Goodbye Kalene

I’m typing this, our final blog post, from the sunny South West of England and the sweet smell of ‘chestnuts roasting on an open fire’ drifts up the stairs. We’ve been home for over a week now and it feels quite odd to think about the life we’ve left at Kalene. It’s been lovely to be reunited with friends and family after a year away. We are enjoying drinking water straight from the tap, internet connection the speed of light, running at a sensible altitude, travelling further than the 500 metre radius of the mission compound, understanding every word spoken to us (apart from when we were in Wales!), wrapping up in winter woollies and warming our feet by the fire. I suspect the re-entry to life in the NHS will be an interesting experience when we will require much patience and grace to face the politics, waste and ungratefulness that we will no doubt encounter. Our lives may have been changed but many remain unaware of another way of life experienced by most people in this world.

In our last couple of weeks at Kalene, we had a very dramatic case to deal with. A young man of about 20 arrived after a twelve hour journey from his home in Angola, strapped to the back of a motorbike. He’d been crossing a river late at night when he was attacked by a crocodile. By looking at him, it was clear that he’d put up a fight but it was too soon to tell who had won. His most obvious injury was an eviscerated bowel. Our first job was to stabilise him as far as possible with blood and fluids before proceeding to a laparotomy. Christopher enlarged the wound to his abdomen in order to inspect and replace his small bowel. He had many other lacerations over his body, including one through to his lung, requiring a chest drain to re-inflate his lung. As the days went by, he seemed to gradually improve and we were really impressed with the nursing care he was receiving. Sadly, though, his chest was in a very bad way and he died from a pneumonia. We were very disappointed having spent so long working on him and believing that he was a survivor.

And there was also much drama on the maternity unit but this time with a happier ending! On Boxing Day, Tess and I were called to help with a breech presentation. We arrived to find the lady fully dilated and I was really excited to deliver her. The naughty baby had his hand at the back of his neck which required me to do a few manoeuvres to release the arm but once this was done, he delivered beautifully. I handed him to Tess to check him over and looked back at the lady. It dawned on me that my work was not done – and neither was hers! ‘Tess,’ I said, ‘I think there’s another one in there!’ I examined the lady to indeed find that there was another baby and that he too was breech! I ruptured the membrane and out he plopped! They were both fine and just lovely as you can see. It was such a thrill to help these little two into the world.

Two little dears - breech twins.

 

We had the opportunity to visit Sachabondu, a rural health clinic about 2 hours from Kalene. Ruth Wallis, a nurse from the UK, has run this clinic for the past 40 years and is a true inspiration. We were just having a tour of the clinic and I popped my head round the door of the delivery room. ‘Everything alright?’ I asked, to which they replied, ‘Oh, perhaps you could help us Sister?’ The lady who was delivering was a primip and had been fully dilated and pushing for sometime. I listened with a Pinard’s to find fetal tachycardia with some late decelerations. ‘We need to deliver this baby,’ I said. The head was nice and low and I thought a vacuum delivery would be appropriate. I called for my husband to supervise me (having done 2 or 3 himself, he was quite the expert!) Our ventouse apparatus looks nothing like the ones we use at home – it is a glass bottle with a bicycle pump and some tubing which you attach this metal cup to. Simple but extremely effective and at times, life saving. I selected a large cup and managed to place it on the baby’s head. With the next contraction, I pulled and the head was out, no episiotomy required. There was much singing and dancing and you can imagine my delight when the family wanted to know my name so they could name this little girl after me!

Baby Emma and her mamma.

 

Christine came to Kalene shortly after Christmas to start her TB treatment. It was lovely to have her and her granny over and to spend some time with them. She is doing very well and seems to be responding to the treatment. The course is for 6 months but we have the assurance that she is being closely monitored by Mel and Anita at Hillwood. We took them back to the orphanage just before we left Kalene and said goodbye. Although I was sad, it is wonderful to know that she and her granny are well-supported at Hillwood and that their future is bright.

Christine and her granny.

This is Robbie, enjoying a chess lesson with Christopher.

More twins! They have helpfully been labelled by the staff!

Sister Dorothy on her last day on maternity - she has worked here for over 30 years - what a legend!

Little Luwi, who was 1.2kg at birth, on the day she went home. Just beautiful.

Luwi and her mamma, Eunice.

Saying goodbye to our Kalene family.

We hope you don't mind a few of our holiday snaps! We were fortunate to spend three days down in Livingstone. Having survived Lusaka bus station (not for the faint-hearted!) and the 7 hour bus journey (also not recommended if you suffer from a nervous disposition), we were able to relax and enjoy the breath-taking Victoria Falls. Just days before our arrival, a woman had plummeted into the water when the bungy rope snapped. Needless to say, we elected to keep our feet well and truly on the ground!

Magnificent.

We got just a little wet when the heavens suddenly opened!

Afternoon tea at The Royal Livingstone (Christopher less than impressed with the teabags and UHT milk)

Baby elephants are almost on a par with black babies in terms of cuteness! Love them!

We were very blessed to get to see 2 lion cubs -they were tucked under a tree waiting for their mother to return.

 

 

 

 

 

 

 

 

 

I think it will be a while before we are able to fully process our experiences at Kalene but we know that we have returned as different people. We are passionate about serving those for whom survival is a struggle and we hope that you too have been touched by some of the stories we have shared. Despite the passing of another year, the reality of unmet healthcare needs in the developing world remains. This challenge has become very personal and real to us and isn't likely to go away. We feel very strongly that this will influence our future choices and path in life. We recognise that without the support and prayers of friends and family at home, this work would have been infinitely harder and that our ability to cope with the pressures of the hospital would have been all the poorer. Thank you for reading our blog, for emailing, for sending the briefest of messages on Facebook, for parcels, for praying and for supporting us in our work. Words cannot really express our gratitude.

'The Spirit of the Sovereign Lord is on me because the Lord has anointed me to preach the good news to the poor. He has sent me to bind up the broken hearted, to proclaim freedom for the captives and release from darkness for the prisoners, to proclaim the year of the Lord’s favour and the day of vengeance of our God, to comfort all who mourn and provide for those who grieve in Zion – to bestow on them a crown of beauty instead of ashes, the oil of gladness instead of mourning and a garment of praise instead of a spirit of despair. They will be called oaks of righteousness, a planting of the Lord for the display of his splendour.' Isaiah 61:1-3.

With love from Emma and Christopher x

 

 

 

 

 

 

 

 

 

 

A Kalene Christmas

You’d be excused for thinking that Christmas is a bit of a non-event out here in the bush but we’ve been determined to bring some festive cheer to Kalene! We started with a Christmas craft afternoon in early December with all the kids which was great fun. Tess and co made a gingerbread house in the kitchen and we had all manner of tinsel and glitter in the living room – cardboard Christmas trees, card making, copious amounts of fake snow etc!

We had a party for the ‘old ladies’ who live in a little of colony just next to Kalene. Years ago they were falsely accused of witchcraft and were made outcasts by the community. Well, the 5 of them had a ball! And they are pretty nimble for ‘old ladies’ – activities included dashing around after balloons (and having them tied onto their head scarves) and running 3-legged races (my idea – just glad nobody sustained a fractured hip in the process as no facility for a replacement anywhere round here!) We also had some Lunda carol singing and then the ladies modelled their new Christmas outfits.

Just a few days later, we held a party for the student nurses. You wouldn’t believe the amount of fun it’s possible to have with a cardboard box! We played the ‘cereal’ game which involves picking up a cereal box with your teeth but it is made increasingly difficult as a layer is cut off the box until you are left with a piece of card flat on the floor. We do know of people who have fractured their noses playing this game but thankfully, we are in Zambia and risk assessment and health and safety is practically non-existent so we risked all and it was well worth it to hear the students scream with laughter! We also played a Zambian version of ‘Chinese laundry.’ This game involves the retrieval of various objects. Wigs and mangoes were all of a flurry in the dash to be the first to retrieve the requested item!

Some Kalene 'bush craft' - I made my Christmas cake, complete with HOMEMADE fondant icing (with much help from Marilyn) and candid peel (a 7 day process - thanks to my mother-in-law!)

Other activities have included a ‘Messiah’ night and carols by candlelight. We enjoyed mince pies and Phil’s mulled Jolly Juice, the most exciting Christmas beverage you can get round here – expectations were high and we weren’t disappointed!



I’ve been getting my hands (and feet!) dirty quite literally on the maternity unit. It is quite hard to imagine the set up but basically, it is like working on the antenatal / postnatal ward, obstetric day unit, early pregnancy unit, obstetric theatre, delivery suite, family planning clinic and special care SIMULTANEOUSLY as one of 2 midwives! I’m gradually acquiring some new skills such as antenatal ultrasound and examination of our tiny babies. Our office has been full of prem / sick babies! We have 3 incubators and at times also have babies in ordinary cots who require nasogastric feeding, IV antibiotics or oxygen.

There’s nothing like working in maternity at Christmas. The delivery suite at Kalene is pretty humble but it’s five star compared to the stable where Mary delivered her son. There's not much fuss made of expectant or new mums here and often, ladies come to Kalene with nothing but a piece of cloth to wrap their new baby in and I feel so desperately sad. And then I think of Mary, another young mum with nothing in the world and I am humbled and amazed that God identifies with the POOR because He himself was poor.  'And she gave birth to her firstborn, a son. She wrapped him in cloths and placed him in a manger because there was no room for them in the inn.' Luke 2:7. 



Little Luwi (which means 'Grace' in Lunda) who weighed 1.2kg at birth

 

One of our incubators!





The team aspirating the effusion

A couple of weeks ago, I admitted a primip who was 20/40 with a cough and arrhythmias + premature rupture of membranes. She looked pretty sick. It turned out that she had a massive pericardial effusion (due to TB) which we tapped (took 600mls off initially and more later – she was very close to tamponading - see above pic). She then miscarried the next day. It was very sad but her life has been saved. She has had about 3 weeks of TB treatment now and looks like a different girl.

We've received the best Christmas present ever! After much prayer, we have had Christine's biopsy results from Glasgow confirming her diagnosis of TB! This is great news because we now know what has caused all her problems and can commence treatment. So she will come to Kalene with her granny after Christmas to start her regimen and we will get to spend some time with her before we leave. Praise God!

Christopher and I are on call for the hospital on Christmas Day – I’m hoping for a Christmas baby, which would go a long way in countering my muted enthusiasm for an nshima Christmas dinner! Still, we are planning to have a nice meal in the evening with Tess, Phil and Mark the medical student. Then on Boxing Day, all the mission staff get together for food and presents etc. So, although we are missing home and family, it will certainly be a Christmas to remember!

May the Lord BLESS you as you celebrate the birth of His son.

Happy Christmas!

With love from Emma and Christopher x
 

Josiah and Obvious carol singing by candlelight at the hospital



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