Chanti chanti (bit by bit)!




Greetings from Kalene!



We are really enjoying living in Bamboo Cottage. James and Ruth, who were living here previously, have made it a lovely home. It is complete with Kenwood mixer and a Singer sewing machine – what more could a girl ask for?! It is nice to be on the mission compound and to feel more part of the community.



One of my joys has been the arrival of Masaku, a baby girl whose mother died shortly after arriving from Angola. Her family asked us to look after her while they grieve. We hope they will come back for her. She is absolutely adorable as you can see! She is being shared amongst the mission staff and I love it when it’s our turn! We have even been doing some night shifts! However, it is nice to be able to have her in the afternoon and evening and then drop her off at maternity for the night so we can sleep!! One morning, while I was getting ready for work, Christopher fed her whilst having his porridge and watching a dvd on ‘how to perfom a hysterectomy,’ in preparation for the morning list – talk about multi-tasking!



We have been on a couple of trips outside of Kalene which has been lovely. We took a walk up Kalene Hill a few weeks ago and went for a drive out to ‘the hydro’ – the hydroelectric power station about 6km away (we’re living on the edge here – that was a really exciting day!!) We have also visited Ikelenge, our nearest ‘town.’ We had to visit the local immigration officer there to have our passports checked. A highlight was having a cold coke out of a glass bottle! We went to the health clinic there too – it was a pretty grim sight. They have no electricity or running water and virtually no drugs or equipment. A couple of weeks ago, Christopher saw a woman who had been seen there and given panadol and sent home. She had raging lactating breast abcesses and required extensive debridement.



Last Sunday, we visited Sakeji school. Once a month, the staff at Kalene get together with Sakeji staff to pray and eat cake! It was a bumpy ride but very worth it – it was a great opportunity to meet some new people and see the school which is beautiful.



We are hoping to spend 2 weeks in the local village to help with our language learning! We have already visited a few homes in the village. People are extremely poor and in their little hut, they may have 2 or three tiny rooms with very few possessions. We are also going to have some Lunda lessons with Paul Fisher, whose grandfather was one of the first missionaries to the area in the late 19th century.



I have taken over as sister on Fisher (female) ward! It is pretty chaotic. My role is quite involved – as well as overseeing the inpatients (who have many and varied conditions), I also see those who turn up outside my office and must decide their fate! It is a very challenging and busy ward. I am trying to get my head around all the tropical/infectious stuff such as sickle cell anaemia, TB and HIV, revise some gynaecology, GUM and paediatrics as well as recall some general medicine, figure out how to set up traction, along with getting to know the ‘system’ (what system?!) i.e. how the off duty works, ensure I fill up various pots with sugar and milk in the morning, order toilet roll on SATURDAYS and desperately trying not to worry too much about ridiculous practices and procedures such as the cleaning of wounds with a solution of saline and BLEACH?! The staff need a great deal of instruction – I keep forgetting that most of them aren’t trained. We have 3 enrolled nurses and the rest are called ‘CDEs’ (and I can’t actually remember what this stands for!!) I was devastated this week to turn up on Tuesday morning to find that a young woman brought in during the evening had not been properly assessed and by the time a qualified member of staff saw her, it was too late. She had a ruptured ectopic pregnancy, a very treatable condition. But there are stories with happy endings too – in fact, too many to list! It is good for me to remember these when I feel like loosing hope. We successfully diagnosed and started treatment for TB in a young boy called Feyason – there is a photo of him at the end, looking very happy as he is going home!



We are very fortunate to have a school of nursing here. The students are the work horses of the hospital – we couldn’t operate without them! There is one called Foster, who I thought wasn’t really on the ball as whenever I ask him to do something, he seems to either not understand or to be somewhat reluctant! However, he came to tell me that he thought one of the patients was in pain. The young woman had mitral valve regurgitation and was having difficulty breathing due to her ascites. I was in the middle of something and said I’d be five minutes and then I’d go and put a drain in to relieve her symptoms. When I was ready, Foster came to me and said ‘Sister, I have prepared the tray – I would like to watch you insert the drain!’ I was so surprised but it was so nice not to have to ask – go Foster!



We will miss our friend Becs who has left us for a month for a well earned rest. We are looking forward to meeting Paul and Katy, two doctors coming from the UK for 3 or 4 months – they arrive this afternoon!



Christopher will be writing soon about some of his surgical experiences, so watch this space!



With our love, Emma and Christopher x

Chota outside Bamboo Cottage - traditional shelters like this are common place and used as meeting places.




Fireplace at Bamboo with our beautiful bunting made by Jennie.



The metropolis of Ikelenge, our nearest 'town.'

On top of Kalene Hill.

Our kitchen, complete with Kenwood mixer!

Two friends, Mamisa and Maria.

Baby Masaku, who we have been looking after since her mother died two weeks ago.

Loving being a foster mum to this beautiful little girl!

Christoph calling home from our office.

Ikelenge Rural Health Clinic - delivery room.

On table cholangiogram, Kalene style.

Feyason, who was treated for TB, with his granny.

Welcome to Kalene

We have been at Kalene for nearly two weeks now! We are gradually acclimatising to life here – there is a lot to get used to! We have had a wonderful welcome both from mission staff and the local people.

We are enjoying living in our little flat. It is fairly modern – we have a sitting room, kitchen, bedroom and bathroom. There is no TV or radio but there are plenty of other activities to keep us occupied!



Chief

One of our first priorities was to visit the local chief who is responsible for Kalene and the surrounding area. We went to see him in his official hut and he greeted us and thanked us for coming to help the people of Kalene. On the way home, we picked up a mum who wanted to take her baby to the hospital – good job as it was hammering down with rain! I was happy as I got to cuddle him all the way home – need to be careful as I could easily end up kidnapping a few Zambian babies – they are all adorable!



Weather

Well, it is positively tropical! Most of the time it is boiling hot but we have also experienced a few storms and they are quite something to behold! I have never heard thunder like it; the lightening is awesome and the rain is torrential – I thought it was bad enough in Llanberis! These storms seem to be short lived. I know I am going to get caught out one day without my brolly and wellies!



Food

We are fortunate to be supplied with dairy and meat products from Hillwood Farm. They visit once a week so we can order milk, cream, butter, eggs and various cuts of meat, including zebra! I am pasturising the milk just now in fact! We bought some items in Lusaka and a lorry of supplies has arrived from Kitwe (the nearest large town 5 hours away) and brought us items such as pasta, rice, dried milk powder, flour (25kg!!!) and tins of things like tomatoes and tuna. We are also very excited by the produce that is available locally! This includes avocado, pineapple, potatoes, tomatoes, lemons, aubergine and probably a whole lot more, depending on the season.



Hospital

Work starts at 7.30am for me (8am for Christopher – slacker!) We have handover from the night staff followed by a short devotion and singing – a very uplifting way to start the day! I am currently on men’s ward with Sister Rebecca, learning the ropes as I will soon be Sister Emma on female ward! She is a good teacher but there is a lot for me to learn. Three times a week at 8am, we attend a hospital meeting where business and clinical issues are discussed. After this, we start our ward round.



The role of charge nurse or sister is quite involved – maybe a bit more like being a senior house officer. The doctors (Christopher and Dr John, the hospital director) will do a ward round twice a week so the rest of the time, the charge nurse admits, assesses, diagnoses, prescribes, reviews and discharges patients. As well as the ward patients, the outpatient department refers patients to us who wait on a bench outside sister’s office to be seen and at times it can get quite busy! Patients have all manor of conditions and injuries on our ward, ranging for general medical problems such as diabetes, stroke, hypertension and heart failure to surgical complaints to orthopaedic issues (we have three wee boys with fractured femurs at the moment) to tropical and infectious diseases that I am much less familiar with such as malaria, TB, HIV, sickle cell anaemia, various worms and parasites etc etc. Conditions in the hospital are nothing like the NHS! Probably the biggest thing for me to deal with is the poor hygiene. It is hard to describe but the ward is quite open, the floor concrete and there are no tiles so it is hard to maintain cleanliness. Also, the home situation of most patients is extremely poor so they present in a poor state of hygiene. Another difficulty is that there is only one sink for the whole ward. We lack many basic things here. We constantly have to think ‘is this test really necessary?’ or ‘can this patient do without this drug?’



On a more positive note, the things we can do are pretty amazing. Many patients are treated and go home well. Last week Christopher and Dr John did a large bowel operation (Hartmann’s procedure for sigmoid volvulus for those of you who are interested) who would have certainly died without such treatment.



I have also attended a few caesarean sections so I can help out the other midwife, Rachel. The plan is for me to look after female ward for a period and then rotate round to maternity.



Operations

Christopher has been involved in some interesting surgical cases. For those doctors amongst you, you may be interested to know of these - they include one Hartmann’s; 4 caesarean sections; 1 urethral dilation; 1 paediatric hernia; 1 pleural biopsy; 2 tubal ligations; 1 recurrent ovarian cancer; 2 EUAs; 2 split skin grafts; 2 debridements (osteomyelitis); 1 lymph node biopsy; 3 MUAs and 4 abcesses. Not bad for a week’s work!



Church

We have visited 2 churches. The first was out in a village and was helpfully translated for us. We really enjoy the singing – although there is usually no musical accompaniment, Africans voices make such a beautiful sound. After the service, we were treated to a traditional meal prepared for us by some of the ladies. This was my first experience of nshima. It can take different forms but here, it is made from kasava, a root vegetable. It is an acquired taste that we have yet to acquire! This was served with cabbage and some tiny fish. We have also visited the church at Kalene.



Friends

There is a lovely community established here amongst the missionaries. Everyone shares what they have with each other and we have been touched to come home to various gifts on our doorstep. We tend to eat with Rachel and Becs and take turns cooking and clearing up. We get together on a Sunday and Tuesday evening. I am hoping to be involved with the girl’s youth group on a Tuesday. Other activities include frisbee, football, swimming, cycling, running and climbing Kalene Hill – I haven’t opened my craft bag since arriving!



Petra

We now have an inside worker called Petra. It was amazing to come home last Wednesday to find the house sparkling, bed sheets and towels washed and bed made, bathroom cleaned, bins emptied, floors swept and mopped and best of all, 2 loaves of fresh bread, bread rolls AND oatmeal and raisin cookies. I have lost all concerns about having someone else clean my house already!!! It is nice to know we can help support a family this way.



Village

We were privileged to be invited for a meal at the home of Peter and Astride Kefwaku (see pictures). It was a very humbling experience for us. We loved playing with the children who are cheeky and affectionate in equal measure. Mama Kefwaku showed us how the traditional kasava is prepared – quite an involved process. They have 2 huts, one for cooking and one for sleeping. They also keep a few animals in an enclosure. It is Lunda tradition for guests to eat alone. The meal consisted of various dishes including beans, cabbage, potatoes, meat, all eaten with nshima. This time we had mixed nshima which is made of kasava and maize which we found really nice and more manageable than plain kasava. This was a very special meal and we felt honoured to be guests at Peter and Astride’s home.



Well folks, this has been a very long blog but so much has happened that we want to share with you.



With our love, Emma and Christopher x



Christopher learning to pound kasava.



Peter and Astride Kefwaku.



First 2 weeks. Warning: not for the faint hearted!

At the Nursing Council of Zambia!

Amen!

In the very miniature plane, ready to fly to Kalene.

'Broadsword calling Danny Boy, over..!'

Add caption

Picked up this baby and his mum on the way back from meeting Chief Nyakaseya.

Our temporary residence.

View from our house - not too bad!

At the girl's youth group which meets on Tuesdays.

This guy broke his leg 9 months ago - who needs a tibia when you've got a fibula?!

But he still seemed quite happy!!

Me and Becs studying hard!

On Men's Ward - our 3 traction boys.

Ingenious traction device!

Me and Gravin, 6. Fractured his femur and will be in traction for several more weeks still.

All smiles in the traction bay.

Getting friendly with the patients! We discharged John today. He will return for cystoscopy once we have the necessary solution for the scope.

Delivering something...but it wasn't a baby! 9kg ovarian tumor.

Christopher removing the enormous tumor.

First Team Houlden C section baby (named 'White'!!) With Amon and Brian, theatre assistants.

Welcome to Zambia!

Mission Lusaka: Work Permits and Registration Thank you for all your prayers – we have been in Zambia for a whole week! The first leg of our journey to Lusaka was very straightforward. We were granted our visitor visas without too much trouble and it was wonderful to be greeted by Becs, a kiwi nurse working at Kalene.

Our accommodation in Lusaka was very comfortable. The CMML (Christian Mission in Many Lands) guesthouse accommodates missionaries flying in and out of Lusaka. Although we weren’t excited about the prospect of staying in the capital for a whole week, the comfort of the guesthouse really helped us to relax after a very busy few weeks preparing to leave the UK.

We had two missions whilst in Lusaka: to register with our respective nursing and medical councils and to obtain work permits from the immigration office. This process certainly helped to hone character and develop patience in us! In total, we visited immigration four times, spending between 1 and 3 hours there at a time. We would sign in each day, after much pushing and shoving in the ‘queue,’ then wait at various desks to find out which stage our application was at. Christopher’s work permit was ready on Day 3 but they had simply added me as ‘wife’ on his permit, even though we had submitted two separate applications. Although this kept me legal to remain in Zambia, I would be unable to work. We were scheduled to fly out on Wednesday and we only found this out on Tuesday! Anyway, we arrived on Wednesday morning, waited one hour and my permit was ready – a huge answer to prayer!

Registering with the nursing council was relatively straightforward. I had a brief interview, paid my money and was granted temporary registration. I will have to return to Lusaka in June to sit an exam for this to become permanent. Christopher had a little more trouble with his registration. He travelled between the medical council and the University Teaching Hospital several times before his exam and interview. He was examined in paediatrics, O&G, medicine and surgery, with his best mark in paeds and worst in surgery?!?! He then was interviewed by a panel consisting of an orthopod, a gynaecologist and a physician. They must have been happy with him as they granted his registration.

First Impressions
I was particularly excited by the African sun! When we stepped off the plane, the airport looked all of a blur in the midday heat but by the time we reached customs, our shirts were wet with sweat. Although I enjoy tropical temperature, I usually experience this while on holiday but I think having to work in the heat with all the smells of a rural hospital may prove quite a challenge.
Another stark impression is poverty. This is apparent wherever you look – roads, cars, buildings, clothing, people.

We were also surprised by how green Lusaka was for an African city. Running alongside the roads are miles of long grass being hacked back by men with blades. We have arrived at the beginning of the wet season and so I have invested in a pair of pink wellies and a golfing umbrella! One of the missionary staff had requested some make-up from town but this was one mission too far and despite asking in several stores (no doubt to the amusement of Zambian service personnel) we failed to obtain mzungu (white people) foundation!

Other than visiting the nursing and medical councils and immigration, the rest of our time in Lusaka was spent between the two malls, Manda Hill and Arcades. These modern shopping centres are very luxurious compared to the rest of Lusaka and we enjoyed western food, cinema and stocked up on supplies that would be unattainable out in the bush. It was great to have Becs on hand to advise on essential items.

Destination: Kalene Mission Hospital, North Western Province
Having collected our work permits, we headed to the airport to fly up to Kalene. We were met by Captain John Loudon and escorted to our aircraft. The plane was a Cessna and looked like it was constructed from Lego!! It was tiny. I sat next to Captain John to try and avoid motion sickness. It was most entertaining wearing the headsets and saying things like ‘Roger’ after each sentence and ‘Broadsword calling Danny Boy’ – entertaining for possibly five minutes! It wasn’t as bumpy as I expected but nonetheless, I clutched my sic sac for the three hour duration. We flew over plains and bush and the odd village and John pointed out various landmarks until we could see the Kalene airstrip. We were finally at our destination. We were greeted by several of the mission staff who helped us carry our bags to our apartment. Becs helpfully put my wellies in the fridge! The apartment is part of the hangar and looks out over a beautiful garden. We have electricity, hot water and internet access so it is very comfortable. We will only be here temporarily before Bamboo Cottage is available for us.

All for now.

Love from Emma and Christopher x

Hwyl fawr Gogledd Cymru / Goodbye North Wales

It is our last day in Caernarfon and as I sit writing this, I am surrounded by packing boxes and chaos! We certainly have mixed feelings about leaving this special place but we know that God has laid Zambia on our hearts and we are looking forward to new challenges at Kalene Hospital.

There is so much to do when you move house, especially it seems when it is abroad. I don't know how anyone could manage to flee the country unnoticed, even if they wanted to! I once found £500 in cash in an old glasses case of Chris's and gently suggested that the bank might be a suitable place for such a large amount of money. He told me that it should remain where it was in case we ever needed to escape the country and leave no trace of whereabouts...I have since confiscated Adventure Stories for Boys as that fine line between fantasy and reality seemed a tad too blurred!

I am very pleased, not to mention relieved, to have qualified as a midwife! I am still awaiting confirmation from the Nursing and Midwifery Council of my registration but hope to have this by the time we leave.

There are many people we wish to thank:
- All the staff in maternity, general surgery and anaesthetics (Christoph had a whistle-stop tour of anaesthetics and obstetrics and, so he tells me, learnt all there is to know in a week, rather than the usual 5 year training programmes?!?) Nadine, Marie and Pat - thank you for being fantastic mentors. Thank you Karen and Gwen for donating your stethoscopes - Chris will have to relearn how to use one! Karen, Kizzy, Carol, Kelly and Lynda, trainee baby catchers united!! It has been a privilege to train with you all - you are going to be fantastic midwives.
- The wonderful Segontium Terrace Crew - we have so enjoyed living on 'Y Terrace' and have had a fab time. We loved our party and will wear our T-Shirts with pride!
- All those at Hope who have encouraged us with words and prayers and in practical ways. We will miss you very much.
- All those at the NEC who have shown such interest in our plans and the work at Kalene.
- The folk at Street Baptist who have also supported us.
- Our parents who have done all manner of things from packing boxes to knitting cases for Kindles - we love you.
- Thank you for the many cards, emails, texts and phone calls of encouragement - we feel very loved.

We are getting our van tomorrow and will be heading down to Somerset/Dorset to see Chris's family. We leave for Lusaka on Wednesday and our next blog will be live from Zambia! We will be in Lusaka for about a week. We hope to have sorted out visas and registrations during that time in order to fly up to Kalene on or before 23rd Feb. We understand internet access is pretty reliable so we will soon be in touch. We are excited to hear from Becs, one of the nurses at Kalene, that she is putting together an orientation programme for us. We will have a lot to learn but are eager to get cracking.

Diolch yn fawr iawn / thank you very much.

Cariad / Love from Emma and Christopher x

Looking forward to an African 2011

We've had a busy few weeks in the run up to Christmas submitting essays, visiting friends and family, applying for visas, booking flights etc. We had a fab time with Tess and Phil who will be joining us at Kalene in August. It was great to meet Colin Breeze who has been visiting Kalene and Zambia for over 20 years with Brass Tacks. He gave us an insight into life at Kalene and even offered to send us a key for the hospital as he said they were short and getting one cut over there would be tricky! You know you're going for real when someone is giving you a key to the place! Thanks to Phil's parents who have very kindly purchased our supply of anti-malarials. They came in 16 tubs but I have managed to cram them into 4 pots so there will be room in my luggage for real essentials such as my new game called Bananagrams (hours of fun!) and my next cross stitch project!

On Boxing Day, we shared about our work in Zambia at  Newtown Evangelical Church and were very much encouraged by the fellowship there. There are many faithful in prayer there and we know that we wouldn't be able to do this without this support. We have also received some financial gifts from people wishing to help and we are truly thankful for such generosity.

The red tape and paperwork is both confusing and time consuming. It has involved preparing documents, obtaining signatures certifying that we are who we say we are! We are currently trying to sort paperwork for registering as doctor and nurse/midwife in Zambia. They even want our GCSE certificates - several degrees and professional qualifications between us are not adequate proof of our education by Zambian standards apparently! This would be fine except Chris can't find his anywhere! I, of course, could put my hand on mine straightaway! This has all been delayed due to Christmas and solicitors not operating from Christmas Eve till this Tuesday so please pray that we can send the documents on Wednesday morning and that they will arrive safely.

I did my last shift at Ysbyty Glan Clwyd on Friday and delivered my 40th baby! It was a great way to finish up. I have been blessed with a great bunch of people to work with during my training. The staff there really have been so supportive and interested in what we are going to do. I am also most grateful for their enthusiasm in sharing their skills and knowledge and I hope I will do them proud as I put all I've learnt into practice.

We have booked our flight and depart London on 16th February. We will be staying at the CMML guesthouse in Lusaka for about a week, allowing us to have our respective interviews for registering as doctor/midwife. We are hoping to get a flight with CMML on 23rd Feb but are awaiting confirmation of this.

We wish you all a peaceful and blessed New Year.

Love from Emma and Christopher xxx