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

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