Final farewell post!

July 7, 2016

Hello friends,

My body has been busy and my thoughts racing in the last many weeks since I last wrote to you all.

I am finally quiet on a flight with my beautiful son Mathieu who is sleeping on me. I'm unable to sleep, thinking about how beautiful he is and reflecting on our trip.  I had written some very insightful things on my departure from Karanda hospital but I was not insightful enough to save to word document.

It seems like my experience at Karanda was some time ago, having spent some R&R with my father in Zambia.  The simplicity of being in nature, family time, wild animals and the African scenery did help me rest, reset, almost putting my mind in a bit of a daze.

Looking back, I remember the Sunday afternoon that we drove away from Karanda; the beautiful red sunset, blurred by the dust on the bumpy, unfinished road. We had all squeezed in the the truck.  Dr Thistle and his wife Padrinah had taken a moment before we started the truck to pray for our safe journey and to give thanks for our stay.

Stopping; to take the time to reflect on the past and say thanks, to think ahead... This seems in my busy life and my busy head to be such a luxury.

So I've decided to try with this blog...

I'd like to reflect on our travels across the world to spend time in Zimbabwe; its financial cost, ecological cost, the cost to my practice and patients.  I've been thinking that everyone on the plane around me has there own story.

I'd like to reflect on the time we have spent at Karanda.  The patients, the nurses, the doctors, the drugs, the operations, the bicycles, the worn one dollar American bills, the food, the children's friends, the school children and teachers, the stories, the odours, the faces - each so unique and complex.

I'd like to reflect on my family and the wonder, excitement and happiness the kids and JF experienced discovering this whole other world.

AND I'd like to give thanks... To JF for being crazy and adventurous enough to embrace and run with my small idea, years ago to come back to this country that helped shape the surgeon and person that I am.

To Dr thistle for his work day in and day out for the people of Zimbabwe, no matter their circumstance, political affiliation or religion.  Thank you for his vision for a better, healthier, more coordinated, self sufficient, humane, respectful world.

To my family and friends who have put up with my absence leading up to and during this trip who support me without conditions or stable wifi.

To those who have donated money, gifts, medicines or supplies- who have helped me ensure that our impact will be felt for months to come. Who have joined my voice in saying to the people of Zimbabwe that others care about them and think that such inequality is unfair and needs to be a thing of the past.

So thinking ahead... I hope that my mind will occasionally be still, long enough to picture myself on that dusty road with the beautiful sunset. To stay grounded, true to myself and to remain thankful for what we have.

Enjoy the rest of the summer dear friends. I look forward to seeing you soon.

Michelle

Our funding at work!

Sorry for the delay in posting ... our last few days have been full of travel in places with little or no wifi.

Here are a few photos to illustrate where our generous donated items and funds went:

It took about 10 days to clear our suitcases full of medication,  surgical equipment, bicycle parts, electrical supplies and hardware of all sorts as well as a full suitcase of soccer equipment, soccer & basket balls!  Our colleagues on site are used to dealing with the customs and worked their magic to make it happen. Nothing lost in the process.

Time to open the suitcases! Jeff was happy to see that all is equipment has arrived!

After spending some time sorting out the equipment we starting distributing all our goodies to the different sections of the hospital.

Operating Theatre:

20 boxes of heavy sutures, specialized foley catheters, head lamps for when the generator or electricity goes down. 

Maternity:

 fetal ultrasound monitors and suction delivery devices (kiwis) for difficult deliveries - this can be life saving - every minutes counts when the baby is in distress.

Laboratory:

Blood sugar test strips at 1$ each - an expense that is well out of reach for this tight budget hospital 

Children's Ward:

Julien and Mathieu joined me on a Saturday to distribute the knitted dolls that one of my patient's had so generously made. The boys made sure that the boys received boy dolls and the girls pink dolls.  This was an eye-opener for my children.  They asked many questions on the walk home about sickness, health, burns etc.

Pharmacy:

This was my favorite stop.  After hearing every monday at our departmental meeting about the drugs in low supply or unavailable - the drugs we brought were going to be immediately useful 

The pharmacist said that her favorite drug that we brought was the IV Ceftiaxone.  IV antibiotics are always hard to come by.  They are more expensive and these days in Zimbabwe cash is in short supply and therefore the suppliers are having a hard time stocking even this basic drug.  It is also most needed for the sickest patients, including the surgical patients who's bowels are not working.

The Bicycle parts brought from Canada including Tire Liners and tubes were used on a daily basis! the number of repairs done over our stay was a great achievement also another few weeks would have been welcomed.


The workshop was a small but busy room with sometimes up to 3 person working inside and outside on bikes and people waiting outside during the day patiently waiting for their bikes to be fixed!

Une autre journée de visite

Bonjour à tous!

Nous avons passés la journée à Harare avec notre guide touristique et par ailleurs ami de la famille qui connait la ville comme sa poche.

A l'heure actuelle sévi une crise monétaire importante dans le pays qui fait craindre une récession pire qu'en 2007 quand Michelle était au Zimbabwe. Les banques ferment leurs guichets automatiques et les montants d'argent que l'on peut retirer diminuent de semaine en semaine. Au moment où j'écris ses quelques lignes le retrait maximum est de $100 par jour et par quand l’on peut trouver une banque ayant des liquidités et des files d'attentes de 2-3 heures apparaissent au gré des rumeurs qui annoncent que tel ou tel guichets on des fonds. Le gouvernement vient d'annoncer le lancement de "bonds" pour le mois d'août afin de pallier au manque de liquidités ce qui rend la situation encore plus tendue puisque beaucoup pensent que cela précipitera le pays dans une récession majeur et durable. Au plus fort de la crise en 2008 nos collègues et amis de l'hôpital de Karanda se relayaient pour aller en Zambie ou Afrique du Sud pour acheter le strict nécessaire.

La situation économique actuelle nous a de nouveau rattrapée lors d’une courte visite dans un centre commercial à la recherche d’un maillot de l’équipe nationale de football. Une bonne moitié des magasins sont fermés ou vacant et c’est d’un centre commercial bien triste que je suis ressorti sans maillot!

A l'aube de notre départ il semble que le futur proche soit très incertain.

Nyasha (notre guide) nous a fait passer d'un extrême à un autre en quelques heures. En premier nous avons visité le (très grand) quartier riche de la capitale. Michelle et moi avons été surpris de la richesse très apparente, la taille des maisons, les priorités sécurisées comme l'on en voit aux Etats-Unis et un centre d'achat construit pour cette clientèle unique. Nous avons visités celui-ci et nous sommes retrouvés entourés en grande majorité de "blancs" : Sentiment étrange après plus d’un mois passés à faire partie d'une très petite minorité. Pour référence les blancs représentent 0.3% de la population zimbabwéenne en 2015. Nous étions donc dans une sorte de ghetto!

D'un extrême à un autre nous nous sommes ensuite rendu dans le sud de la ville et sa banlieue défavorisée. Ici pas de ZEP, ZUP, banlieue prioritaire ou autre abréviation intelligente comme l’on en voit souvent dans les nouvelles en Europe ces temps-ci. Seulement une continuité de maisons, immeubles et un environnement dégradés. Pour la première fois je ne me suis pas senti en contrôle de la situation et Nyasha était visiblement très nerveux à l'idée de nous avoir dans sa voiture et encore plus quand nous nous sommes retrouvés piégés dans les bouchons du bidonville à cause de match de football qui venait de se terminer. Dans un pays au climat racial tendu et à la situation politique précaire ce n'était pas forcément l'idée du jour de visiter cette partie de la ville.  J'ai dû me résoudre à ranger mon appareil photo après plusieurs demandes explicites de Nyasha. Il n'y a eu aucune agressivité physique mais les regards et les mots parfois virulents à mes tentatives de prendre des photos (même dérobées) nous ont fait comprendre que la situation pouvait dégénérer à tout moment.

Nous avons donc fait profil bas pour le reste de la traversée, les enfants avec maman derrière et moi avec Nyasha devant évitant tout regard direct. Un gros mal à l’aise à la sortie du quartier pas à cause de la situation mais de voir tant de pauvreté à seulement quelques encablures d’une richesse exubérante qui amplifie l’écart entre les catégories sociales.

Après discussion Michelle et moi nous sommes dit que la pauvreté des gens à Karanda n’avait pas grand chose à voir avec celle que nous venions de voir. Même si les gens de Karanda semblent très pauvres une grand majorité est en mesure de survivre cultivant un lopin de terre qui leur permettant ainsi de subvenir aux besoins de base de leur famille même si, évidemment, cela ne leur permet pas de sortir de la pauvreté. Nous n’avons pas eu le même sentiment en traversant ce quartier ou les gens vivent dans une pauvreté extrême, dans des conditions difficiles quand 3 à 4 familles partagent un appartement de 2 chambres et des conditions de salubrité qui catégorisent le Zimbabwé comme pays du tiers-monde.

Les quelques photos ci-dessous parlent pour elles mêmes.

Pour finir la journée nous sommes allés visiter la Galerie d’art Nationale d’Hararé. Une visite intéressante pour nous et les enfants qui ont pu se dégourdir les jambes dans le parc du musée. L’idée originale était de les laissant dans un parc adjacent avec Nyasha pendant que moi et Michelle faisions le tour du musée. Les conditions de sécurités dans le parc n’’étaient satisfaisantes et nous sommes finalement allés en famille au musée.  Il y avait d’ailleurs une petite exposition d’art utilisant des déchets recyclés comme de bouteilles de verre, des rubans de cassettes vidéos et toutes sortes d’objets réinventés.

Cette exposition était intéressante puisqu’elle fait un lien intéressant avec ce que j’ai peu observé depuis notre arrivée au Zimbabwé et qui se résume par la capacité à réutiliser et réinventer chaque objet de la vie quotidienne.  Dans cette exposition se trouvait un série de courts documentaires de la BBC, de témoignages d’artistes locaux et internationaux engagés dans la protection de l’environnement. J’ai été intrigué par la vidéo de Prince EA P(lien ci-dessous) que je ne connaissais pas auparavant mais qui – dans le contexte actuel du zimbabwé et de  l’Afrique en générale – est intéressante à regarder.

Je vous laisse la dessus.

https://www.youtube.com/watch?v=o9f7sSEqUw8

Visit to an Orphanage

May 31, 2016

Good morning friends,

We are waiting for Nyasha to arrive to pick us up.  He is demonstrating the concept of African time as we were hoping to be on the go at 9am and its 11:09.  I know he has a good excuse - having hit a safety bump too hard last night while showing us around this massive Chinese shopping centre / amusement park. A piece of the shocks were loose and he was trying to see a mechanic before we start our day of shopping /visiting.

So we have spent the last 2 hours playing hide and seek on this massive 2 acre gated compound that is our guest house - an old Rodesian home that still belongs to the general surgeon at Karanda - who is on his 1 year leave in the US.  He grew up here - his father was a missionary and physician, founder of Karanda and who worked into his 80s.

Yesterday was an incredible day.  We were asked to visit, St-Marcellin’s Children Village, an orphanage that is supported by Emirates airline in exchange for free extra luggage.  We obviously said yes and were in communication with the founders Norman and Sybil before our departure.  They too requested soccer balls as well as thermometers and a child's BP cuff.  We also brought a bag of knitted dolls from one of my generous patients.  So we set off in the morning to their home in the capital.  What a beautiful visit.  This lovely South-African white couple gave us a tour and shared their story.  They are in there early 70s I’m guessing and have 6 children (a pilot who lives in Dubai and 5 in South Africa).  After a career in banking, this religious couple felt the need to dedicate their lives to God and gave up their home and finances to help a Leper colony in a remote part of North Eastern part of Zimbabwe in the late 90s.  They were forced to leave, with 2 hours notice when the house was near completion and after re-contemplating options and having reached out to Italian donors they founded their orphanage in ~ 2002.  They have 77 orphans aged 2-18, having received some of the children from social welfare as young as 4hours old.  The children live as a family, in 3 separate sparse homes; 23 children in each home, ~ 3 children per room (each decorated with magazine cut-outs and stuffed toys).  There are 7 special needs children, including a lovely blind 18y.o. girl, who has taken up making bead necklaces and who has a contagious giggle.  To make ends meet in times of hardships, they have been VERY resourceful… they are almost self-sustainable, with their own garden and chickens, they have invited nuns to live and help with the children (especially when there were many young infants – with nappies everywhere) and they have opened a private school (grades pre-school to grade 7) to offset the costs of running the place.  The nuns teach and they charge 380$ per trimester.  The classrooms are impeccable and the children well-behaved (as you can imagine if you went to nun-lead school). 

Mathieu has enjoyed the day at the orphanage... 6 dogs to play with!

Norman told us about his sales-pitch to the board of Emirates in Dubai; the conference room, the luxury, his nerves … he mustered up his courage and told his story- just like he was telling it to us – and they lucked out with a sizable yearly subsidy from Emirates that comes from the change that we are asked to leave behind at the end of flights.  This funding is crucial for there sustainance.  They tell me that they have received less than 5000$ USD from Social Welfare or any other government source since there inception 14 years ago.  They say that their operating costs are over 15 000$ USD per month.

It was a humbling experience.  The children looked happy yet poor. We felt privileged to have met these two selfless, kind individuals who shared with us an excellent meal and their vision for a better life for these children who otherwise would have no-one. 

Adoption is very taboo in Zimbabwe.  Most orphaned children are raised by extended family, aunts, grandmothers – so to actually been given to the state- must reflect the total desperation that these mothers had.  Sad to think about this, when contraception, education… prevention are such simple concepts to us.

Well, enough about our visit to St-Marcellin… we finished our day in a completely different reality; visiting a stone sculpture garden and savoring our first real coffee of our trip in a Belgian coffee shop – with monkeys jumping on the tin roof top above us.

Nyasha should be here soon – my husband is going stir crazy waiting… I’ll keep you updated on today’s adventures soon...

Take care,

Michelle

A quiet Saturday night ...

May 28^th, 2016

Good evening friends,

I thought that I would jot down a few words before I go to bed.  My husband is out watching the “Something cup” soccer game Madrid vs Madrid at Prosper’s house– so I am enjoying an hour of quiet time.

I wanted to share a few things for which I am very grateful.  We shared a few lovely meals today… one at our guesthouse – homemade pizza for ~ 18 people that we hosted; children, friends, housemates and neighbors and again this evening – a quiet dinner at Dr Thistle’s house.  I was really nice to exchange views, talk openly about the challenges of health care delivery in Zimbabwe and elsewhere, about the past, present and future role of Missionaries in Karanda. about our children and our families.   We share many things in common- despite the kms that separate us.  It was nice to take time to really share in our otherwise busy busy lives.  We got called about an incarcerated inguinal hernia during dessert (the second this week).  I’ll do it tomorrow at 8am before the day gets too busy.  Walking home, with Mathieu in PJs, snuggled in JFs arms – the stars completely lit up the sky.  Again, something we don’t take the time or the drive out of the city to appreciate enough.

The end of the week has been busy – operating until 5pm both Thursday and Friday.  You never really know what the day has in hold for you.  I performed a below knee amputation for a gangrenous foot in a 60 y.o. gentleman who has been diabetic for 20+ years on Thursday.  The case was listed on the white board – so I reviewed the patient and as his spinal was being inserted I was reading up on the procedure.  I thought that the young nursing student from the US was going to pass out.  That day we did a skin graft for a burn, a liver biopsy for massive nodular hepatomegaly (I hate this semi-blind procedure!!) and an open cholecystectomy (gallbladder removal), something I haven’t done since my first month in practice in Winchester.  It went pretty well considering.

Today, I have said goodbye to many of my patients.  We are heading to Harare tomorrow to visit an orphanage and to do a few errands.  My patient with the BKA was so relieved to not be in pain – he was very thankful.  My stoma lady (with perforated obstruction) is doing very well; smiling, walking and has received her 1^st of 3 pre-ART (Anti-Retroviral Treatment) counseling sessions.  I am hoping for discharge this week with reversal of her ostomy in a few months when her immune system is stronger.  Her pathology came back as a benign uterine fibroid with adhesions.

So I guess that’s all that I have to say.  I am grateful for the tangible results of my surgical profession.  I am grateful for friendships; here and back home and for the time to enjoy them.  I am grateful for nature and I am grateful that Mathieu is no longer vomiting.  Oops – I forgot to mention that.  He had a brief (3-4 hrs) bout of sickness during our pizza party after eating something off the ground - ? ant food? The local boys told him that it was a good idea to eat it.  Ah! Boys !  He’s better now – that’s what counts – maybe he’ll listen to Papa a bit better.

Enjoy your Sunday my friends.  I hope it is restful.

Xo

Michelle