Pimm's and twins

Chris masters lighting a fire with a plastic bag















Mum visits Mulamba school

29th April 2007

Sunday morning in Mpanshya, and I am in isolation ward, along with fourteen cases of suspected cholera. The outbreak began earlier this week, and patients began coming to the hospital on Friday. I have never seen cholera before, but it presents unambiguously and is therefore not hard to recognise. One by one, the patients have arrived, clammy, prostrated and groaning. Everyone who made it to hospital has survived so far, largely thanks to the efforts of the staff, who have worked all day and night. They have kept the IV lines going continuously, and are trying to enforce infection control measures. This is not easy – patients’ relatives wander in and out of the ward, and one woman is insistent in her efforts to keep breastfeeding her baby (despite being in a fairly advanced state of dehydration). My role has been much less hands-on, but all the same, I scrub my fingernails assiduously and disinfect my stethoscope whenever I can. A dose of cholera is not an attractive prospect.

I am just leaving the hospital when a delegation from the district health management team arrives. They have displayed an unusual interest in the hospital during the cholera outbreak; yesterday they came to see us twice. One of them introduces himself to me as Mr Choongo, and asks me to accompany them to isolation. The visitors bustle round with clipboards in hand, surveying the chaos within. Mr Choongo stops by the bed of one of the female patients and interrogates her about the appearance and consistency of her diarrhoea. He considers her reply, and then pronounces that this is not in fact cholera but malaria. Having no particular opinion on the diagnostic relevance of stool colour, I nod silently and follow him as he moves on to the next ward.

Later, I find out he is the human resources manager.

3rd May 2007

It is 6am, and we are at the airport waiting for Mum, Aunt Dianne and Christine. The flight they are arriving on is an auspicious one – not only is the Duke of Gloucester on board, but Sister Sabina is returning from Poland as well. The arrivals hall is full of nuns, not just from Mpanshya, but also from the sister congregations in Makeni and Chilanga. Eventually, I spot my mother in the crowd, warmly embracing Sister Josefa. I wave, trying to attract her attention, “Remember me?” Aunt Dianne follows, trailing an illegal quantity of luggage behind her. “Isn’t this great!” she exclaims. The shabby interior of Lusaka International can seldom have seen this much excitement.

We proceed to the shopping centre, where Aunt Dianne obtains an outsized fly swatter for the purposes of cockroach control. We then board the minibus for the drive back to Mpanshya, which takes slightly longer than anticipated. Just outside Lusaka, we stop at a roadside market to buy tomatoes. Aunt Dianne purchases some inedible-looking roots from one of the stalls. I have no idea how to cook them, but somehow she manages to get the vendor to mime a recipe. Further down the road, we have a tyre blow-out when Chas accidentally hits a pothole at high speed, and we have to enlist the help of a passing cyclist to get the wheel off. I assign myself the task of erecting the emergency triangle, which is about as far as my skills extend in situations such as these.

When we finally get to the house, we are greeted by Corinna, our new cleaner, who has killed a chicken for the visitors. (Chas employed her after getting thoroughly sick of washing clothes by hand in cold water; we don’t really have enough domestic duties to justify having hired help in five mornings a week, but luckily she works slowly.) Aunt Dianne shows her the roots she bought and she wrinkles her nose in horror. Shortly afterwards, there is a similar display of disgust from the guests when they are presented with the cooked chicken. It may only have died this morning, but they reckon that it was likely to have been born many years before.

But everyone is pleased to be in Mpanshya. Chris fulfils her dream of sitting out in the African sunshine, drinking rooibois tea. Aunt Dianne, who has conducted a lifelong crusade against waste, is delighted to discover that the shredded tyre from the minibus is being rapidly recycled into footwear by the general workers. And I am happy because never before was there any prospect of obtaining a decent Pimm’s around here, and at last, this regrettable situation has been rectified.

17th May 2007

I am finishing work for the day when Catherine approaches me in the office. She asks me to see a woman who has arrived in labour. I tell her to get the nurse on duty to see her, but apparently Odesta has gone for one of her extended breaks. With some bad grace, I go to see Joyce, who is heavily pregnant and appears to have left a trail of meconium when she entered labour room a few minutes before. Despite her obvious state of discomfort, she is apologetically wiping it up of the floor.

A quick examination reveals that the umbilical cord is prolapsed. The baby is breech but still alive. I tell Catherine to run for help. I am trying to manoeuvre Joyce so that she is kneeling on all fours, when suddenly the baby’s foot falls out. At this point, it seems that things cannot possibly get worse. Then I discover that nobody actually knows where the keys to theatre are. Mr Phiri has gone to town for the day, and the only other person who has keys is Sister Josefa, who is in Poland. I stare at the little purple toes, hanging in mid-air, and suppress the urge to scream.

Luckily, the ambulance returns from town shortly afterwards, and Mr Phiri is hastily pressed into service. An hour after her arrival, Joyce is wheeled into theatre. It takes me several attempts to get the baby out, because the placenta is lodged in the lower womb, and there is a lot of bleeding when I open it up. We deliver him eventually, but still, something doesn’t seem right. There is a large sac pushing out through the wound. Initially I think it is an ovarian cyst. I am trying to replace it inside her abdomen, when I belatedly realise what is going on.

I say “I think there’s another baby in here.” The sac bursts, and a fat-cheeked girl emerges in a gush of fluid, gasping for air. We had only brought one blanket to theatre, and Esther (the midwife) is still resuscitating the first baby, so Sister Valeria (the anaesthetist) improvises with a discarded gown. I check inside again; definitely no more, so we close up.

As we are putting the final sutures in the skin, Phiri says regretfully that he didn’t bring a camera to commemorate my last operation in Mpanshya. I look down at my bloodstained gown, and tell him that there are some things I’d prefer not to remember.