will still repeat this test, due to the fact that she's had this strange problem with her ear and enlarged lymph nodes but we do pray that this result is accurate. An ENT surgeon is going to be at Beit Cure Hospital in Lusaka. I am trying to contact him to see if he can have a look at Christine as we are no further forward with her ear problem. Do pray he can see her next week and that I will be able to fly down with her - we would love to have this sorted for her before we leave.

We had a great time with Christopher's mum and dad in October. I think anyone who visits Kalene cannot failed to be touched by what they experience and the people they meet here. We were really encouraged by their visit and I know they had a special time here and at Sakeji school.

We celebrated Jackie's birthday at 'the hydro' with a picnic and a swim in the river.

We were invited to Chitokoloki Mission Hospital for a month. We had a very interesting and enjoyable time and it was a very useful experience to see another mission station and different ways of working. The best bit about Chitokoloki is the food, namely morning tea and cake which is served daily at 10am without fail!

The hospital is in a beautiful setting on the Zambezi. 

My first time assisting Mr H in theatre! I am trying to use a retractor here. This was a laparotomy for a pelvic abcess - you wouldn't believe the amount of pus and how bad it smelt! Thankfully, I had Tanis to help me figure out what all those instruments are for and for moral support - the amount of abuse I suffered was shocking, especially considering we were in a mission hospital!

Washing out that manky pelvis.

We got to wear some very snazzy theatre outfits. Christopher is looking particularly camp, yet pleased, in his floral scrub top.

The very beautiful Hope, 6 months (above) and Mika, 2 years (below). We had such fun with these girls! Tanis, one of the mission nurses at Chit, has adopted them.

We were the flying doctors for the day! We flew to Chavuma Mission Hospital to do some hernia repairs. Here we are with Rachel (anaesthetist, Northern Ireland) David McAdam (surgeon, Northern Ireland) and Larry our pilot.

We also visited Dipalata Mission Hospital. Here is a typical pose of Dr McAdam. On arrival at Dipalata, we were given tea and scones before beginning the day's list. It's a hard life being medical missionaries!

The 'pharmacy' at Dipalata. The five bottles are boiled water, glucose, quinine, more boiled water and carminitive. You just have to hope that there's nothing else wrong with you other than tummy upset, diabetes or malaria!

Assisting with what felt like the umpteenth hernia!

I am in love with the maternity unit at Dipalata! It has recently been built and is absolutely beautiful. The patchwork quilts are gorgeous and they even have a birthing ball! Who wouldn't want to deliver here? It goes to show that it is possible to build and run health facilities of high standards in rural Africa.

The cutest 'resusitaire' I have ever seen.

Larry flew us along the Zambezi on the way home from Chavuma. Slightly vomit-inducing but nonetheless breathtaking - we even spotted a big croc in the middle of the river. Croc attacks are common along this stretch of the Zambezi - we had a 12 year old boy who'd been attacked but miraculously escaped with some nasty fleshy wounds to his leg, perineum and hip.

The Zambezi at Chit. Our canoe trip was pre-planned for the afternoon after the croc attack!

We had a lovely river 'cruise' with Gayle, Rachel and Jay. The Zambezi's answer to punting! This of course involved many potential croc spottings and capsizings and Christopher had to actually get in the river when we became grounded on several occasions!

Pimms? Strawberries? That would be marvellous!

Rachel kept us entertained during our stay. We learnt lots about anaesthetics - I had a go at doing some spinals and intubation.

Chitokoloki babies!

This little chap had a diaphragmatic hernia. He was very sick and weak on arrival but is doing so well now and putting on weight chovu chovu. He was a very happy wee soul and a highlight of the ward round.

This little girl was having serial manipulations and casts for club feet. This method is very effective and means that these children don't need to have an operation to correct their feet.



Rachel is looking ecstatic about the spleen Christopher has just removed! This child (12) fell from a mango tree and ruptured his spleen. Injuries are very seasonal - mangoes and catepillars cause all manner of trauma.

This is Beatrice who had an abcess on her buttock. This was my first I+D and I loved it! If there's pus about, let it out!

Joseph, one of the star patients at Chit. I take back my words about tracheostomies in Zambia! Joseph has a papilloma in his trachea / larynx so the trachie allows him to maintain his airway. He is an absolute delight. He currently lives in the 'ICU' at Chit as he has to have regular suctioning - he has actually blocked off his trachie several times due to all the secretions he gets. He is going to Lusaka to see the ENT specialist at Beit Cure who will hopefully be able to remove the papilloma. We also looked after another little boy who required an emergency tracheostomy. He had a 2 week history of swallowing a fish bone and had been unwell ever since. He was agitated and febrile. There was nothing to see on chest xray but he looked like he had a pericardial effusion. We took him to theatre to try and have a look with a scope but after he was given ketamine, Rachel tried to look with the laryngoscope but she couldn’t ventilate him – the pharynx was massively swollen. So Dr McA did an emergency tracheostomy! It was pretty slick. He had a look and thought there was something in the pharynx so he stuck a needle in it and all this revolting purulent pus came out – it was disgusting. You could smell it down the corridor! He did very well and the trachie was removed about a week later.

Our last day at Chit with Julie-Rachel, Gayle and Rachel. Thanks guys - it was great working with you.

We are now back at Kalene and only have 6 weeks left. I am now working on maternity which I'm enjoying although it's quite a challenge trying to look after labouring women, antenates, postnates and family planning clinic, not to mention all the 'special care' babies who are in the office! Do look out for our 'Christmas Special' blog later on in December.

With our love,

Emma and Christopher x

A month to remember

October was quite a month for us! It seems to have been a time of mixed emotion. We’ve had the joy of welcoming family and the sadness of saying farewell to friends who have been very dear to us here. We’ve felt disappointment but have also seen God answer prayer in a powerful way. We’ve left our familiar surroundings at Kalene for pastures new at Chitokoloki for the next month.

 

The beginning of the month was a particularly low point. The visit of the provincial medical officer did not provide us with any hope that the situation with the nursing council could be resolved. In fact, it seemed quite hopeless. I found it difficult to envisage spending the next 3 months redundant when I could have been making myself useful at the hospital. I could not travel to Lusaka for the first part of the month due to the fact that the majority of Zambia’s nurses were at the nursing council for registration, leaving many hospitals, including Kalene, deplete of staff for up to four weeks! I was also waiting for an available flight and I was warned that the whole trip was probably futile as the council do not usually re-issue temporary registration. All in all, I was not feeling overly positive about the trip! However, I was very much encouraged through prayer and knew that I could do nothing else than trust God to take charge of the situation.

One thing that really helped me to have hope was when Pete Fisher, a well known and respected figure in Zambia, put me in touch with the local MP for our area. The minister agreed to meet me in Lusaka and help me in my mission. I had 2 days to get it sorted. When I arrived in Lusaka however, he was in another part of the country and would not be arriving until the following day. I felt I needed to get to the nursing council straightaway because in Africa, such business has a tendency to take an extremely convoluted path before it even nears execution: simply, I needed all the time available. So I made my way there and went to reception and asked to see one of the registrars. I was told that they were away until the following week. I explained my situation and that I would really like to see someone who could help. The receptionist sighed and directed me to see ‘Mrs Musamba.’ I was trembling as I went to find her office. I introduced myself and a lady greeted me, ‘I am Beatrice Musamba.’ I was ecstatic to hear this! We had specifically prayed that I would be able to see this lady as she is about the only helpful person at the nursing council. She couldn’t have been nicer. I was able to tell her everything with complete honesty and she carefully listened before saying, ‘Well, we will have to do something about that!’ She made some calls and eventually concluded that I could renew my registration (as long as I paid the fee of 1 million kwacha again, naturally) and that I would not need to re-sit the exam! I couldn’t believe how simple and stress-free the process was. The only issue then was that the template of the letter I needed was on a computer which was in a locked office and ‘the man with the key is not here.’ (if I had a thousand kwacha for every time I have heard that phrase, my registration fee would have been more than covered!) But never fear, Beatrice had a plan! She told me to get a photocopy of my receipt for the fee and that she would get the letter written which she would personally scan and email (?!) and at a later point, our pilot could pick up the hard copy. I was barely aware that the GNC even had a computer, let alone internet or the wherewithal to actually prepare a document and send it electronically. But lo and behold, two days ago, I received an email from Beatrice to tell me that my letter was ready and waiting at reception.

Although in many ways, this was a very testing performance, I have learnt a lot through it all. I was tempted to just try and ignore the rules or create my own justification for continuing to work or agree to resit the exam and then not turn up for it but in the end, I was able to act with integrity, speak truthfully and God did not let me down: ‘Those who honour me, I will honour.’ (1 Samuel 2:30).

We had a very special time with Christopher’s mum and dad during their month with us. We did all the usual Kalene tourist attractions (all 3 of them!!) which included a game drive at Hillwood Farm - a great experience which we all thoroughly enjoyed. It was really nice to be able to show them some of the work we’ve been involved with here. As usual, a lot of activities have revolved around food. We celebrated Canadian Thanksgiving, Jackie and Rachel’s birthday and Independence Day, which was a real highlight with a visit to the orphanage to see our dear Christine, followed by fireworks at Sakeji which were spectacular! We were sad to say goodbye after a wonderful month together.

We also said goodbye to some special friends. Becs has returned to New Zealand after nearly 3 years at Kalene. Then Rachel and Kirsty flew out on the same flight as Jackie and Richard. Living and working so closely with the same few people means that you become close very quickly. We’ve so appreciated these friendships – we will miss you girls very much!

We’ve also left Kalene for a brief time to visit another mission hospital called Chitokoloki. We have been here for a week already and are really enjoying our experience. So far, it’s feeling like a bit of a holiday compared to life at Kalene!! (I feel this statement may be controversial but it’s only right that people know the truth!!) It’s a beautiful area, our house is very smart and we have a lovely view of the river. The terrain is deep sand. It is much hotter here which is taking some adjusting to. We only have electricity for 3 hours a day between the hours of 6 and 9pm. On the up side, the pool here is great. Water volleyball is like a religion amongst the mission staff here so work at the hospital stops at 4 or 5pm for our daily game.

The hospital itself is in much better condition than Kalene with ceilings, tiled floors, sinks, decent beds and an amazing theatre complex. They also seem to have much more equipment and resources available. I used their ultrasound machine for some antenatal scanning and could not believe the quality of the picture. I managed to find TWO babies in one woman – just hope I haven’t missed any twins at Kalene!

We’ve been doing all sorts! This morning we did a caesarean section, a laparotomy (I assisted Mr H for the first time!!) and a big skin graft on a poor man who fell into a fire burning his whole abdomen. I also stitched a little boy’s ear back on – they have a very nice room for ‘procedures’ like suturing and dressings which is linked to the theatre complex.

The hospital routine is very different. We do a round of ALL the patients on every ward which sounds bad but there are much fewer inpatients. Then 10am is tea break with scones / cakes which is a definite plus! Then there is clinic or theatre. It is nice not to have the responsibility of running a ward or to have to be on call the whole time. We are told this ‘quiet spell’ is very unusual and we are expecting an orthopaedic team tomorrow and the eye team next week…

As always, photos to follow when I can find the bit of paper with instructions for uploading them again!!!

 

With our love,

Emma and Christopher x

Some photos!

Stitching a finger back together in theatre

Learning to scan - we start 'em young at KMH!

Christopher just checking her findings

Dr Phil with little Willie (omphalacoele) who has now gone home

Josiah helping to look after Christine on Fisher Ward

Sofa time!

Bath time

Helping to make cupcakes - what could be more perfect?

Hanging out

I nearly lost her on her play mat she was so colour co-ordinated!

Special times

TIA: This Is Africa

It is with a heavy heart that I write this month’s blog. As of last week, I have been banned from working at the hospital as a nurse / midwife.

The General Nursing Council of Zambia allow foreign-trained nurses to register temporarily for 6 months. In order to renew your registration, you must sit an exam. In June, 3 of us from Kalene travelled to Lusaka for the exam. It was difficult to prepare as we really had no idea what we might be examined in. The paper was rather random to say the least. Questions included ‘what is the name of the bed you make up for an amputee?’* The exam contained multiple choice, short answer and essay questions. I managed to write quite a bit (or so I thought) about the indications for and management of patients with a tracheostomy, while wandering how many hospitals in Zambia have the facilities to care for such patients. I also answered questions about neonatal tetanus and the causes, management and complications of patients with acute renal failure. There were no questions on what one might expect to see on a paper for foreign trained nurses working in rural Africa – topics such as malaria, HIV, TB and malnutrition were not included, which was a shame, as these were the subjects I had spent a lot of time revising. The 3 of us all failed the exam, along with about 90% of the others who sat. The cost of travelling to Lusaka and the exam fees totalled over $1000.

We are hoping that when the provincial medical officer visits next week, he will allow me to continue to work. If he does agree, this will entail another trip to Lusaka to re-register and the re-sit is in November. In the meantime, Fisher Ward is being run by unqualified, unregistered staff. Although I feel that the standard of care has improved recently, attention to detail and use of initiative are still lacking and I know patient care will suffer as a result.

It is difficult not to feel insulted, frustrated, demoralised and bemused. It is easy to be cynical and to see this as a money spinner for the GNC. Systems and processes here seem to be designed to cause the most inconvenience for those who have come to help – 9 years nursing experience, nursing and midwifery UK registration, 2 British university degrees and a diploma in tropical nursing is not evidence enough of qualification or competence for the GNC. We realised that we first made contact with Kalene in 2007. Since qualifying in 2002, most of my decisions regarding jobs and training have been based around my desire to work in the developing world. This kind of bureaucracy in Africa is surely fuelling the cycle of inefficiency, corruption and dependence. This is precisely why so much help is required.

Christine

I have so far been kept busy, despite my loss of role. It has been nice to devote all my time to Christine. She has been an absolute delight and we have felt so privileged to have had her over the past 3 months. Her mother Maria, died at the beginning of September and her grandmother returned to Angola for 3 weeks while Christine remained here. It was quite a challenge to look after her and Fisher Ward! At times, I would just strap her on me and go off on the ward round, much to the amusement of the patients! He grandmother returned last week and she has been coming over to our house so I can show her how to bath her, care for her bad ear, change her and give her her bottle. She is now nearly 3 months old, 4.1kg (she was 1.4kg when arrived!) and smiling lots. We have had some fun times – we even found the most miniature swimming costume for her! We were sad to say goodbye yesterday as she and her granny left for their new home at Hillwood. Still, it is good to know they have each other and that they will be supported there.

I am trusting God to show me how I can serve Him here at Kalene in other ways. There is plenty to do – I just need to try and get over the frustration of being unable to use what I would perceive to be my most useful skills! I have been helping with the pharmacy stock take. I have also used the opportunity to spring clean Bamboo Cottage, which has been timely as my in-laws arrive in two days time ekkkk! Thankfully, I know my identity is secure in God and not in my job and I know He doesn’t ever make mistakes.

Hydro

We’ve had 4 days without power or hot water here which has proved a bit of a challenge! We take it so much for granted! I joked with Mama Kafweku that we’d be coming to her house every night for nshima as we weren’t accustomed to cooking without power! We were lent a camping stove thankfully so we could heat water for Christine’s bottles and baths and make some basic meals. We had to be very organised and ensure we boiled enough water for drinking each night.

A difficult day

A few weeks ago, the maternity ward rang to ask if a 2 week old baby with measles could be isolated in my side room. They brought her down to the ward. I took one look at her and thought she looked dreadful. I went about trying to sort her out, getting IV antibiotics and fluid into her and helping the mother to express milk. I went home at lunch with a screaming Christine to find someone trying to sell me potatoes (usually VERY exciting as they are rare) and that Andrew, our worker had eaten all of the meal I had prepared for us (knowing I was on call and C was in theatre all day!) and the phone was ringing - it was the ward asking me to come back and see someone with a possible bowel obstruction! I went back but before I got to the bowel obstruction, I checked the baby and she looked worse (and I was wishing I'd paid more attention on my SCBU placement) so I decided she needed a nasogatric tube. Thankfully, Kirsty, our paediatric nurse was there to help me. She was just commenting that the baby was very tachypnoeic (breathing fast). I looked at the baby and said, 'Or...apnoeic' - she'd stopped breathing. So we started trying to resuscitate her – we were in the worse place as we had no suction / equipment so we moved her to maternity but after half an hour, there were no signs of response so we stopped. I hate the injustice of situations like this - knowing that a baby would never die from measles or its complications at home. It is a comfort to read God’s promise for the new heaven and new earth: ‘The sound of weeping and of crying will be heard no more. Never again will there be in it an infant who lives but a few days…my chosen ones…will not bear children doomed to misfortune: for they will be a people blessed by the Lord, they and their descendants with them.’ (Isaiah 65:19, 20, 22, 23).

Doctors
The biggest change to Chris’ working life has been the addition of two more doctors. Tess and Phil are a couple from Sheffield, UK. Phil is an anaesthetic registrar and Tess an Obs and Gynae registrar. We have divided the work load so that each doctor nominally looks after one ward each; Tess – Maternity, Chris – Female ward, John – Male ward and Phil – Children’s Ward. The on-call burden has gone from one in two to one in four allowing for much more sleep! The surgical work load has also been divided and having a ‘proper’ anaesthetist around has made operating days less tiring. This is a rough tally of the operating for September to give an idea of the ‘average’ surgery going on here:

Caesarean section 16

Thyroidectomy 4

Tubal ligation 23

Paediatric hernia 4

Adult hernia 4

Skin graft 7

Laparotomy and appendicectomy 1 (very unusual here)

Abdominal-peroneal resection of rectal cancer 1

Hydrocoele 2

Internal fixation fracture humerus 1

Varicose veins 1 (very rare –first at kalene for years!)

Cervical Schroeder suture 1

Omphalocoele repair 1

Hysterectomy 1

Amputation toes 4

Colonoscopy 1

OGD 11

Revision orchidopexy 1

MUA 4

Wound or burn debridement 11

Lateral internal anal sphincterotomy 1 (anal fissure is very rare here, but no medical therapy available)

Abscess 4

Lymph node excision biopsy 5

Lumps and bumps 8

D&C 2

Urethral dilatation 4

Banding of piles 2 (again very rare here)

Cystoscopy 2

Also at the end of August we did a nephrectomy for a kidney tumour

Another interesting case was Clivious, a 6 year old boy who presented with an eye ‘infection.’ Within a matter of days, his whole eye globe was protruding massively. We made a clinical diagnosis of Burkitt’s lymphoma and started a fairly prolonged course of intravenous and intra-thecal chemotherapy and all be it early days, he seems to be cured, despite a couple of hiccups with neutropaenic sepsis and parents threatening to remove their child because we weren’t operating on his eye ‘abscess!’

Celebrations

It’s great to be able to have times of celebration out here in the bush. We celebrated 4 years of marriage and 33 years of Christopher’s life! We had a Mexican themed night (well, to an extent! Basically, this just meant that I made some fahitas!) It was also lovely to have our first visitor from home as well. John Perkins from Newtown, made a special effort to come and see. It was a difficult time for travel due to the fact that election fever had seized the nation! He made it here and he was able to experience Kalene life firsthand and we were encouraged to see a friend from home.

On Tuesday, we will welcome Christopher’s mum and dad to Kalene, so I hope the house is up to scratch by then!! We are looking forward to spending time with them and showing them what we have been involved with here so far.

With our love, Emma and Christopher x

* In case you are wandering, it’s called a divided bed. I was indeed grateful that my students were able to introduce me to the different types of bed that can be prepared for patients, as this was clearly a gap in my nursing education!

Snakes and scorpions!

You might not expect to witness the changing of the seasons in sub-saharan Africa but we can feel a real difference in the climate now. The roads have turned to sand; we are about to do away with our duvet; we can no longer get any milk or dairy products from the farm and I can work up a nice sweat in the time it takes me to walk home from the hospital for lunch.




We have had a few visitations from some of the local wildlife over the past month! When we arrived here, someone kindly pointed out that the area is famous for its ‘insects for the visually impaired,’ several of which we have now spotted first hand.



I was privileged to be invited to the local ‘girl’s camp.’ About a hundred girls aged 14-18 (though there were a couple of couldn’t have been more than 8!) turned up for a week in the bush. Several ‘shelters’ had been made for us, made of grass, with no roof. I was a bit anxious about the massive range of disease-carrying creepy crawlies I might encounter but I got through the night without incident and actually slept remarkably well. Next day, the girls finished playing games and headed back to camp when someone shouted, ‘KAPELA!’ (Lunda for snake) I looked up and saw a long, black snake high up in the trees. The girls all started throwing rocks and sticks at it as it came sliding down and found it’s way into a hollow in a tree. Someone stuck some lit twigs into the hole in an effort to smoke it out. But Mamma Kefweku, our cook for the week, decided that she was going to chop this tree down! So, single-handedly, this little 50 year old lady felled the tree! It was very impressive, given that I could hardly lift the axe, let alone chip out any of the trunk! The tree was down but the snake could not be found, so she started to enlarge the hole and suddenly, it appeared. Mamma killed it dead, to the delight of all the girls, me included! I think Zambia is actually run by its women, even though the direct opposite may at first glance appear to be true.



A few nights later, another near catastrophe occurred when several of the shelters caught fire. No one was hurt, though a few of the girls lost their personal items. Christopher and I visited the following night to talk to the girls about relationships. A tree was still smouldering and throwing out sparks and ash, threatening to start another fire. Christopher climbed the tree and we handed up bottles of water on a stick and he was able to put it out – what a hero! You can just imagine the scene, the only male, up a tree, surrounded by 100 girls! One girl told me, ‘Your husband, he is very handsome!’ ‘Yes,’ I replied, ‘That’s why I married him!’ It was great to have the opportunity to talk to them about relationships and they asked some good questions. Young people face the same temptations and pressures the world over. We have been invited to speak to the student nurses this week on the same theme.



One morning when I was getting ready for work, I glanced in the mirror and noticed something on the lapel of my uniform. It was a HUGE scorpion! I have never undressed so quickly! Once again, my husband came to the rescue, this time with his snake stick. We have seen some very small ones in the house but this was a beast – though I’m not sure size influences severity of sting but I’m not too interested in finding out!





News from the hospital

Reading back over last month’s blog is a bit sad as most of the patients we told you about then have died. Jedian, the baby with the intersusseption, died a few days after her operation, as did the baby with the omphalocele. This is the harsh reality of life here.



Little Katengo (age 5) also died last week. I was very relieved that her suffering had come to an end. Trying to provide palliative care in this setting is extremely difficult. We have no opiates and jabbing her with pethidine injections (of which we have a very limited supply) was far from ideal. We did manage to find some tramadol droplets from Germany, expiry 2003, but they seemed to do a good job over her last few days with us. I was able to attend her funeral. She was buried in a simple box made out of scrap wood in the forest near the hospital. Her parents have returned to their home in the Congo after many months of caring for their daughter at Kalene.



Baby Christine is still with us. Her mother’s condition remains unchanged. However, Christine has been having problems with her left ear. At first, we noticed a purulent smell coming from the ear. Christopher had a look and all he could see was pus. She continued to feed well and didn’t seem to have any pain and she didn’t have fevers. We gave her drops and oral antibiotics for a week with no improvement. Christopher decided to take her to theatre to have a good look under sedation. A ‘good look’ wasn’t possible due to the lack of appropriate speculums but he could visualise something fleshy and took a biopsy of it. We don’t know what it could be and will have to wait 6 weeks for the histology report from Glasgow. I am very worried that it may be something untreatable in this setting. We were also very sad to discover that Christine is HIV positive, like her mother. What a way to start life. This is the case for many babies of HIV positive mothers but we know and love this little one. I read a statistic that 30% of babies born to HIV positive mothers do not survive the first year of life. We don’t know what will happen to her yet – she may still go to Hillwood orphanage – but in the meantime, we just will just give her lots of love.



We’ve of course had more middle-of-the-night-capers. I was called in to see a man who’d had his perforated ulcer repaired earlier that day. The information you receive is usually fairly limited but I have learnt that the words ‘gasping’ and ‘collapsed’ imply that the patient is far from perky. On arrival, I found him with an obstructed airway and oxygen saturations of 60% and one of the qualified staff trying to ‘manage’ his airway with 2 tongue depressors. I started asking for an oral airway and a bag and mask and was brought a neonatal ambibag to try and resuscitate the 80kg man! At home, even though you might feel slightly panicked in similar situations, there are always people around who know what to do and you work together as a team but here, no one has a clue what to do and when you arrive, they decide to then take their leave!! So I called upon the oncall doctor to assist me and we were able to work as a team with a good result. The training needs are huge but most days, we feel like we are fire fighting and don’t have the time, energy or inspiration to teach these basic skills. We are delighted that Tess and Phil have now arrived. It is great to have more hands on deck and we are hoping that there will now be more time for training now that they are here. We hope there will also be time for baking, board games and general fun!



We are looking forward to a visit from John Perkins from Newtown mid September and Christopher’s parents arrive at the beginning of October.



With our love,



Emma and Christopher x

This guy had a bad leg!

Ouch

Christopher and Conor reducing the fracture

That's better

An excellent example of health and safety at Kalene

This is Joshua's spleen (age 6). This chap has sickle cell anaemia and was having nose bleeds requiring multiple transfusions. So whipped out his rather enormous spleen. He has gone home.

This man had a plate fitted in Congo in 1988 apparently! As you can see, it is rather manky. It was removed and the wound debrided. It will take some months to heal.

Paul, who we've mentioned before, is doing very well.

This was the chap who, at 5 days old, had not pooed (high anal atresia).

.

Stoma brought out. He is doing well.

Jedian, 7 months, with intersusseption

Decompressing Jedian's bowel. Sadly, she died a few days later.

Becs and Mamisa at girl's camp. This was our sleeping hut.

On the snake hunt: mamma Kefweku chopping down the tree!

One dead snake

Baby Christine looking adorable.

With some of the second year student nurses on Fisher

Time for a cuddle with Uncle Christopher - she is getting quite fat!