Songs of praise

19th August 2006

Chas and I are out on a morning jog, and as we pant our way down the home strait, we spot the police vehicle at the hospital entrance. We stagger back to the house, reasoning that if it is anything important, someone will come to get me. The error of this assumption only becomes apparent after I have had a leisurely breakfast and strolled over to the main building an hour later. The A&E ward is jammed with dazed looking casualties from the latest road traffic accident. I am ushered through to the dressing room next door to attend to the individual who is deemed to be most seriously injured. He has a skull fracture, and he is reeking of alcohol. The driver, obviously. I make sure he is breathing, and I get him to grunt a few reasonably coherent sentences. I decide that the scope for further intervention is limited, and move on to the next one.

About an hour later, Esnart and Esther return from the scene of the accident with a patient whom they have managed to retrieve from the wreckage of the vehicle, which now lies 50ft below the road, down a steep slope. The woman has the most appalling chest wound I have ever seen, but she is conscious and able to speak to us. I put up a drip and wonder what to do next. Her elderly mother asks to see her, and I bow my head as she prays beside the trolley. I’m sure I should be doing something smarter and more doctor-like than this, but the correct course of action eludes me again.

The last casualty arrives in the afternoon, after all the patients with serious injuries have been dispatched to Lusaka. He had the misfortune of being thrown from the truck and then rolling to the bottom of the precipice, so nobody found him for hours. He has a number of head wounds, and is totally confused. I bend over him to put a needle in his arm, and he protests by kicking me in the side of the head. I hear myself swearing loudly, and look up to meet the disapproving glare of Mrs Lipalille. I get Catherine to sit on his chest while I piece together the jigsaw of his scalp, a process which occupies me for the next couple of hours.

20th August 2006

Sisters Martha and Regina are taking Dineke to Lukwipa to see the waterfall, and they ask Chas and me if we would like to come along. We climb into the back of the pickup and set off. We stop at the church to collect some extra people, and we look on with a sense of mild dismay as the whole of Lukwipa Girls’ Choir scrambles into the van with us. Leg room completely eradicated, the vehicle bounces slowly down the dirt road, the engine straining against the weight of its passengers. The girls begin to sing and do not stop until we reach our destination half an hour later. It is picture postcard Africa, travelling in the back of an open vehicle under an enormous blue sky, squashed together with singing children.

23rd August 2006

I am having a sweaty moment. It is midnight, and I am back in theatre again, trying to extract a baby from the abdomen of a very tired teenager called Queen. A case of obstructed labour – not such an emergency this time, and I could have insisted that we referred her to Lusaka for a Caesarean. But somehow, I was persuaded that doing it myself was the best course of action, for reasons that are suddenly seeming less robust.

The baby’s head is stuck in his mother’s pelvis, and I can’t get my hand in far enough to lift it out. Trying to suppress a growing feeling of desperation, I hook my finger under a foetal armpit and tug, but still nothing happens. The inside of my surgical mask is sticky with perspiration. I look blankly at Mr Phiri, who suggests that a bigger hole is required. Reluctantly, I extend our already large abdominal incision up the midline.

Queen’s son then enters the world bum first, and stubbornly refuses to breathe. I leave the midwife to resuscitate him, and try to concentrate on piecing together the gaping wound in his mother’s belly. I am wondering if all this cutting has actually achieved anything when I hear the baby cry. Sister Valeria murmurs “Hallelujah”, a word which I have only ever used to express sarcastic weariness. But at this moment it seems appropriate, a long sigh of relief. I spend the next hour stitching, and then go back to bed to enjoy several hours of insomnia and an intermittent urge to get up to perform blood pressure checks.

24th August 2006

The babies keep on coming. I return from lunch break to find that two were born simultaneously in my hour long absence, and there is an ambulance call for the third. I spot the pickup driving towards the hospital at top speed with Esnart crouching in the back. I walk round to the grandiosely titled Casualty entrance (which is actually just a door with a wheelchair stored behind it). There is a startled new mother sitting in the truck, and Esnart is jumping out with a bloodied bundle in her arms. Her chitenge falls off, but like a consummate professional, she leaps out of it, hardly breaking her stride as she runs towards the delivery room with the baby.