Thirty-three
Well, we finally made it back from Mpanshya - Father Eugene from the Lusaka Archdiocese was doing a workshop at the hospital, and generously offered to give us a lift back to town yesterday. It's good to be in the city again.
I've been writing a kind of diary on our laptop in the evenings - it's always a bit frantic because we only have mains electricity for 2 hours on alternate evenings, so it's a bit of a race against time to get the day's events down before the battery goes. There is a strange comfort to be had in cataloguing the small details of your everyday existence, especially when everything is so strange. So, please don't feel any obligation to read it - it's more for me than any of you. (My mother excepted, obviously.)
It was my birthday yesterday - we celebrated on the day with beer and curry, so no different from any other year really. I did however have a more unusual pre-birthday celebration at the convent - the nuns threw a party with coca-cola, cake and traditional Zambian dancing (see photo). They are trying very hard to make us feel at home, and it is hard not to be won over by all their goodwill.
And now some edited highlights from the bush diary:
4th March 2006
The day starts at 7. All the other volunteers are heading to their placements today, so we say goodbye and wish each other good luck. Another goodbye so soon after the last round at home.
Sister Valeria arrives just before Bernadette, Joost, Chas and I head off for last minute shopping. She’s in a fancy Landcruiser, and we are all quietly pleased – a comfortable journey ahead. We head to the mall for last minute supplies and I spend 10 minutes frantically e-mailing a sequence of nonsensical typos home.
We get back to the Commonwealth Centre and pack our stuff in a rush, and return downstairs. There’s no driver. Sister V doesn’t know where he is. Eventually it emerges that he’d arrived at the neighbouring church (some 100 metres from where we are) and couldn’t find us so he drove back to a convent 20km away. He returns, but not in the fancy 4WD – some battered old ambulance with a wooden bench in the back. We climb in resignedly, surrounded by piles of shopping bags.
We crawl into central Lusaka – the Saturday traffic is the worst I’ve seen so far. After a confusing stop at the post office, we arrive at Kamwala market. It’s great – a muddy warren of stalls and shops. We busy some pots and Sister V does some hard bargaining for us for some wooden spoons. We then get back in the ambulance and crawl up Cairo Road. My bum is aching already and we’re not out of Lusaka yet.
Another stop for petrol, then one for Sister V to buy bread for the patients. We get greasy cheese toasties from a café that looks like it might be a place of ill repute.
Back in the van again, and we head out on the Great East Road. Everything is green when we get out of the city. I try to imagine what it will look like after the rains have gone. We head into the Zambezi Valley, and the surrounding land becomes more hilly. The driver points out the roof of Chief Mpanshya’s palace (the head of the local kingdom).
Eventually we turn off onto a gravel road and ascend 6km to the hospital. It seems to go on and on. Having dozed and stared blankly out of the window for most of the trip, I now feel suddenly anxious. What on earth are we doing here? We reach the hospital gate and it looks nice – tidy low buildings, a mural saying “We Treat, Jesus Heals”. We get out of the van and stretch. Sister Sabina is there to greet us. She smiles and shakes our hands. Sister V explains about the mix up with the driver earlier. Sister S: “Ah but there is always something with Mr Banda. If he had just gone in the church and prayed he would have found you”. We laugh, relieved that our new boss cracks jokes, even if it is at Mr Banda’s expense.
We are taken to out new houses. Both are nice, but we get one that is obviously much bigger. The doctor’s house I suppose. Chas looks pleased but I am just worrying that the magnitude of the house reflects the size of the expectations of their new doctor. Sister S shows us round – there is a wood burning stove (“So old we say that Adam and Eve must have left us it!” – the jokes keep coming).
Dinner at the convent – I am working myself up to explain that I don’t eat meat, but I find out that Maggie, the Polish hospice nurse is vegetarian. I am relieved that I don’t have to explain myself elaborately. Thanks for our meal is given in song, and the four newcomers fail to cross themselves at the conclusion. We sit and eat, and Sister S details her grand plans for us. She has many fundraising projects in mind for Chas, but Joost seems to be getting the worst deal – the hospice roof needs to be completed within the next 2 weeks, and she is expecting him to sort it all out. She tries to reassure me about what I will be doing. I realise that despite my attempts to project an air of polite bonhomie, I must look terrified. The evening finishes with an invitation to church in the morning – an offer we can’t refuse.
We go home and have a half-hearted game of travel Scrabble with double measures of duty free whisky. Chas has insects dropping in his hair. He eventually can’t stand it any more, and the game is abandoned. We find BBC World Service on our radio, loud and clear, and are very happy. We can do this, maybe.
5th March 2006.
We wake early and spend some time trying to switch on the gas stove. No success. The first of many domestic technical problems, I’m sure. Maggie comes to get us and we walk to church in the rain. We pass the village market, a row of stalls with a thatched canopy.
Beyond this, we see the church – a surprisingly solid looking red brick building. We shuffle in and choose a pew at the back. The service begins. Father Leschek, the Polish priest gives the sermon in apparently fluent Nyanga. The singing is astonishingly good, but no dancing today – the first Sunday of Lent. People come and go throughout the service. I think there are more than 200 people there.
A member of the congregation gets up to give what I assume to be the intimations. We become aware that everyone has turned round to look at us, and we are asked to come up to the front to be greeted. No choice. We walk to the altar and stand in a line, grinning sheepishly. We are invited to give our names and titles, and I blurt out that I am “an ARV support doctor”, and instantly regret it. (Maggie tells me that no one could hear what I said later.)
The choir begin to sing “Muli Bwanje” and the whole congregation comes forward to shake our hands. The men first, who look straight at us and smile, then the women, who are mostly reluctant to make eye contact. And the children, stretching up for a handshake with each of us. This lasts about five minutes, I think. This could be the oddest experience of my life so far, but it would be impossible not to be moved by the welcome of all these people in this small church. Even if you are a cynical backsliding Presbyterian…
6th March 2006
Sister Sabina comes to the house first thing, with Joost and Bernadette trailing behind her. She sits down with all of us and outlines her plans for us. Joost is assigned a major construction project, including the building of a computer centre and a nursing school. Chas is to find finance for all these schemes, and arrange a satellite internet connection at the request of a Swiss doctor who is coming to work here at some nebulous point in the future. I am required to do nothing but strut around the wards in the manner of a doctor, laying my hands on the suffering poor of the parish. I think she thinks I am going to run if she asks any more of me.
Then the tour of the hospital. The four of us are marched through the wards and introduced to patients. I can’t imagine what they are thinking of us, a gaggle of mzungus smiling and nodding nervously. My worst fears are not confirmed however – the hospital is less than half full, and there is a definite absence of festering wounds, wailing patients and all the other 10 o’ clock news horrors that I had imagined there might be. Chas reckons Sister S had thrown all the sick ones out in advance of our visit.
The buildings seem to go on forever – we are taken to see the new hospice building which Joost is charged with completing within the next 2 weeks. It’s not looking hopeful – there is no sign of a roof and even to my untutored eye, the walls look a bit wonky. I begin to feel that I might have the easy option here.
We go by the baby clinic, and there is a queue of women standing outside with children on their backs. They are here for the babies to be vaccinated. Some of them have probably walked for an hour or more to be there. I think of all those long consultations with anxious parents back home, trying to convince them about MMR safety. The women here need no such persuasion.
In the afternoon, we visit the hospital workers’ homes, and some poor woman who had given birth the day before is obliged to invite us in to her tiny house. More smiling and nodding from us as Sister pinches the baby’s cheek approvingly, and then onto the next attraction – the Mpanshya police station. I can’t imagine what the local constabulary do all day, but Sister is very keen that we inspect the cell at the side of the police house. A cursory glance over the police record book reveals that a third of detainees manage to escape lawful custody.
After a visit to the boreholes and the mission farm, the tour is over. I think we are all taken aback at the scale of the hospital. We cook by candlelight as the generator doesn’t come on until 8 on Mondays. I suspect this is the end of the induction period now.
Friday 10th March
The end of the first week. We are still here. It has been an interesting time. I am trying not to think about the remaining 51 weeks to which we have committed ourselves. I am thinking in little units of time, because being here for the long haul just seems too hard at the moment.
As we thought, the induction period was notable only for its brevity, and the real work started on Tuesday. It’s not the staff’s fault, everyone on the wards is incredibly busy, and there’s no time for extended welcoming and orientation. So, we are getting on with it, as much as our pigeon Nyanga will allow.
I am rapidly acquiring expertise in the management of malaria (number of cases seen in last 8 years: 2; number of cases seen in last 4 days: possibly 30). Until now, the nursing staff have been managing all these patients with the aid of the clinical officer. I’m not sure what I can add to all their skills, but the nurses are being polite and kind despite my constant indecisiveness. I think it’s probably a relief to pass ultimate responsibility on to someone else. There have been several moments this week when the extreme desirability of being able to pass the buck has occurred to me as well.
The HIV work is less of an issue than the general management of the hospital at the moment, but I think I will be able to become more involved in this. Maggie runs the hospice and the ARV clinic, and has plans for an outreach service, if the funding for a 4WD comes through. The clinic is a bit low tech for my liking, even as a GP with Luddite tendencies – no chest X-rays, CD4 counts or even basic biochemistry, the things I would consider the bare minimum in order to prescribe safely. But seeing the condition of the hospice patients who are not receiving treatment, perhaps some calculated risk taking is necessary. I’m not sure.
Chas is having a more leisurely week – he’s been thinking and writing for most of the time. Sister Sabina has set him his first task – to apply to the World Bank for funding. The woman is not lacking in ambition. As Chas said, she’ll have him ringing up Kofi Annan next.
We really need to make some contact with the outside world soon. The promised trip to Lusaka did not materialise this week, so we’re hoping to travel there on Wednesday. I have had moments of feeling like a hostage this week – we are completely reliant on hospital transport in order to come and go here. And I think that the sisters will prefer that we are here rather than larging it in Lusaka. Some assertiveness may be called for.
Anyway, there are some treats to be had here – we had banana cake from Maggie tonight, followed by watching the first episode of Shameless on the laptop (thank you, thank you, Simon). Maybe not one to share with the nuns though.
Sunday 12th March
It’s Sunday afternoon and we’re just back from a rather sweaty cycle along the road to Rufunsa. In retrospect, it was a bit daft to go out on our bikes in the middle of the day, but it did feel good to escape Mpanshya mission and do a little exploring. The VSO issue bikes have no gears, so next time you see me I may be endowed with thighs that would put Kelly Holmes to shame.
There is now a serious thunderstorm going on outside, and Chas is getting panicky about the house flooding. (As much as he ever panics about anything.)
It’s been a nice weekend – after a cursory ward round on Saturday morning, we went for a walk with Bernadette, Joost and Maggie. The area around here is quite hilly, and everything is so green at the moment; it was the first time since getting here I felt really happy about my new home. My inner hippy was clearly needing a bit of tree hugging time.
We also discovered the local off licence – a concrete shack with a pool table and about 12 blokes crammed around it, in varying stages of inebriation. The local market is full of men weaving uncertainly by late Saturday afternoon – we’re a long way from the Gallowgate, but it does feel strangely familiar here. Anyway, it was a huge relief to be able to source Mosi beer here, as we were down to our last bottle with no prospect of more supplies until we go back to Lusaka.
The beer situation was not the only emergency I had to contend with yesterday – I got called over to the hospital in the evening to see someone who had been in an RTA. Grabbing my auroscope (still not sure why – in case the casualty had an ear wax problem in addition to his multiple fractures? More likely because arriving on the ward with some fancy kit might give people the impression that I’m a real doctor) I went over, dreading what I might be about to find.
I came in to find Runa, one of the European nurses capably stitching up an enormous head wound. She had called me for a second opinion on the nasty looking crush injury he had sustained to his left lower leg, suggesting we might do a fasciotomy to prevent him from developing compartment syndrome. Huh? I was not expecting this. At no time during my preparation for coming here had I considered that there might be Swiss nurses who would be infinitely more competent than me. I had nothing useful to suggest – well, nothing that she hadn’t thought of already. I am glad for the patient that he is being looked after by someone who knows what they’re doing, but I feel completely incompetent. I left her to get on with it, although not before I had managed to get my left foot liberally doused in the patient’s blood, just in case anyone in the room hadn’t noticed that the new doctor is a klutz.
And this is the problem I have here. The hospital has been functioning without medical supervision for almost 2 years now. I don’t know what I can do here that the staff aren’t doing very effectively already. I think they had hoped that they would get a doctor who was a bit more handy with a scalpel than I am. In my arrogance, I had thought I would be overburdened with demands for my care here; perhaps the reality is that they don’t really need me at all.
Tuesday 14th March
Half an hour to go until my birthday party – I think the instigator (Maggie) had intended it to be a surprise, but Sister Sabina collared me outside the hospice today to tell me of the plans. So, we’re off to the convent this evening for a celebration. I don’t know what to expect (party hats over wimples maybe? I can only hope) but it’s a nice gesture, if a slightly embarrassing one. I will try and obtain photographic evidence of what ensues.
My first day of manning the ARV clinic today – six solid hours of people coming and going in various stages of ill health. People travel for miles on foot to come to the clinic, and sit outside the tiny room on plastic chairs until they are seen. No one grumbles about the wait. One woman brought me an outsize cucumber as a thank you for her medicine. Some people look fantastic – the ones who have been on therapy for 6 months or more – but others look like thin limbed children, with their eyes sunken deep into their skulls. They know that this is the last chance, and they put up with the horrible side effects that the crap drugs we have here bring them. I desperately want to get this right, and I am not sure if I am doing everything that I should be.
Ok, it's 7 o' clock - time to go.
posted by june @ 7:27 am
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