Blood, sweat and tears

We've had a bit of a rocky time during the past couple of weeks here at Kalene. Christopher was involved in a big operation to remove a pelvic mass that was attached to every imaginable bit of tissue – it is impossible to know the extent of a problem without diagnostic tools such as CT scan. After a couple of hours, they were committed. Thirteen hours later (sweat), the tumour had been removed but the woman was very unstable. I spent most of the day trying to find blood donors – she required 7 units in total, at a time when the hospital had no blood in stock. It was handy that her blood group was AB! I very bravely donated (you’d think so too if you could see our laboratory!) and have a very beautiful bruise to show for it (blood)! Needless to say, we were very sad and disappointed to come in the following morning to find that she had died.


It was also the day that Masaku’s father came back so I was feeling pretty emotional (tears). It is wonderful that he came for her but sadly, he is unable to look after her himself. So she has gone to an orphanage nearby. He can visit her there from his home in Congo and when she is a bit older and not reliant on formula milk, she will hopefully go back and live with her family. She has been such a delight. We look forward to visiting her at Hillwood.



I am finding being Sister In Charge on Fisher Ward extremely challenging. It is very busy with a huge variety of conditions. Daily problems range from lack of resources e.g. no x-ray, no sputum staining, no ESR (as if diagnosing TB isn’t difficult enough!!), no blood, no fluids etc - to someone locking the keys in the linen cupboard - to patients refusing to put their mosquito nets down at night.


I will tell you about some of my patients…


Elena (20ish) was in labour for 5 days in her village in Angola. She finally delivered her dead baby but she was left with what is known as a vesico-vaginal fistula (VVF). After the pressure of prolonged labour, the blood supply is cut off to the wall of the bladder and vagina. A hole forms, connecting the bladder and vagina so that urine is constantly leaked. Women like Elena are often ostracised from their village because of the terrible smell and lead sad and lonely lives. Elena came to us soon afterwards and so we were able to help her. Dr John (with some help from Christopher) repaired the fistula. A urinary catheter was left in situ. After 2 weeks, I removed the catheter and to our delight, there was no leakage! We tell women like Elena not to have intercourse for 3 months to allow healing. There is no reason why she should not conceive again. When they become pregnant, we advise them to start walking to hospital soon after they can feel movements, so that they can deliver safely here at Kalene.

Betty (50ish) is HIV positive and is being treated for TB. She has a CD4 count of 3 (CD4 cells are the ‘soldier’ cells which fight infection in the body – a count of 3 is hardly compatible with life!) and she also has cryptococcal meningitis. The trouble is, she has virtually no resources to cope with infection. We cannot start her on ARVs (anti-retrovirals) at the moment due to their toxicity (the TB meds she’s already on are probably pickling her liver so it’s a good job we can’t do liver function tests here as we’d be all the more worried!) She is also malnourished and anaemic and we can’t give her blood because a) she wouldn’t be able to cope with anything dodgy that might be in the transfusion (screening isn’t exactly rigorous!) and b) there isn’t actually any available.


Florence (14) was referred from a rural health clinic, ‘complaining of screaming, suspecting witchcrafts.’ It is very common to find that patients have consulted local ‘healers’ who often make the situation worse or crucial time is wasted in getting appropriate treatment to the patient. Florence was extremely agitated and confused when she was admitted. Finally, after 2 days, we had a result of a reactive test for syphilis. Treatment was commenced but she has been fitting, requiring airway management and ventilation (bag and mask). It is horrible to watch a young girl in this condition. She is also being treated for TB meningitis. She is on a huge concoction of drugs. We are trying to teach her family how to use her NG tube and to participate in her care. One day this week, it was just me and one other enrolled nurse on and Florence was still requiring airway management at times so I didn’t even look at another patient till the afternoon! This wasn’t ideal, given that other patients include a woman with necrotising fascitis (groin to umbilicus) and a white cell count of 137 (probably leukaemia) and a girl with an Hb 3.2 and no blood available (in fact, her husband donated but she didn’t get much as she reacted to the transfusion – this seems to happen on a regular basis but isn’t a great surprise given that neither full x-match or rigorous screening are available) and the admissions waiting outside my office remain blissfully unaware of the ensuing chaos on Fisher…


I will end with something a little more positive! Mary (9) has been with us for months. She had osteomyelitis and was treated at another hospital with a spika cast (full pelvic and leg plaster of paris) but developed terrible sores from her hip down her leg. Half her femur was missing due to the infection and her hip joint continues to discharge a greenish pus. We all thought she was headed for a high amputation, a very bad outcome when you live here in the middle of the bush. However, we received a visit from Professor Jellis, an orthopaedic surgeon, who believes there is hope that this wee girl will one day walk again. We re x-rayed her (film having just arrived) and were amazed at how she has re-grown herself a femur!

We haven’t had a lot of time for other activities! Work at the hospital is pretty all-consuming. We go to bed dreaming about it – Christopher dreamt that he was having a laparotomy himself and that I was the surgeon!! He felt like he was in a bed full of blood and had to put the light on to check! We share quite a few of our meals with other mission staff. We have instituted pizza and film night on Saturdays which has been fun. Next Sunday is Easter Day and we are hoping to get hold of some lamb to roast (though it might be warthog as lamb is a bit of a rarity round here!)



Christopher gave his first sermon at church a couple of weeks ago! He did a good job – brevity is the key, as the service has normally been going for 2 hours before we even get to the preach!

Mid-May, we are hoping to get to Hillwood for 2 weeks of intensive Lunda lessons! The plan is to stay at the farm there and have lessons with Paul Fisher in the mornings and then go out to the villages to practice our new skills! It will really help us in our work and relationships to be able to speak and understand more Lunda.


I have my nursing / midwifery exams in Lusaka on 2nd June (really no idea what this entails but apparently, the date of Florence Nightingale’s birthday is a guaranteed question!) and we fly home on 4th June for 3 weeks so if you wanna see us, just drop us a line!



With our love, Emma and Christopher x

PS Sorry about the random order of the pics below - I just couldn't get them into the order I wanted but they are mostly labelled so hopefully make some sense! There is a very big one of a little girl with some caterpillers - it is the season to catch them...and eat them! Christopher has sampled them - I spent a good 10 minutes yesterday scraping the remains off my toes. I had questioned what this moist, warm feeling between my toes was at some point over the course of the morning...anyway, the poor soul must have came to a nasty end after crawling into my shoe and being squelched around in their for several hours - what a way to die!

Betty on a good day

Paul, a young boy with epilepsy. He had a fit into a fire. He has had about 6 debridement operations and will soon have his skin graft.



Delivery suite.

Mary's femur.

I've only gone and regrown myself a femur!

Emma with enrolled nurse Chrispard in Fisher office.

Front entrance to the hospital.

Breakin thru with Josiah (who is deaf and mute), our resident mascot.

Edwin, lab technician, probably taking a difficult call from Sister Emma!

Internet cafe...in a shipping container, natually!

Me and Mary.

Mary.

Masaku and her dad.

Mary's pelvis.

Postnats.

An encouraging poster outside the paediatric ward..!

Spider (?? taranchula) outside Bamboo.

TB patients united.

Elena smiling and ready to go home.

Theatre 1.

Theatre 2.

View from Fisher.

The treatment room on Fisher aka gynae clinic!

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Christoph enjoying a cuddle with our wee poppet.