Weekly update from Michelle

May 15^th, 2016

Hello again,

Maybe this is becoming a Sunday afternoon ritual.  I have just come back from a 1.5hr walk with JF while a lovely 14y.o watched the kids while they nap.  His name is Innocent and he has been adopted by the headmistress of the nursing school.  We were told that he was dropped off at birth, on the steps of the hospital.  He is tall, wears round glasses and has perfect English.  He is in grade six at the same school Julien is going to and he has spent his last week watching JF repair bikes in the afternoons.  The kids love him and call him “chicken” for some reason.

Another week has gone by.  I can’t believe how fast the days past.  Let me tell you a little bit about my daily routine.  I am up and out the door by 7am.  The nursing students and senior medical people (at least those who choose to get up or who are guests) begin their day with 15 minutes of song and a daily devotion that anyone can lead.  I then finish my coffee and head to male ward to round on all surgical patients (except ortho – I had to draw the line).  Male ward has about 45 beds.  A nurse who helps translate to/from Shona accompanies me.  My gentleman who has had the penectomy was discharged on Friday.  He was so grateful, cheerful – he kept clapping his hands with a smile ear to ear, chanting our praise.  When I feel grounded – I am grateful for this type of response.  When I am tired – I question his response, his understanding – I feel like we did nothing at all – at least nothing curative. Another gentleman has had a laparotomy for a perforated peptic ulcer.  I brought him back to the OR for washout of a pelvic abscess on Friday.  Finally, a smile on his face.  Finally, feeling better.  I can just imaging this man’s life… very tall (~ 6’2), strong, a farmer – not used to being sick – never mind spending 2 weeks in hospital.  How is his family coping? What is the economic impact of his illness?  I hope he stops spiking temperatures.

Then, I go to female ward, where Dr Thistle has already started – I only see the non-gyne patients and it usually goes faster.  We have been following a young lady (~ 21 y.o) with agenesis (absence of vagina).  Dr Thistle created a vagina on my first day and the passage keeps closing.  We have brought her back may times to dilate the passage in hopes that she can be discharged.  We admitted 2 ladies with probable bowel obstructions on Friday.  A ~45 y.o who is has a partial obstruction from I suspect carcinomatosis (cancer all over the lining of the abdomen), 6 months after a surgery in Harare for sigmoid colon cancer (T4N3).  Despite the fact that she is well dressed, speaks perfect English and lives in the capital – she has no funds for chemotherapy and stated that she could not return to the same hospital because of unpaid bills.  Her abdomen is tense and nodular with hard masses that I can feel.  I gave her an enema through her stoma, IV fluids and I suspect that she will be discharged on Monday.  The other lady has recently been diagnosed with HIV.  Her CD4 count is 57 (over 400, they offer Anti-retro virals).  She had not urinated for 4 days and was draining >1L of feculent stuff from her NG.  She had no peritonitis. No money for a blood count or X-rays.  We are resuscitating her and we’ll see.  I didn’t round today but I was told that she is improving.

Oh ya, so the rest of the day goes as follows – I head to the operating theatre usually by 9:30am – the team is not ready to start until after tea time (10-10:30) so I organize dressings that are all mixed up and not used or understood by the physicians here (or by me for that matter).  I have tea with the team and we start cases at 10:30.  There is a list that is not followed in order.  Most of the physicians pop in and out, being called for the cases that they are most in charge of.  Dr Thistle does the big hysterectomies, Dr Stacey Harms a new general surgeon from the states, does the VP shunts (tubes that drain excess fluid from the brain into the abdominal cavity for children with enlarged heads).  I take the dirty cases (huge sacral pressure soars), the familiar cases (hernias, scopes, hemorrhoids) or anything else (this week prostatectomy, hydrocelectomy, D&C, bilateral orchidectomy).  We work until lunch.  Take a break to go home for lunch (1-2pm) and then until 5ish.

Enough medical talk…

The highlight of the week had to be watching the Karanda truck arrive around 7pm on Wednesday from Harare.  My husband and John (the American - in charge of maintenance) had travelled to purchase IV fluids, parts for the bikes and … picked up our bags that had passed customs.  To see the suitcases on the roof – It was like Christmas. We were so happy to show the contents to Dr Thistle and his wife Padrinah (how teaches midwifery here) – 2 full duffle bags of medications, surgical supplies, soccer balls and training equipment, hand-knitted dolls for the children of hospital and an orphanage that we plan on visiting.  All intact and in time – the hospital has run out of Penicillin G, Amoxicillin, Acetaminophen and all PPIs.  We are slowly distributing things to the areas where they belong.  The lady in the pharmacy was so excited – to see the line of patients waiting outside her door was well worth the administrative headaches. We are planning a trip to the local village school next week with the boys.

As a write this, I have been interrupted.  I am surrounded by 4 crazy boys (ages 7-9; Proud, Nokutenda, Anesu and Garikai) they are making up stories about an avocado stuck in their throat making a funny sound – gueeo gueeo gueeo.  They find themselves very funny and are reading my words as I write them.  We took photos with Photo Booth and laughed out loud.

Connecting with people, from all walks of life is really my favorite part of travel adventures.  From Hannah or Prosper the OR nurses, to Camilla, our housemate – a med student from the UK who is interested in pursuing Missionary work.  Sharing pizza with Dr Thistle and his sons as well as his insights on overseas work, the present and future of this hospital.  Making popcorn with Miriam and chatting about visitors and their impact (or lack of).  We are really savoring these moments and are doing well.

The boys are now fast asleep.  They come home exhausted and filthy.  We had a great birthday party yesterday for Mathieu who turned four.  My homemade cake (he wanted a rainbow cake with super heroes) was a bit undercooked but looked great in my opinion. The kids played hockey, ate popcorn and pizza and just before going to sleep Mathieu said that if fact he would have preferred that the super hero “Flash” had been drawn on the cake and asked when could I make him another.  Oh well… I am left with his beautiful pouty face – thinking that … I can try as hard as I can, give all that I have got to give, but that just like in life – it may never be perfect. And that it’s ok.

Thinking of you all very much, I hope that you have a great week,

xo

 

Michelle