Mother's day post... a little late!

May 8^th, 2016

Good afternoon friends,

Happy Mother’s Day to all mothers!!

It is Sunday afternoon and I have been awoken from a luxury nap by the persistent knock on the door by 5 local children wanting to play with Mathieu and Julien who were cuddled up to me in bed.  The children are calling them by their names … “Juleean?” “Mathew”. They are also on a bike so maybe they are here to see JF – I think the word has got around that he fixes bikes.  I have let them sleep and have asked the children to come back in 30minutes so we have a few minutes together for me to write this blog.

This is the second time that I have been awoken abruptly today.  In the wee hours of the morning I got called to assist with a STAT C-section on a 39 y.o. female who was 30 weeks pregnant with triplets.  Dr Thistle had warned me that she was admitted but we all hoped that she would not yet go into labor.  Well, here she was in labor with the umbilical cord prolapsing into the vagina, potentially squeezing the blood supply to the first of these fragile babies.  So I had asked to be assisted with my first c-section but I hadn’t quite imagined that it would be this way.  Dr Thistle’s hand was pushing upwards on the cord and I was performing the emergency c-section with a speed like I have never done.  Never mind half of the small details of controlling bleeding, using our various instruments… just get to that uterus with a scalpel and using fingers to tear, I just got that baby out ASAP.  The baby was a bit flat… apgar scores of 7/10 and the two others were smaller but surprising, 15min later they were all crying , breathing on there own and bundled in an incubator.  Let’s see what the next few days bring.  I walked home, with the rising sun, wondering if they were going to make it home.

We have been at Karanda for 4 days.  Obviously, by the first paragraph – the children are settling in very well.  They are so playful and positive that I am glad that they are here to keep me grounded.  Julien is going to start his first day in grade 1 at school tomorrow at 7:15am.  We have borrowed an old grey uniform and have bought knee-high grey sox so we are all set.  I spent 2.5hrs yesterday with the school matron, a 65 y.o. female American Missionary, who’s husband is in charge of maintenance and who has been working with JF.  We developed a lesson plan for Julien with word flash cards and his first step English book.  Hopefully, he will be able to follow along.  His teacher is a lovely Shona woman, the wife of the Chaplin, the gentleman who is supposed to be in charge of the bike program.  There are 2 other children in his class and they follow correspondence classes.  I have been told that the Karanda Group is not technically allowed to be called a school as the correspondence lessons are meant for individual learners and that the small numbers of students can be explained by strict standards, white teachers, the English only environment or that it is only for the senior staff’s children.  So who knows, the truth is probably meddled somewhere in these opinions. The village school is a 30min walk away.  Hopefully, we will get a chance to visit.

Mathieu will stay with Miriam, a lovely women who helps maintain the guest house here.  She has a generous smile and 3 children.  Her husband works in Harare.  I will report back on how the transition goes.

Medically, I am finding it a bit more challenging than I expected.  The first day OR list was 3 upper scopes  (1 obstructing esophageal cancer, 1 obstructing oropharyngeal cancer and 1 normal scope – abdominal tumour ? ), a hysterectomy for cervical cancer, a prostatectomy for benign prostatic hypertrophy and an above knee amputation that I performed for a gangrenous foot due to peripheral vascular disease.  The second was a hernia, a liver biopsy for a large tumor ridden liver, a parencenthesis  to drain ascites in the abdomen, a patellar fracture that Dr Thistle did, 2 penectomies (removal of penis), both for advanced squamous cell cancers.  One gentleman’s cancer was so advanced that he was urinated from spots in his scrotal skin.  We were unable to find his urethra and ending up placing a catheter directly into his bladder from his abdomen. Both cancers were not curable with large palpable groin lymph nodes, both in HIV positive patients (they use the acronym ISD – immunosuppressive disease to decrease the stigma?), both patients unlikely to get advanced therapies like chemo or radiation that may be available in Harare (not that I am certain that it would be of much assistance).

So just by listing the types of cases, you can see that we are seeing advanced, almost untreatable disease.  I am not really fully qualified, fully knowledgeable or fully comfortable with the breath of this type of practice.  I wonder if anyone really is.  It will be interesting to talk to Dr Thristle and Dr Harms, both North American trained surgeons for their perspectives.  I know that they have both found themselves here for missionary purposes and I always feel a bit uncomfortable approaching this topic.  We are living with a UK Medical student who has received missionary training and who hopes to continue in this type of work.  I just don’t see how the two worlds collide – medicine and religion.  So I walk this line cautiously as the missionary vibe is much more present here in Karanda than it was at Howard, 9 years ago.  I even pulled out a skirt today for mass to try not to offend.  The instructions / orientation papers clearly say that long dresses should be worn out of respect and my husband was told to wear long pants this morning.  This type of speech is harder for me to swallow than my Malaria pill.  My husband is surprisingly patient.

We sat through a long church service – being introduced as guests – having songs and sermons translated in English by the lovely man named “Prosper” an OR nurse sitting next to us.  Handsome and in his best suit, he was following along with his bible, sharing his bible with JF to read.  I was chuckling in my mind.

So this has been my last few days here – I’m not sure that I quite figured out where I belong within the 2 extremes of care provided in this world…. too little too late on the one hand and not really needed, sometimes wasteful on the other.  As I have said to myself before  “Over thinking kills your happiness”.  So I will try to follow my husband’s advice and make the most of these weeks, knowing that I will not change the world – but will make a small impact with each of my actions.

Good night…