Saying goodbye to Katete

Working hard on the ward 1

Our time at St Francis has finally come to an end.  Its been a busy few weeks, and two weeks ago we drove the 500km to Lusaka to collect Becca’s parents for their grand tour of Zambia.  It is always a bit odd going to the big city which provides more of a culture shock than London with its big malls, big cars and big people. When you’re sitting in ‘Mugg and Bean’ the South African coffee chain having coffee and muffins, you can’t believe this is the same Zambia we know and love.

More working hard

Sue and Peter headed off for a safari in South Luangwa and  we set about our last week of work.  It has been great to be able to hand over to Hamish and Yasmine, two doctors from New Zealand, and know that the wards will continue to run (very competetently!)

Tom and Mary!!

Getting ready for a girls night out...

Getting ready for a boys night out

Becca and Betty - not sleeping

Captain Patrick!

In TB corner with Dennis

Working hard 3

Last weekend we said our sad goodbyes to all our colleagues and friends from the last six months.  On Friday we had a reasonably civilised day without working too much and then on Friday night we tried to imitate a good Zambian party with plenty of very loud music, Mosi lager and dancing.  We had a fantastic time and lots of people came, which made it really special, a personal highlight was dancing with the translators without whom our work in clinic would not have been possible, they are just so fab (and have some amazing moves, once again showing us how it’s done!) For sake of tradition we finished the night at Drums our very classy local nightclub.

Tembo!

Becca and the boys

On Saturday Becca’s parents arrived back from South Luangwa, and we took them on a tour of Katete market.  At the weekend we visited Nelson (our gardener) and his family, as well as George (our favourite taxi driver) and were treated to a roast chicken, a cuddle from his lovely baby Jasmine and a song from his wife.  We felt honoured and humbled  and lucky to have got to know such genuine generous people.

Becca with more boys!

Our time in Katete has been the most amazing rewarding part of our career to date, and we will never forget the fantastic people we have worked with, and the many patients who have been so much fun and rewarding to treat.   It has been great to learn from and to teach our medical licentiates and clinical officers, and hopefully have had a positive influence on the patients and the hospital, although we know that six months is such a short time.  We would definitely recommend  working at somewhere like St Francis. The tropical medicine diploma was fantastic preparation and with an open-mind, a flexible approach and being prepared to be challenged at times, we found the whole experience incredible and definitely worthwhile.

There aint no party like a Zambian Party

We will add a little more soon following our travels to Livingstone and beyond!.. 

The Cold Season

After a brief hiatus when we had to travel back to the UK for job interviews (fortunately we both got jobs!) we have now both been back in Zambia for a few weeks, and are enjoying the relative calm that comes with the end of the rains in what is known as “the cold season”.  Judging by people’s attire, you may think that we are about to get snowfall, but in reality the temperatures are very pleasant, dropping down from a chilly 25 degrees during the day to a positively freezing 13 degrees at night! 

St Lukes Cathedral Msoro (Nice flying buttresses)

Today we had a very exciting outing with the hospital’s HIV service to an outreach clinic at Msoro.  Msoro is an old Anglican mission station 2 hours down a dirt road to the north of Katete.  We arrived to the sight of the intrepid missionary’s grand cathedral, which was quite amazing for such a small remote place; before entering the health centre to a queue of 140 or so HIV patients.  We helped out the ARV prescribers, who are both nurses, although I’m sure they both saw many more patients than we did.  It was fantastic to see so many well HIV patients, some who had been on anti-retroviral drugs for up to 8 years.  Sometimes you get a slightly skewed view of the HIV epidemic being in hospital, only seeing those who have failed treatment or been diagnosed too late. 

It has been a time of change here with doctors departing (including ourselves in a few weeks) and new arrivals.  It’s all a bit strange making this transition, and we will really miss being here, but nice to know that there will be people to take over from us when we leave.  

Becca about to enter the clinic

Our clinic room (the aftermath)

St Lukes Health Centre Msoro

A last view of Msoro

The journey home...

Back in Katete

Our vegetable garden (an update for those who are interested) - we have harvested one aubergine and 12 tomatoes

The Chuda market (next to the hospital)

Evening on the Great East Road

Weird and wonderful

It’s been a tough week this week and certainly has had it’s ups and downs.

Tom went to the UK for an interview and the same evening I found out that I have been offered a Sexual Health/HIV training number in London which I am pretty excited about! (and thank you to everyone who helped with interview prep etc!)

The hospital has been busy as we have been 3 doctors down, and it has felt like an uphill struggle at times! We’ve had a lot of very sick patients, although a lot of interesting ones as well. My worst day was when a young 17 year old girl who has been in and out of our ward for the last 3 months, (and as a result I’ve got to know her very well), died on Wednesday. She was HIV positive with widespread growths everywhere which we treated initially as TB, but eventually found out it was Kaposi’s sarcoma (a type of cancer mainly seen in HIV positive people). Even in a resource replete setting her disease would have been very difficult to treat (maybe some comfort) and I have never seen such an extreme case, but it was really tragic, she was a lovely intelligent girl, with perfect English who should have had her whole life ahead of her. It just seemed like such a waste.

As well as sad cases we’ve had a week of weird and wonderful diagnoses. I diagnosed Tabes Dorsalis (I think!), which is Neurosyphilis affecting the neurological system and causing pain/deformity in the leg. I’m not sure who was more surprised, me or the patient ! ( a woman in her fifties). And Jamie who works on Augustine (male ward), has diagnosed the very rare African Trypanosomiasis (causing sleeping sickness). We both got rather excited when we could see it down the microscope. To those fellow Liverpool DTM+H students, you’ll know what we mean! Sadly the treatment doesn’t seem to be available in Zambia, so the search goes on..

In other non-hospital related news, we have several tomatoes on our tomato plants, although they are still pretty green. After the very lush wet season when everything was green, in the last few weeks it has dried out almost completely and the landscape is starting to look totally different. We’ve had a great bunch of medical students here for the last few weeks who are sadly leaving this week and we had a leaving BBQ this evening with delicious food including the local delicacy of pumpkin leaves mixed with tomatoes and ground nuts (actually it is surprisingly nice when made properly!)

More cheery stories and photos to follow soon!... 

Pumpkins and Drums

Another update. One sad story (sorry) and 2 more light-hearted ones..

When we were on the Diploma last year in Liverpool we were lucky enough to have some fascinating lectures on the effect of snakebite on the rural poor communities in Africa. We had seen a few cases since getting here but none very severe. Last Friday a 19 year old girl was brought to my ward having been bitten on the forehead by a puff adder while sleeping on the floor of her hut. This is a very venomous snake and her face swelled up quickly and she had difficulty breathing. We started to treat her and then tried to source some antivenom, which is intravenous medication which can be life-saving. She had a tracheostomy put in to help her breathe (by a surgeon who was off sick but got out of bed to come and do it) and by 5pm I had managed to source some anti-venom from a hospital 2 hours away, which the hospital car went to pick up. The whole day had seemed like one huge team effort with different departments working together in a way that any hospital could be proud of. I would love to tell you that this story had a happy ending but tragically the girl died that same evening, while the anti-venom was still en route from the other hospital. I have no idea whether if we had had anti-venom at our hospital it would have made the difference, I’m inclined to think it may not have done as the bite was so severe and in such an unfortunate place, but we will never know.

We had already been told in Liverpool that anti-venom was difficult to come by and often not accessible to those who need it most, but seeing the effects first hand was pretty devastating.

We deal with high mortality here a lot, but every now and then a case comes along which just seems tragic and pointless and makes you angry for the injustice people here suffer.

The support from everyone here is fantastic though and although cases like that can be hard to deal with there are also the really amazing stories of patient’s recovering against all the odds.

Right.. on to the happy stories…

On Saturday Nelson (our gardener) invited us to his home in a village the other side of the Great East Road. We cycled there in the beautiful sunshine and arrived to a line up of chairs outside his house and some cold cokes, bread rolls and cucumber bought especially for the occasion, as well as a lot of very curious children – see photos! It was very humbling to see how he and his family (wife and 3 kids with another on the way) live and they were really hospitable. We saw their house, fields (where they grow maize, pumpkins and sunflowers) and Nelson’s cow and calf (a gift from Nigel the English paediatrician last year!) They are better off than many as they live in a brick house with a tin roof, but they still worry about food, school fees and so forth.

After a relaxing day we decided it was about time to sample Katete’s night-life, so Tom and I, Charlotte and Gustav (a Norwegian Dr who has been every year for the last 5) headed out into the dark night with some of Gustav’s Zambian pals. It was pretty dark as Zesco (the slightly inept power supplier!) had decided on yet another power out, but when we arrived at the bar we were delighted to find some light, cold beers and music, all courtesy of a very noisy generator!! The power did eventually return however so we went to Drums (Katete’s  ?only night-club) and danced Zambian style to an eclectic mix featuring Celine Dion and other classics.  

That’s all for now..  In the words of our Medical Superintendant, ‘I hope you have a quiet week.’ 

Becca x

Tom with Mr and Mrs Nelson (and their pumpkins)

Becca and Nat on a Sunday outing

We're not just on holiday..

As we seem to be in a blogging mood today, we thought we should post an entry about our life at the hospital, as mostly it looks like we are having a jolly fine holiday…  So I’ll start with a ‘typical’ day, and see where it goes…

After a fine breakfast of filter coffee and cornflakes (I don’t think the English language can do justice to my increasing hatred of soggy cornflakes), we head into the hospital at 8am.  After passing through the entrance Becca heads right to St Monica ward (ladies), and I turn left to St Augustine ward (gents).  The ward round starts with the ITU (Intensive Care) round.  It is a little different from our previous intensive care experiences, but the patients do have the luxury of an oxygen concentrating machine (2 per ward, 2-4L oxygen per patient) and slightly closer observations.  The intensive care patients range from those with meningitis, severe pneumonias, strokes, poisoning (the favourites here are methanol, organophosphates and battery acid).  This usually takes the best part of an hour before we move to the rest of the ward to see the remaining, hopefully not quite so sick, 30 or so patients.  Our Nyanja language skills are improving, I can ask people if they have been vomiting, coughing, or had diarrhoea or fevers; although thankfully (for the patients) we are usually accompanied by a nurse to translate.  We have patients with quite a range of medical conditions, although there is a lot of TB and HIV-related complications (opportunistic infections as well as drug side effects), other infections like malaria and diarrhoeal diseases, we also have a lot of patients with heart failure, diabetes, asthma and the usual fare!  Patients care is mostly provided by relatives, known as ‘bedsiders’ who stay with the patients 24 hours a day – not something you’d see in the UK!

The ward round hopefully finishes, or is interrupted, at 11am for a cup of tea and a freshly-baked roll, before we head to outpatients to get started on the long queue of people.  People arrive to queue from about 5am (I am told) and whilst usually very patient and uncomplaining, the stress of the queue can occasionally lead to physical fights breaking out.  Due to a shortage of translators, 4-6 doctors consult in one room with 1 or 2 translators who seem to not only help with the language, but also throw in the odd comment and keep everyone in check.  In clinic we see everything from ‘stretcher cases’ (meaning you’re too unwell to walk) to people with chronic diseases to the worried well.  We break for lunch at one for an hour, much to the annoyance of the queue, and then head back for a full afternoon of clinic.  Consulting in a room with several other consultations is not great for confidentiality, but certainly provides regular moments of hilarity (Becca got patted on the head by an elderly lady last week, and sending someone behind the curtain to be examined not infrequently results in them taking all their clothes off..)

Clinic finishes at around 5 and then it’s back to the ward to review the new admissions and do the evening ward round of ITU, hopefully in time for dinner at 6.30.  When there’s a possibility of goat I am usually quite good at leaving the hospital promptly.  About once a week, and every few weekends we have on-calls, covering medicine, paediatrics and neonates overnight.  Becca is now very familiar with paeds, having done several weekends there, and I do not seem to be able to do a night on-call without 2 or 3 calls to SCBU (Special Care Baby Unit). 

Having got to the half way stage of our stay, we have both really enjoyed working at this very welcoming, friendly hospital.  Although we have our frustrations with essential drugs (such as insulin) going out of stock from time to time, as well as lab machines breaking down (the full blood count machine has been awaiting an engineer for about 2 months), it has been a great time.  The patients are really good fun – you never know what could be coming in next, and it is really exciting to be here at a time when so many people are now living with HIV as a chronic disease, rather than a terminal diagnosis, and be part of an organisation that is providing a really excellent service free-of-charge to the local community. 

The Westlife Boy Band

Apologies for the poor quality - I think you have to go to Cape Maclear to fully appreciate it, but they could do well on one of these pop factor programmes?

The Mad Month of March

It’s been ages since we last posted on the blog so thought it was time for an update. We’ve had a hectic but fun month, the rainy season is drawing to an end, work has had it’s ups and downs, but we’ve had some good time off as well! Oh and we also had the fun of applying for registrar jobs back home…. we’ll let you know how that goes..

We had a great visit from Hilary and Stephen (for those who don’t know.. Tom’s Mum and Dad!) earlier this month. We met them off the plane in Lilongwe, Malawi and then spent a very relaxing and fun few days by the beach at Cape Maclear, Lake Malawi. Our time was spent swimming, eating fish, kayaking, playing games etc. It is such a nice setting as it’s a resort within a fishing village, so you get a flavour of life there. A definite highlight is the ‘boy band - Westlife’; a band of Malawian boys of varying ages who for a small fee will entertain with their songs accompanied by music played on jerry can drums (see uploaded photo/video). We then headed back to St Francis where we spent a couple of days showing Hilary and Stephen the exotic sights of Katete. They liked the hospital and our little house and enjoyed the novelty of a BBQ in March.  They also loved the church and singing, and meeting some of our friends and people we work with.

After another busy stretch of work we decided to escape again for the weekend. This time only as far as Chipata (our usual destination for shopping). We stayed at a little hillside lodge and had a wild night out with Nat and Will (ok ok it wasn’t that wild but it was never the less a night out complete with neon lit bar selling more than one type of drink… ). We had some time chilling by a pool and today walked up a hill with amazing views over Zambia, Malawi and Mozambique.

This may sound like we are on one long holiday, so we will post a few stories from the hospital very soon! 

Hope everyone isn’t too snowed in and that spring comes soon! Happy Easter!

Hilary doing a rare bit of paddling

Westlife

Easter Walk Climbing Mount Chipata

N'cwala

Yesterday, along with our tour group of nine medical students, we headed east towards Chipata, not for our usual trip to the supermarket and hotel swimming pool (although we managed to fit these in as well), but to the N’cwala Traditional Ceremony.  N’cwala is the annual festival of the Ngoni tribe, warriors who settled in Zambia, Malawi and Tanzania, descended from South African Zulus, whose chief drinks the blood of a freshly slaughtered ox to mark the end of the rainy season, and the beginning of the harvest.  Suitably tempted by this take on a harvest festival, we thought it would be a good way to encounter some traditional Zambian culture. 

The party had started before we left Katete, flat-bed trucks full of people standing packed onto the back (very safe!), complete with animal skin head-dresses making lots of noise and slowly making the journey east.  By the time we reached the festival site, there seemed to be thousands of people there, with an array of stalls selling all sorts of things, along with a bouncy castle, giving quite a festival atmosphere (especially as there was a healthy amount of mud – it could have almost been Glastonbury..).  We were ushered into one of the VIP areas with some quite important-looking Zambians, who told us that we were welcome as tourism is very important, and that we were to take lots of photos to share with our friends (see below)… 

There was a lot of dancing by men draped in animal skins, mostly impala, small wild cats, and occasionally leopard skins (the best ones were those that were faux-fur -  well bling!), and bare-chested women (sorry if some of the photos give this entry a bit of a page 3 feel).  Interspersed with the dancing were political speeches, giving of gifts, including fridges and washing machines, all for the king of the Ngonis (who sat draped in a lion skin on a very grand throne).   After all the gifts came the killing of the ox, which seemed to cause quite a lot of excitement, Becca managed to catch the start of it by standing on the back of a truck, but we couldn’t quite see whether the king actually had some blood to drink, he was probably quite well refreshed already by all the coca cola he had been drinking.  We left at that point and headed to Chipata.  On the way home as we passed the after-party seemed to be in full swing in the nearby village, with the bars doing a roaring trade! 

Today has been more sedate, welcoming Charlotte (our new doctor who we know from Liverpool) and sitting in the garden.  We feel well refreshed after our 12-day stretch of work and ready for more fun and games tomorrow! 

 

The traditional meets the modern

The King of the Ngonis

...and his pet lion

Nice use of a feather duster