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).

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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!