life and death

This is how report is given in Zimba each day!



Me with the children at the orphanage this week.  One of the kids was asking to take some "photos" with my camera.  I wasn't quite ready, but I still like how you can see the diapers hanging out on the line after a washing!



It has been too long since I have written last, and SO much has happened over the last week and a half!! I’ll try to give you a good picture of what I’ve done and seen, but I’ll still try to be brief!

Last week we were in Zimba, about 2 hours away from Choma.  There is a small mission hospital that we spent several days at.  I was really impressed with this hospital, mostly because they had more resources and it was cleaner than the others we have been in.  The staff is extremely limited there.  To give you an idea, the Clinical Officer or “House Supervisor” did not only have that responsibility but she also took on the Maternity Ward and Pediatric Units all by herself.  You could say she is a busy woman.  All of the staff was more than thrilled we were there, because we help ease their load immensely.  Almost every one of the nurses works EVERY SINGLE DAY of the week, sometimes with one day off.  It’s incredibly taxing, and I have no idea how they do it stretched so thin all the time.  Also, the hospital has built homes for the nurses right behind the hospital.  They are very nice, but I would never feel like I had left work- behind the hospital, living among your co-workers.  Despite those circumstances, the nursing staff is still very dedicated and conveys a servant’s heart.  God must have given these people ten times the patience and endurance as the rest of us!

I started out my first clinical day working in a family planning clinic.  They have an open clinic every day at the hospital for women to come get free birth control injections.  Depending on the medication, they only have to come once every two to three months.  Quite a few women take advantage of this, but not every woman tells their husbands that they come.  You can see some cases where the woman has delivered 6 children, and the husband wants to have more, but the mother is tired and overwhelmed as it is.  So, she keeps it a secret and continues to not get pregnant.  That was something I found very interesting! Counseling also goes on too, but not while I was there.  It is a neat program, and I think pretty effective.

The next clinical day was my favorite!! I went to the outpatient ward where I helped take the vital signs of over 100 people waiting out in the intense heat to see a doctor.  Some had spent the night outside from waiting the day before.  When the doctor is ready to go home, he has to tell the patients they have to wait until the next day until they can be seen, unless it’s an emergency.   The doctors put in incredibly long hours along with the nurses, and if they could literally spend the rest of their days stuck in the office seeing a continuous line of patients if they didn’t cut themselves off from their work.  During part of my time, I stepped in to ask the doctor if I could listen while he saw patients.  He was thrilled we were there and was more than happy to have us sit in.  He was one of the best doctors and teachers.  Dr. Miyanda would translate the patient’s complaints to us and then ask us what we thought might be going on.  As we guessed, he would steer us in the right direction of making the diagnosis he thought it might be.  We stayed and talked his ear off for a few hours during his time in the clinic, and he joked around with us, saying that we were bad luck.  He is a surgeon, and his list of surgery patients was growing quickly.  By the time we left, he had a list of 13 patients needing surgery the next day! Oh, and Dr. Miyanda was on holiday.  He was not supposed to be working, but knew the need and came to work on his vacation.  He truly loves his job!  The next day, the three of us who had followed him in outpatient, followed him in surgery. 

The next day proved to provide the same experience.  He used each surgery as a lesson, and we each got to scrub in on an inguinal hernia repair.  Hernias are extremely common here- mostly inguinal and umbilical hernias.  Four of his surgeries were for hernias, and all seven of the surgeries we were able to see involved the reproductive system.  I’m not sure why, but there seems to be lots of complications and problems with these systems!  Dr. Miyanda has only practiced 2 years so far, and he showed us that last year he performed around 700 surgeries.  I was impressed!

My last day at Zimba was spent in the female ward.  I followed Dr. Patrick around and saw many things.  The ward was pretty full with sick women.  Many had HIV and were in the end stages of fighting with the disease.  Some had heart problems, TB, terrible ascites, miscarriages, and other things.  I was able to perform my first blood draws, which I thought were a bigger deal than they are! They are much easier than IV starts, but similar.  The one woman who had the incredibly bad ascites was breathing with a lot of difficulty, because fluid was up around her lungs.  She was so bad that Dr. Patrick stuck her twice with needles in her lower abdomen to simply allow the cavity to drain.  It was unlike anything I’ve seen before and I’m pretty sure I stood there with my mouth open for a while.  Yellow fluid (she had a TB infection, making it yellow instead of clear) started coming out in a pretty steady flow.  It seemed like such a simple procedure, but really the doctor has to be very careful to not stick the gut or other organs when inserting the needles.  By the time I left she had drained off about a liter and a half- and she had a long way to go!  Instead of pulling the fluids out like I have heard they do at home, the fluids drain by gravity- so it takes much longer.  Since the woman had been admitted, this was the fourth time this procedure had been done on her! 

Later that afternoon I went back to the hospital, because I heard twins were going to be born.  I was hoping to help assist in their delivery, and I thought it would be great seeing twins born naturally as opposed to a c-section like they often are in the states.  It took a few hours before the mom was ready to push, but once she got started, she went fast.  Before I had my gloves on, one baby was half delivered.  About 2 minutes later, I was being given the second baby boy.  Both did wonderfully, and were both head-down.  I got to help with the initial transition phase of the boys and it was great!  About 3 minutes after the mom had delivered, the nurse asked the patient to get up so she could start cleaning the bed.  The patient was compliant but about fainted when she stood up.  I caught her and eased her down on a nearby stool.  The nurse told me to find her a drink while she started the clean-up.  Each woman has a list of items she is supposed to bring in with her when she delivers.  It includes the cleaner used to wipe up the delivery mess.  It helps the hospital save on cost, since they already provide free services for everything else.  It was all very neat to see.

After our week at clinical, we had planned on going to an orphanage for the day, but the night before a big windstorm had blown through, taking down many power lines.  We lost power, and water was limited.  One girl started to get pretty sick, and the absence of water was doing her no good.  By morning we were completely out of water, except for a couple cases of bottled water.  We decided we had to skip the orphanage and come back early to Choma, where they still had power.  It was nice to be able to get a good amount of homework done!

This week we have spent our time at Choma General Hospital.  It’s been a good experience so far, and I already feel like I have met a good number of the staff members.  This hospital is owned by the government, and therefore they have more resources than the other mission hospitals we have been at.  This is partly because the Presidential elections were last month and, ironically, the hospitals resources become plentiful each time around the elections!  So funny! 

More to come tomorrow on this blog! I am tired and have a big teaching presentation in the morning….

This is the little girl I would bring home in a second!!  This is Sarah, wearing Katana's headband.

The first day we went to the hospital, I went to the dental clinic.  This is the first hospital that has offered this service, and they stay busy. At the clinic, many tooth extractions are performed on a daily basis.  It is the most common thing performed in the clinic.  Patients wait to see the specialists until their tooth is very bad.  Eurom, the dental specialist, said that many times the tooth can still be saved, but extracting the tooth is a quarter the cost of preserving the tooth.  Therefore, patients have their teeth pulled as their means of treatment.  Eurom is frustrated by this, but said there is little that can be done about it.  Unlike most areas in the hospital, the dental clinic charges patients for all procedures.  This is one of the main sources of income for the hospital, even though not many are able to afford it.  I was surprised to see each patient who was getting a tooth extracted being numbed first.  Eurom said the patient wouldn’t be able to sit still otherwise, which makes perfect sense.  I also saw an abscessed tooth and a little boy who fell and knocked his front tooth out in addition to many tooth extraction procedures.

For our leadership and management course we each have to each find something to teach on in clinical practice.  Choma General has recently received 3 new infant isolettes, but they do not know how to use them yet.  So, Christine and I decided to teach the staff about this.  We spent the next two days on the Maternity Ward, spending time reading about the isolettes and asking the nurses questions about what they already know of them.  They have a couple of old isolettes, however, have been very neglected.  Yesterday we were asked if we would clean the old ones.  Supposedly they are washed every week, but there is no way!  The isolette I cleaned had dead cockroaches in it, tons of bug poop, and a thick layer of red dust! It was soo grimy and disgusting.  We spent the next hour each cleaning one.  It was much better, and we narrowed down the topics we should speak about for our presentation of the new isolettes- safety & cautions, how to clean them properly, and the neonatal criteria for benefitting from an isolette.  Another thing, they rarely ever use the isolettes they do have, when they have so many babies who would benefit from it.  Currently there is a baby who was born at 27 weeks of gestation who is just staying with the mom.  That baby needs the more controlled environment of the isolette to help grow and stay healthy.  But, there is another mother on the ward who is in grade 12 of her schooling, and has exams to take while being in the hospital.  She is taking the exams in the room where the isolettes are, and therefore the nurses won’t put the babies in there with her.  It doesn’t make any sense to me.  But the exam seems to be more important than helping this very immature baby.  Mrs. Mukonde, our Zambian leader of the trip, was having a fit.  She is a retired nurse and has a much more westernized way of thinking.  So, hopefully Christine and I can have some impact with our teaching! We bought pastries from the bakery to take in, and we’re hoping that will draw in the midwives and nursing staff!

The day before on the maternity ward, Christine and I saw two c-sections.  The first mother who came in, had PIH, pregnancy induced hypertension.  The doctor told Christine and I he wanted to give us a lecture.  We followed him in to the room where the mother was, and he proceeded to tell us all about this risk factor and the possible complications.  He said the baby doesn’t receive adequate oxygen and nutrients during pregnancy when the mom has this, and you can usually expect the baby to be smaller and immature.  He decided this mother needed a c-section and the two of us were able to go in the theater to watch it.  Dr. Moonga is a wonderful surgeon, and had the baby out 58 seconds after his initial cut!  He has years of experience and also loves to teach while he works.  We were impressed with his work, and after the delivery of this woman’s fourth boy being born (she wanted a girl so badly!) we headed back to the ward.  When we got there, another woman had been driven in from a rural village with lots of problems.  The woman herself has spina bifida, and has a very deformed back with a prominent hump.  She is unable to lie on her back flat.  Olivia was also having severe pains in her abdomen.  A fetal heart rate couldn’t be found and Christine was sent to go get Dr. Moonga so he could quickly see this woman.  Her baby was also laying sideways, which is not conducive to labor! As soon as he arrived, he thought she had placenta abruption, a serious complication.  She was also given an emergency c-section.  The girl was only twenty, and because of her back deformity, was not given spinal anesthesia like the other mother, but just ketamine.  Ketamine put her to sleep and will help her forget everything that happens during the surgery- so she will be able to feel everything : ( She was crying out for her “mama” like crazy because she was so scared.  One of the girls held her hand as she went to sleep.  As soon as Dr. Moonga opened her, so much blood and fluid came out.  This woman probably weighed 90 lbs pregnant.  She had enormous blood clots, and the doctor’s thoughts about placenta abruption were true.  The baby was born a stillborn at 28 weeks.  The baby girl had probably been gone for about a week.  The mother continued to lose lots of blood, and the nursing staff was giving her fluids.  She needed blood, but it takes 2 weeks to receive it from Lusaka! 

So yesterday when Christine and I came back to the ward, we found out that the baby boy born from the first c-section had passed away.  He had been in respiratory distress when I saw him, but by the time I left the nurses had put oxygen on him.  I thought he would be fine after the help of the O2.  He should not have died and I took it pretty hard! The family was all around the ward after burying him that morning.  They were incredibly somber and it was so hard to see them grieve.  Christine and I also learned that the mother from the 2^nd c-section passed away four hours after surgery.  I was not so surprised, but it felt like another blow.  3 of the 4 patients we had worked with, the moms and their unborn babies, had died.  That same afternoon, another woman came to the hospital with her baby who was bleeding through the nose.  Although I wasn’t involved in the care of that baby, that child also passed away.  The air was very heavy in the maternity ward.  I overheard one of the nurses telling the mother of the first c- section that “the Lord giveth and take away.”  She was right, but it was hard to see so much death in one day. 

Although all that went on this week, I spent some time at the orphanage and had the best time with the kids.  I took dum-dum suckers, two nerf balls, and a soccer ball for them.  The suckers were a hit as usual, and we gave the soccer ball to the couple older boys who live in the orphanage.  They loved it and started playing right away.  I also gave these two boys the nerf balls, and they both felt like they had been given the world.  The held the kids a lot, and they showed me their garden once again.  We sat on the swings, and they showed me how they can hang upside down from the tree.  The kids were wonderful and I am starting to realize it will be hard to say goodbye to them in a few weeks!  So, I have captured many of the kids to remember them by. 

Two weeks of clinicals makes for one long post! I’ll try not to do that again : ) But, I also wanted to share one of the highlights of the whole trip so far that happened this week.  THE RAINS FINALLY CAME!!! We were all like little kids again, we were so excited.  We had been worshipping after a meeting, and then it started pouring.  So we ran outside in the rain and soaked it up.  It was finally cool! We started singing our worship songs outside and had a prayer for the next 15 minutes out in the thunderstorm.  It was wonderful and much needed by all of us.  We were completely soaked and trembling.  But it felt so good to be cold for a change.  It felt like a huge blessing!

We all saw some of the hardest things this week we have experienced so far at clinicals, but we continue to feel God’s presence here. 

Our soaked selves after a night in the rain!

The girls Yvonne and Doro.  Each child has their own bean plant, and they each made their own sign to label them.  They are very proud of them! You can see part of the rest of their garden in the back.

These are busy kids!

Here is the soccer ball we gave away.  This is Talent kicking it to Michael.  Talent loved this picture of himself when I showed it to him. I think I'll have to print it out to give to him!