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 

South Luangwa National Park

Last weekend we ventured away from the hospital to South Luangwa National Park, a few hours north west of Katete.  We had been here for four weeks and felt that it was time for a quick break to go and see some animals.  The (at times) bumpy four hour drive was well worth it, and we arrived to the sight of antelopes grazing in the fields outside our lodge!  As it is the rainy season currently the park was amazingly green, but also wet, making some parts of it inaccessible (unfortunately where the lions were hanging out) but the wildlife was fantastic!   Becca had not seen Giraffes, Zebras and Leopards in the wild before so was particularly excited to see those and we were lucky to see Leopards on four separate occasions.  We attach a few of our photos although if you want to see what the animals really look like you should check out http://www.burrard-lucas.com.  It’s Will’s website who is Nat one of the doctor’s husband and lives with us at SFH.  He is a professional wildlife photographer and takes awe-inspiring photos.  I think our best moment was seeing a Leopard stalk a Puku (antelope) before being scared away by an Elephant!  We had a really fun group on safari with us and when we weren’t on game drives, we spent time relaxing by the pool and eating delicious food (no goat in sight..) We were also very appreciative of the loans of suncream, a torch and binoculars, it seems we weren’t that well prepared!!

After a refreshing break, it has been nice to get back to our house (the garden does not yet deserve a full mention) and the hospital.  I think we are settling into the work now and really enjoying it, despite occasional frustrations such as running out of HIV tests this week!!!   It was sad to say goodbye to Geoff and Charlotte who left today, but it was nice to have a goodbye barbecue yesterday (not sure we’ve had a BBQ in February before)! 

We’re about to start another 12-day stretch of work, but we’ve had a good day preparing by making tomato soup, stocking up on fruit from Katete, and possibly slightly less successfully, Tom having a haircut by Becca (no photos as yet)… 

 

PS Apologies about the slightly random layout - this is the best we can manage!!

Three Weeks in Katete

We’ve now been in Katete for 3 weeks so thought it was time for an update!  The rains seem to have set in here, although there are usually a few nice days followed by  some pretty wet ones so not too bad. We are settling into a quite a nice rhythm of busy days at work, dinner in the mess and then some relaxation time.  We had ‘curry night’ on Monday and managed a chicken Rogan Josh (of sorts, not a patch on a Selly Oak curry though) and Nat one of the other doctors made a delicious butternut squash curry. After alternating meat and chicken stew it certainly makes a change.

Life in the hospital is getting busy.  We have just finished a 12-day stretch before a weekend, so feeling fairly exhausted. I started off working in paediatrics and having never done any paeds before this was quite daunting. It’s the busy time of year for paediatrics as rainy season equals malaria season (because mosquitoes breed in stagnant water collections), so the ward is fairly full, often with more than one child to a bed.  The ward (called Mbusa) has about 60 children on at the moment and is expected to get busier.  It is divided into an ITU (so called because there are 2 oxygen concentrators), a malnutrition area and then some general paediatrics bays.  Most children are admitted with malaria, pneumonia, gastroenteritis and dehydration or quite often a combination of the above. Although the nurses are very good, the children often present late and so sadly the mortality is fairly high. This has taken a bit of getting used to (and I suppose it’s not something you ever want to get completely used to) and what is often hard is the feeling that if we had the facilities a lot of these children could survive. They are dying from preventable, treatable conditions which is pretty tragic.  On the plus side, plenty of really sick ones where the outlook seems bleak  in the evening turn the corner really quickly and can be sitting up playing the next morning.  The weekend I just spent on call for paediatrics was definitely one of the toughest things I’ve had to do (neonatal resuscitation is not my area!) and I was relieved to return to the adult ward which I’ll now be on during the week to balance out numbers.

Our exciting project of the week is that we are in the process of having a garden made!!  Our house is all one room, so we thought it would be nice to have some outdoor space where we could sit in the sun in a bit of privacy.  Our gardener Nelson has so far fenced off a bit of grass or rather scrub with rather a nice straw and wood fence (photos to follow…).  I think he is rather bemused/perplexed by our wish for ‘grass to sit on’ and so we came back at lunchtime to find him digging up(!!) our nice bit of newly fenced off grass!  So we have compromised and he is only cultivating one third of it to plant crops (eggplants or maize I think).  I guess the idea of having a patch of land for recreation rather than sustenance is rather an extravagant one..

We are very excited about our trip to the great metropolis of Chipata tomorrow, for some much needed supermarket indulgence, as well as swimming and burgers at a hotel (luxury!)!

Becca xx

Arriving in Katete

We have now been at St Francis’ for just over a week.  We travelled here on Wednesday 2^nd January and were welcomed to Zambia by an almighty downpour of rain which followed us along the Great Eastern Road as we were driven the 100km from the border to the hospital.  On arrival we were impressed to find a nice little studio which is to be our home for the next six months (complete with double bed, fridge, cooker and hot water!!)   Now with the addition of our filter coffee machine and 2kg Malawi coffee, we are only one guardian subscription away (I don’t think they deliver here) from a very pleasant existence.  For food, our evening meals are provided by the Doctors’ Mess, where Patrick and his team cook up an excellent selection of Goat stew and rice, chicken stew and rice, Fluorescent-red sausages and spaghetti, and of course the quintessential Sunday chicken roast – sort of (Becca)

After a day to settle in, we started work on Friday, and had to fight it out between Medicine and Paediatrics.  Becca won (LOST!! – Becca) and has spent the week on the Paeds Ward, opting for the baptism-of-fire approach to African Medicine.  With Fi (a GP trainee who has been here for 6 months) as a tutor, she seems to have become quickly quite confident, and her language skills in local Chichewa have come on a lot more than mine (although I can now ask about coughs, diarrhoea, and tell people to sit up and lie down). 

The adult male medical ward has become my main place of work, and is fortunately not too alien an environment.  There are some similarities with the UK (you have to get along with the nurses, drug charts go missing, and most people go home eventually, although some die).  The differences are mainly the underlying conditions, with most being HIV positive, often newly diagnosed with advanced HIV, and most patients being the same age as me.  It has been a good challenge, diagnosing and treating without the benefit of many investigations, and reassuringly our management does seem to work in most cases (learning a bit of Tropical Medicine in Liverpool has certainly helped). 

After ward rounds we head to the outpatient department (OPD) which has taken a bit of getting used to, but is quite good fun.  Patients turn up in the morning and join the queue for clinic, turning up with anything and everything, in all conditions from being completely well to moribund.  There are usually 3-4 doctors sitting in one room with a patient each, and a couple of translators providing interpretation, as well as, I think, a good measure of their own advice.   The whole thing seems somewhere between General Practice, A&E and a medical clinic, which gives a good amount of variety.  The lack of confidentiality is quite something to get used to as everyone hears everyone else’s problems in details, and sometimes even gets involved themselves!

I think we will enjoy our next six months in Katete, as I think the clinical work will be good fun and interesting, and the doctors mess has a great social atmosphere.  I hope that as well as providing clinical care, although more challenging, we will have a positive impact on the educational and organisational side of things, although we are realistic about the likelihood of this happening.

Our House (the outside)

Our House (the inside)