Near final thoughts from Africa

Dear friend,

I am two hours away from starting my long journey home. All that separates me from breathing in New Zealand’s glorious air is a 31hour trip onwards. I miss home oh so much. After a much needed shower I know the first thing I will want to do is see the ocean once again.

My last day at Kalene (Wednesday) was interestin,g to say the least. It was the official opening of the new Theatre Block, a project two years in the making. Kalene has only ever had one operating theatre (= operating room) and it is not sterile enough for a lot of procedures, especially orthopaedic operations. Dr J saw the need and two years later, after a lot of work by many people and generous funding, that need was filled.

The program for the official opening was set to begin at 1pm on Wednesday and finish an hour later – but that was before the surprising turn of events. The opening was quite a big deal, with all the hospital staff and students in attendance, as well as three dignitaries: the region’s key government official as well as the head medical honchos for the province and the district. The local village chiefs were also invited along.

Due to the very late arrival of the village chiefs the ceremony began more than an hour behind schedule. There ceremony itself was not just a celebration but thanksgiving to God for His hand in the project as well as goodbye to Dr J who, after five years of service at Kalene, is heading back home for good in a couple of weeks.

Speeches from Dr J and the three dignitaries ten minutes on the program ended up being more than twenty minutes each. Two hours later, with the afternoon heat blazing down on us, the ceremony was brought to an official close. Or so we thought! One of the three village chiefs who has quite the notorious (mostly alcohol-induced) reputation stood up and shouted, “Why did you invite us [the chiefs] to this event if you didn’t even put us on the program!!” The event organizers had sought advice from the Zambian dignitaries who had insisted merely invitation of the chiefs to the event would suffice. Yet this chief would not stop. He took centre stage and for the following thirty minutes berated the missionaries for not giving him due respect and recognition (“God is all powerful God! Thanks be to God! God appointed the chiefs, so we are like God here, sent by God. And we should be thanked!” or something along those lines – some of it may have been lost in translation); he then berated the audience for not appreciating the missionaries as they should, evident in the fact that they would just “let” Dr J leave without trying to stop him (“We should be holding on to him, holding on to his legs, refusing to accept him leaving!”); and finally, he also berated the government officials for not offering Dr J citizenship and 20 acres of land to get him to stay. With his shouting chastisement and wild gesticulations, his usurpation of the ceremony was comical at best, an embarrassment at worst.

My time out in the African bush has been quite an experience. The division between rich and poor, in any country, is a sad sight but not a unique sight. I have seen this contrast in South America, Africa, the US, and even my own country! Yet what I have seen on this trip as been the divide between the enlightened, the educated, and those that are not; the latter with absolutely no concept of the anything outside of their village, their thinking based largely on tradition and superstition. With the educated Zambian dignitaries sitting on one side of the stage and the local village chiefs sitting on the other, this stark contrast could not have been any more evident.

Alas, my time at Kalene came to an end and the next day (Thursday) was spent travelling from one corner of Zambia to another. At dawn I bid my final farewells and jumped on the tiny 4-seater plane destined for Lusaka, the capital. After the three and a half hour flight I landed in Lusaka and went straight to the bus terminal. Almost two hours later I was Livingstone bound. Livingstone is the adventure capital of Zambia, at the borders Zimbabwe and Bostwana, and houses not only game parks but also Victoria Falls (one of the Seven Natural Wonders of the World). I hadn’t originally intended on going down there, but the alternative would have been four nights in Lusaka where, trust me, there is absolutely nothing to do or see!

The bus ride down to Livingstone was grueling – all credit goes to Middlemore Hospital, which taught me the key skills of not having to eat, drink or pee for up to eleven hours! By the time I arrived in Livingstone it was 8pm – how grateful I was that the owner of the lodge I was staying at was there to pick me up, otherwise it might have been a repeat of my horrible experience transiting through Dakar, Senegal, two years ago.

Despite not having booked any activities or knowing much about Livingstone I had a fantastic time.

Again, nothing worked out as I had initially planned but God is good.

On Friday I decided to go to Victoria Falls. While standing in line at the ticket booth I met a lone German traveller who had been backpacking up from Cape Town. Having just arrived into Zambia from Zimbabwe, he had no local currency so I offered to exchange some of mine. After that we decided we would explore the Falls together. Because it is dry season the Falls, apparently, aren’t quite as spectacular as they are in the rainy season, but in saying that it was still an indescribable sight. We ended up doing all four of the trails, including the steep climb down to Boiling Point (at the foot of the Falls under the bridge demarcating the border between Zambia and Zimbabwe). Unfortunately my newfound friend, in his excitement, jumped into the water without realizing his phone was still in the back-pocket of his shorts! The disappointment and inconvenience only slightly mitigated by the fact that he was only two days from heading home.

After a short poolside break at my lodge I was picked up for my microlight over Victoria Falls. (A Microlight looks like a two-seater handglide with a small, motored propeller.) Afternoon flights are normally a bit bumpier compared to early morning – and the first few minutes were much scarier than I had anticipated! As soon as we were airborne it dawned on me that (a.) I actually had no idea how microlights worked and (b.) I would be putting all my faith in a few pieces of metal and a complete stranger who was “a pilot” (what did that even mean?!). Holding onto the sidebars of my seat I wondered if this was it: “Young New Zealand Doctor Glides to Her Death in Zambia!” But as the nerves wore off I began to take in the views and they were glorious. If you ever visit Victoria Falls you must see all 1.8 miles of it from the sky. Airborne, you truly get to appreciate its full grandeur.

With it being low season for tourism most companies were not accepting a party of one. A sad rejection, as I had initially been planning on doing an Elephant Back Safari, Lion Encounter and a Game Drive. The people at my lodge, however, recommended a Rhino Walk for which there was space for one – sold! And it turned out to be a fantastic, once-in-a-lifetime experience. Mosi-O-Tunya Park in Livingstone boasts the rare White Rhino, rare even in Africa. The tour I was on was tracking these rhino on foot in the wild, led by a professional safari guide. The rhino are tracked constantly by official government “scouts” carrying AK-47s in order to protect the rhino and themselves from poachers willing to kill to get their hands on these rhino. It all felt very Bear Grylls and I particularly enjoyed exploring the park on foot under the heat of the African sun. In the end our group were fortunate enough to have three rhino encounters, one of which was of a mum and baby rhino! (At one point we were within six metres of them.) We also saw giraffe, zebras, the various antelope species, and even a herd of elephants! Even our guide was surprised at how “lucky” we were!

On the rhino walk I met a group of optometrists from the UK who are here volunteering with a charity organization for two weeks. They were all very lovely and invited me out to a sunset dinner with them at a restaurant by the river. Again, I was blessed to have company for my second day in Livingstone. It turned out to be a gorgeous dinner with indescribable, classically “African” views – a special night all around.

Another long bus ride later, I arrived back to Lusaka yesterday for my last night in Zambia.

Final thoughts to come once I am back home but suffice it to say, it’s been a long two months – what a trip it has been!

Always,

-A

Mama Afrika does it again

Dear friend,

The day after my last post, despite still feeling completely wiped, after four days in bed I needed some fresh air so I walked over to the Kalene Mission Bookstore. A cute, Podunk, little building with a handful of shelves filled with books on sale, it contained writings in English, French (for the visiting Congolese), Portuguese (for the visiting Angolans), Lunda (the local tribal dialect) and even Bimba (another tribal dialect). There I bought the book, “Ndtolo” (= “Doctor” in Lunda), an account of the life of Dr. and Mrs Fisher, the missionaries who set up Kalene Mission Hospital in the early 1900s. I finished the book, cover to cover, in a matter of six hours – and what a blessing and a treat it was!

Imagine being a missionary to Central Africa in the late 1800s, a time when the slave trade was still rife. To come inland you needed 100 “carriers” for a party of six to walk with you for months on end. (The carriers were locals who, for some calico, would carry a load of whatever it was, including the women who weren’t allowed to walk but sat in a hammock requiring four carriers!) When Dr Fischer and his family first arrived in Kalene there was literally… nothing. Everything they needed he built with his two hands.

It’s amazing because this couple (and their family) sacrificed every aspect of their lives to this calling, even a most precious child. Yet they never grumbled, never complained, and were never self-righteous. All they wanted was to please God, breath by breath, day by day. They did not go down in history recognized for their work; their names are little less than whispers in one moment in time, here one minute, gone the next. And yet I cannot find a better example of what it means to be “the change you want to see in the world.” A hundred years later their imprint of their love for God and their heart for service remains.

There is still so much darkness here that goes unnoticed by the world. I know the bush here on the borders of Zambia, Angola and The Congo is not the only place in the world where such darkness prevails, but being here has been truly insightful. The people here are crippled by fear of “dark spirits” and superstition, the witch doctors the only ones to gain from such fear. After someone dies the relatives, the community, will go see the witch doctor; the witch doctor will then tell them who it was that put the “spell” on the person who has died. They’ll then either gang up to expel the that person out of their community, or, sadly, gang up to kill them for the sake of the “greater good.” The other common practice is something they call “flying coffins,” where, as the coffin of the dead is being burned, the direction of the smoke will point out the person in the crowd who is to blame. A month ago three members of a nearby village were beheaded because they were unfortunate enough to stand in the wind.

Despite there being so much progress since the days of Dr. Fisher I was amazed by how little has changed in the grand scheme of things. And the call to be “the light of the world” feels almost literal in this kind of place.

On Saturday a group of us made an afternoon trip to the orphanage, also originally set up by Dr. Fisher and his wife. Of course at that stage it was pretty crude; today they have a large site about 15kms from the hospital, complete with dorms and a substantial farm, all run by the great, great grandson of Dr. Fisher. It was so beautiful, so special, simply to see forty children who were plump and smiling and clean. As we were walking through the gates the children ran out to greet us, shouting in Lunda, “I’ve bathed! I’ve bathed! I’ve bathed!”

It’s stunningly unbelievable what a series of individual people can do over time. The hospital, the nursing school, the high school, the orphanage. The hydro, which provides continuous electricity to a random area in the middle of the African bush, was developed from beginning to end by one orthopaedic surgeon from Newcastle who comes here to volunteer three months on, three months off (including all the fundraising!).

In this past week I have once again been truly humbled. I have come to realize just how self-absorbed I have been for most of this trip. Why am I not enjoying myself? Why am I so exhausted? Why is no one appreciating me despite ALL I have given to be here and ALL I’m doing here!?! Every patient is just more work for me! Every patient just wants to take a bigger piece of me! There is so little I can do, so what am I even doing here?! Me, me, me, me, me! I, I, I, I, I!

There is a building the missionaries set up many years ago, a refuge for old women who have been accused of witch craft and cast out of their villages, sometimes even by their own children. Currently there are about half a dozen in residence. Beautiful, radiant women, they work out in the fields to provide for themselves. After being introduced to these women a couple weeks ago I keep running into one of them in particular on my dawn walk. Tiny in stature, hunched over, with only half a left arm, she carries hoes and shovels on her shoulders as she walks to the fields every morning at 6.30am. Every time she sees us, without fail, her face glows with joy and love as she claps and bows in respect and happiness before giving us the biggest of hugs.

“Blessed are the poor in spirit, for theirs is the kingdom of heaven.”

Yet another turning point, Mama Afrika has done it again. It has taken me eight weeks but I am finally starting to remember all the things I fell in love with two years ago. I find myself falling in love with Mama Afrika once again.

I have been humbled by the strength and resilience of her people. I have been inspired by the outsiders who have come for a lifetime of wholehearted service. And I have been broken – only to be put back together, once again. Thank you, Heavenly Father. 

A tummy in turmoil

Dear friend,

The big adventure for last week was adapting to having virtually no running water. It started with poor water pressure in the afternoon, followed by no water in the evening the next day -- then no water at all! It’s amazing how your priorities are forcibly unveiled in a situation like this. Of course drinking water must come first. Then you must keep in mind that out in the African bush, with no grocery stores, you are reliant on your vegetable garden for a substantial portion of your sustenance; a vegetable garden which needs daily watering in the dry season! Then third down the line of importance – a new lesson for me! – is toilet flushing water! I would rather have that than a running shower. Actually you’d be amazed just how far down the list a shower comes in this situation. (I was just glad no one from home was here to witness, i.e. smell, this experience.)

You’d think, living in the 21^st century, we shouldn’t have to make these distinctions! But then I’m reminded how little of the global population actually live in what we deem as “21^st century” times.

After that hoo-ha, unfortunately I’ve been pretty sick (again). A week and a half ago I had really bad nausea, abdominal pain and loss of appetite; after starting a course of ciprofloxacin (a tummy antibiotic) I started to feel better and by Wednesday last week I was back to normal. Or so I thought. 

On Monday about five minutes into my ward round all the symptoms rushed back with a vengeance. I managed to finish my round then came straight back home. I went over to Dr J’s place to talk to his wife who said with this ‘recurrence’ it was most likely giardia and gave me a high-dose three day course of another antibiotic. She warned me that I should try to take it with food and that it was known to worsen nausea.

A bread roll, two grams of tinidazole and thirty minutes later, I vomited all over the floor of my room.

Yuck.

That’s what happens when it’s so hot that you lie in bed under your mosquito net in your underwear and you know your flatmates are home for their lunch-break and a sudden urge to vomit hits you from nowhere and you’re rushing in this state to try to get some clothes on… but you just don’t make it to the bathroom in time.

Sitting with my head in the toilet and at the same time trying to fight off the ants crawling up my legs, I thought to myself, nothing is easy here.

Nothing.

I’ve been pretty incapacitated since then. I haven’t had anything to eat the past two days. I’m so sick of lying in bed, but I’m so drained I can barely keep myself in a sitting position. The pain has been horrendous, like a giant alien parasite is crawling around inside my small intestines wrecking havoc. I promised myself I wouldn’t talk about my bowel motions on this blog, but lets just say there would be plenty to talk about and it ain’t pretty.

Thankfully last week saw the arrival of the new permanent doctor from the States. Dr R is a Family Medicine specialist (= General Practitioner) and his wife is a nurse by training, although she won’t be working in that capacity here. Dr R is my favourite kind of American – the kind with a firm, strong handshake, burly American accent and a good sense of humour. Because he will be taking over the care of the Female Ward (one I have been in charge of during my stay) he joined me for a full ward round on Saturday morning. On retrospect, I’m really glad he did since I’ll be out of action most of this week.

I just can’t get over how challenging this trip has been. One obstacle after another. I have no regrets, but I am more than ready to be home.

Fourteen days until I am back on New Zealand soil. What a glorious, joyous day that will be!

‘Till next time,

-A

Generous in grace, thorough in discipline

Dear friend,

                   “God is generous in His grace,

                     and thorough in His discipline.”

                    –Andy Stanley, “White Flag” (DVD)

On Saturday morning John-Paul (the theatre nurse) and I were debriding a large open wound. At the end of the procedure I asked him what dressings we had.

“Mission bandages?” he answered.

“What are mission bandages?” I asked.

“You know, long, thin strips of cotton cloth. I think they used to use the missionaries’ old bed-sheets, so they call them ‘mission bandages.’”

“How interesting!” I replied.

[pause]

“Are you a missionary?” John Paul asked me, point-blank.

“Ummm… [can you sense my hesitation?] well, I’m only here two months… and I’m here more to learn, as I work, because I’m still relatively junior… and… and I think to qualify as a ‘missionary’ you have to give at least… a year?”

With our two heads hovering over a child’s ankle, he looked straight at me and said, “So why don’t you give a year?”

I laughed, taken aback by how simple he made it sound, not realizing how loaded his statement was for me in the context of my experience here.

“Wow, John-Paul,” I replied, chuckling. “You sound like Jesus, Jesus speaking right at me.”

A couple weeks ago I was angry and frustrated at not knowing The Purpose, The Reason, The Point of this trip. It’s divinely ironic because in the evening after writing that post the devotional I have been going through (Oswald Chambers, “My Upmost for His Highest”; the gift from a precious friend and sister in Christ) started a three-part series on Purpose. How we often don’t know (or sometimes don’t ever know) God’s Purpose for x or y, but how he certainly does have a purpose in everything; that growing in oneness with Christ is to Trust in that and not having to always know.

So since then I have been trying to let go of this need to know. I thought, even if this trip chugs along and I leave still wondering, it’s okay. My near-sightedness replaced by Faith in God’s eternal perspective.

Work has continued to be busy and exhausting then I had the incident with the crazy man, which was quickly followed by my getting sick! On Friday I woke up with really, really bad nausea, even having to stop my ward round a few times in order to sit down in the nurses station and dry-wretch. I had complete loss of appetite (which, for those of you who know me would know, is very unusual) and vague abdominal pain. I didn’t eat anything for most of the weekend and subsequently had absolutely no energy. 

After reading through the Tropical Medicine textbook on Sunday morning and convincing myself I had, in the very least, worms (do you know how many weird and wonderful tropical disease cause the constellation of nausea, abdo pain and loss of appetite? Too many!) I spoke to Dr J, who immediately dismissed my notion that it was worms. (“You haven’t been here long enough. They wouldn’t have grown long enough to cause symptoms yet.” Reassuring for now but, note to self, take worm medication before I go home.) Instead, he suggested I take a course of antibiotics geared toward various local tummy bugs.

I spent most of Sunday afternoon on the couch in the fetal position (literally). The nausea got so bad in the evening that while Steph and Mel were at church I went to the bathroom to force myself to vomit – and the little I had to eat that day all came back up.

Utterly feeling sorry for myself and feeling the most alone I have felt, In my distress I called to the LORD – and he answered me. (Jonah 2:2)

Why have I not enjoyed my work here? Back home, my enthusiasm has always made up for any lack in knowledge. Yet here, despite getting the surgical exposure I long for, despite doing similar hours, despite similar roles and responsibilities, I struggled to have any enthusiasm or enjoyment.

Why?

In my distress I called to the LORD and he answered me.

There are no rewards in mission work. It is so different from being a volunteer “visiting specialist” – a few weeks, a month, of travel to an exotic location doing only what you love doing, leaving all the local problems behind with the locals. Don’t get me wrong, I’m not undervaluing the role and impact of giving up your time in that way. I plan on making “visiting specialist” a part of my career regardless of where I end up. But my point is that mission work is so different. Mission work, that long term commitment, is completely thankless by the world’s standards. And the bigger revelation for me on Sunday evening was the reverse of that latter statement: there are so many (worldly) rewards for this job in the Western world! Money, appreciation, prestige, respect, pride… With mission work, none of those exist.

The girl who I talked about in my last post, the girl from Angola who died after two hours of intensive resuscitation, her father returned the next day asking for his money back. (As they are not Zambian they had to pay a registration fee of ~US$5.) He asked for his money back stating we had not helped her, despite the fluids, blood transfusion, oxygen, and all the heart that went into trying to help her in her last hours of life. I’m not implying everyone here is like that, there are many people who are appreciative, but it’s… different. Somehow.

With money, appreciation, prestige, respect and pride out of the equation, you are left with… work, in return for absolutely nothing.

Nothing.

My understanding and insight into service, into true self-sacrifice, has so deepened because of this trip. Not undervaluing the work I, and other doctors, do back home. But when you’re stripped of all returns, all rewards how many of us would, could, keep doing what we do over our lifetimes? Not many, if any.

Not me?

I don’t know how this will impact my work once I am back home, how this will apply once the rewards have returned. But the first step to change is recognizing where change is needed. And I pray – simply – that God would have his way in me.

Very early on this trip I looked at Dr J, at all the missionaries here, and thought to myself, I am most definitely not cut out for mission work. With just two weeks left of my trip, I still don’t think I’m cut out for mission work. But if God does call me to it in the future (who knows!) I know I will be better prepared – physically, emotionally, psychologically – because of this trip and that, “All things are possible through Christ who strengthens me.” (Philippians 4:13)

A little bit shaken: a true fright-flight experience

A close friend of mine from my University days had, at the time, recently emigrated from South Africa with her family. Tall and fair-skinned with strawberry blonde hair, she is one of the gentlest people I know. What amazed (and slightly humoured) me however was her over-vigilance: she would routinely lock the steering wheel of her car, alarmed as well, and carry personal alarm in her bag at all times, the kind that would blare out an extremely loud distress signal. Blessed with being raised in one of the safest countries in the world I could never quite relate to my friend’s overly cautious nature. 

That is, until today.

The day started off a bit strange – Kalene woke up to cloud cover, for the first time in my trip. This was quickly followed by down-pourings of rain. I pulled out my rainjacket from the depths of my suitcase and geared up for the wintry day ahead – long trousers instead of shorts, clunky rubber (theatre) shoes instead of sandals and a fleece for extra warmth.

After a ward round followed by reviewing patients I had sent from my afternoon (“GP”) Clinic on Monday I was home in time for a mid-day break before heading back for yet another afternoon Clinic(!). Not long after I had arrived home and sat down with a cup of coffee did I get a phone call from Rachel, one of the missionaries (also a midwife and de facto hospital administrator). A child had arrived just over an hour ago from Angola who was very sick -- on arrival the child had been seizing and she had large nodes in random parts of her body. According to the family she had been unwell for a while and had been receiving “treatment” from Angola.

In the hour following her arrival to Kalene she deteriorated quickly. With a very low blood count (?cause) the oxygen in their body was no where near sufficient. Steph and Mel (the two Australian paediatric nurses I am living with) had managed to get in intravenous lines and start a blood transfusion, but it wasn’t enough. She continued to deteriorate in front of their eyes and they proceeded to bag-masking (= mechanically pushing air into her lungs).

As all this was unfolding, with the two surgeons in theatre for a major case of a child with Hirschsprung’s, they had called me frantically looking for a doctor to come help. Unfortunately in the few minutes it took for me to walk back to the hospital the child passed away. 

I’ll never forget Steph and Mel’s faces as I opened the door to the side room of the Children’s Ward. Mel was standing at the child’s head limply holding a bag-mask, Steph at the child’s side, and as I walked into the room their heads quickly turned to the door like deer caught in headlights, with puffy red eyes and tissues in their hands. The child stared blankly ahead, the father wailed and cried at the top of his lungs and a crowd of strangers began to gather outside the room hoping for a glimpse of the dead.

Steph, Mel and I had all been invited to lunch today by one of the missionaries. Already late we decided I would go ahead and give our collective apology.

The missionary houses (including mine) are about 500metres from the hospital. Though there are some fences and gates, none of it is secure. It is generally pretty safe here (apart from the inescapable petty theft), the hospital and its missionaries, having been here for a hundred years, held in high regard by the villagers. I have never felt unsafe here during the day, even when I go for my runs through the villages outside the hospital compound. There have been moments of nervousness walking by myself to the hospital at night when I have been on-call, but mostly at the sound of the intimidating winds and the blackness of night in the absence of any street-lights.

After today, this has all changed.

As I was leaving the hospital I heard some shouting which I assumed were a couple of locals having a lively conversation. Paying little attention I kept walking. Slowly the shouting started to get louder and louder. It is not unusual for locals to shout after the female foreigner, wanting your attention. The remedy is to ignore and keep walking -- which I did. But something in that moment wasn’t quite right. I could now hear one distinct voice shouting aggressively, getting closer and closer as it got louder and louder. I turned around to see a tall (at least six-foot), broad shouldered middle-aged man only a few metres behind me. My heart quickened, my fright-flight response kicking in. I started to walk faster but he instantly met my pace, getting ever closer; at that, I started to run. In my clunky rubber theatre shoes, holding my bag and rainjacket, I started to run towards the house -- but he was still only a breath away. Realising I wouldn’t be able to outrun him I changed direction and ran back towards the hospital where there were people standing around.

I’ve never been chased before in my life; I’ve never been threatened in that way before. There are no words to describe how it feels. 

The moment keeps coming back to me, over and over again, and I feel sick to my stomach.

What was more… horrible, was that as I started running towards the hospital where there were people standing around outside, running towards them for help, they simply watched -- with amusement -- and even laughed. One shouted to me, “He’s mad!” (as in, he’s our local crazy man) and continued to laugh, as if that was supposed to bring me comfort whilst I was being chased.

As I reached the hospital gates the man just suddenly changed directions, leaving me completely shaken, unable to process what had just happened. I walked straight back to the Children’s Ward where I knew Rachel and the girls were, walked into the room with the child who had just passed away, closed the door behind me and burst into tears. In between gasps and sobs I explained to them what had just happened.

The man who chased me is notorious in the area. He is, indeed, the local “mad man,” and has caused trouble for the mission and the hospital for a long time. This man has been threatening and violent to (mostly female) missionaries in the past. He has even recently tried to snatch a baby from the maternity ward. Despite repeated reports to the local police very little has been done. They did once take him across the border to The Congo (where he is allegedly from) only to have him walk back in a few days, border control being non-existent.

I’m still quite shaken up to be honest. I'm not sure if I'll ever feel comfortable again walking around here by myself (definitely not at night!). I can’t seem to stop seeing images of the man standing, running, right behind me. I can’t seem to escape that gut-wrenching feeling you get when your personal safety is under threat. Watching episodes of the West Wing, the debate on gun control always seemed so black-and-white to me: for the life of me, I couldn’t comprehend why someone might want a gun! After today it no longer seems as simple as that. Not that I ever would use a gun, not that I’ve changed my stance on the theoretical debate, but I got a glimpse today of why some people might be driven to that point.

Thinking back to my friend from South Africa, I realised today just how much we/I take for granted life back home in New Zealand...

Since my last post I have been meditating on God’s Purpose. There is more to say but I might save that for another day. For now I leave you with Jonah’s prayer (from Jonah Chapter 2). 'Till next time.

In my distress I called to the LORD,

and he answered me.

From deep in the realm of the dead I

called for help,

and you listened to my cry.

You hurled me into the deep,

into the very heart of the seas,

and the currents swirled about me;

all your waves and breakers

swept over me.

I said, “I have been banished

from your sight;

yet I will look again

toward your holy temple.”

The engulfing waters threatened me,

the deep surrounded me,

seaweed was wrapped around my head.

To the roots of the mountains I sank down;

the earth beneath barred me in forever.

But you, LORD my God,

brought my life up from the pit.

When my life was ebbing away,

I remembered you, LORD,

and my prayer rose to you,

to your holy temple.

Those who cling to worthless idols

forfeit God’s love for them.

But I, with shouts of grateful praise,

will sacrifice to you.

What I have vowed I will make good.

I will say, ‘Salvation comes from the LORD.’

Just a little bit lost and a little bit sad

Dear friend,

Today marks the halfway point of my trip. Apologies for the delay in update but I think I may have been subconsciously avoiding writing a post. A piece of wisdom my mum gave me as a young’un, “If you don’t have anything nice to say, don’t say anything at all.” And that’s definitely where I’ve been as of late.

I’m not sure why I’m struggling so much, but I am. Maybe I shouldn’t be writing straight after a(nother) bad day when the Sunglasses Gloomy are tinting everything a different shade of grey.

Where do I start? It all feels very messy and illogical. I like things to make sense: A + B = C, therefore C – B = A. Yet despite reflection and prayer it continues to elude me.

I’m not sure what my role is here. De facto, it’s whatever I want it to be. I thought I wanted it to be that of a surgical registrar, but it's hard when the expectations of you remain inexplicit. Without a clear role you have no idea if you’re doing what you should be or performing as you should be; whether you are doing well or not-so-well. There are no successes to celebrate nor any certainty over failures. A metaphor for this country, I seem to have no landmarks to guide my way.

I guess all this reflection stems from the fact that I made my first “surgical registrar” mistake on Wednesday.

Each day here is chaotic. On top of the wards and the clinics patients just seem to appear all around you, constantly. To make matters worse, so many of them are perfectly well, complaining of non-specific aches and pains (a pandemic!). It’s frustrating when you have an afternoon at clinic with patient after patient whose presenting complaints are, “Chest pain, ribache, neckache and backache.” How long has this been going on, you ask. Oh, years. Years! Then when you exam them they exaggerate their response, crying out in pain and grimacing at the lightest touch of their tummy (this is after jumping up onto the examination bed without any pain whatsoever and with no response whatsoever if I ask my translator-nurse to distract them by making small talk). One after another they make for long afternoons at clinic. Although, can you really blame them when the simplest of pain relief (paracetamol) is like gold here. Even Kalene is struggling with a lack of supply of paracetamol and ibuprofen, reserving them for post-operative patients because that’s all we have for them! The occasional oral codeine or tramadol. But imagine having major abdominal surgery and all you have post-op is brufen! Life, here. But I digress.

So in the context of another chaotic day I reviewed an older woman who, as soon as she saw me (the doctor) walk into the room, started crying out in pain and writhing around. Her history was of two days not opening her bowels and severe (Severe! She says) abdominal pain. Maybe one episode of vomiting. How often do you normally open your bowels? Oh, once every one to two days. Do you have a history of constipation? Oh, sometimes. When I tried touching her tummy ever so softly she started crying out in pain. Where is it sore? EVERYWHERE!

Sigh. A quick rectal exam later, which confirmed she had some constipation, I was happy to watch her over the day and if she settled, discharge home on pain relief. (No laxatives because we have none! Can you imagine a hospital back home without laxatives?)

The next morning, a theatre day, debriefing with my charge nurse about concerns on the ward before heading to get changed, she mentioned that the same woman I had reviewed yesterday might be going to theatre. For what? I asked. Bowel obstruction (=completely blocked system; very serious!).

Sigh. No way.

Nowaynowaynowaynowaynowaynowaynoway.

NO WAY.

No.

While scrubbed up for our first case in theatre one of the nurse brought that patient’s Xray, which showed classic signs of obstruction (=air-fluid levels). We proceeded to take her for a laparotomy (=opening up the tummy to see what’s going on), which showed a caecal volvulus (=twisting of some bowel).

No way.

Yes, I was (am) embarrassed. Yes, I let “constipation” lead me astray. Despite every Emergency Department Consultant telling us over and over again never to diagnose a patient with constipation. But I think the worst part of this whole experience is… Dr J reviewed the patient half a day after I did at the request of the charge nurse. He must have read my note. Yet he (as a consultant surgeon with a wealth of experience, I know, I know, I can't really compare) picked up on the possibility of an obstruction straight away. And he was right. No harm was done in the end with the safety nets in place, but I just know that if I were a surgical registrar back home I would have gotten a good talking to in the very least. But here, am I house officer? Am I a surgical registrar? Did I make a mistake? Or did Dr J not expect anything “more” of me in the first place? The worst part of this whole experience is that I remain unsure of whether I failed in my role or not.

I have berated myself enough to (clinically) learn from this mistake and take from it what I should… but I haven’t been able to debrief. Maybe there really is just absolutely no expectations of me here. But if that's the case then how do I do a “good job”? Does it even matter? Do I really need that affirmation? I thought I was more “independent” than that? Or is it just a basic human need, this desire for, "Well done, Anna"?

It’s hard when you have no one you can talk to who can relate. The only other doctors are the two much older, male consultant surgeons. Lovely, sure, but attempted deep and meaningfuls wouldn’t be particularly comfortable for either party.

Apart from this not-so fun experience this week I am struggling with being in such a remote place. There is no “getting away” to clear my head. Apart from my runs there is time or space to myself. I am at work ten hours a day, six days a week, and the only Zambians I interact with are those with complaints and need something from me, and/or unsolicited visitors knocking on my door wanting something from me. As a result I fear I might be developing a conditioned response to the locals here before they even approach me – please, leave me alone for just one second…!

I recognize this as unhealthy. Most definitely. But how do I go about rectifying it? When I’m working as much as I am and there’s nowhere else to go, nothing else to do? When I’m seemingly the only one who feels this way? 


When the one baby I have "let in" has led to heartbreak?

Day 30, Case 4 continued

(Albertine, you’re breaking my heart)

An update. Last week Albertine’s mum also started to develop severe neuropathic (=nerve) pain from the waist down. On Monday ward round she was distraught – she now had weakness in both legs and was hardly able to stand. By Wednesday ward round she had no strength in her legs at all. Today she reported incontinence, a bad sign associated with a very poor prognosis.

I try not to compare things here to back home. That kind of thinking is futile and distracting. Yet something about this woman, about this case, just seems to get to me in a way I cannot describe. If this woman were back home, or any Western country, her Xray would have had the immediate attention of a handful of spinal specialist surgeons and after a series of MRIs and other imaging she would have been operated on by now and on her way home!

Her family, this week, have been adamant that they want to take her home, back to the Congo. It’s understandable. But I cannot fathom for the life of me how they will travel back. It’s a three-day journey by foot. Apparently they will take her on the back of a motorbike. The glaring question being, how do you keep a paralyzed 60kg woman on the back of a motorbike for hours over bumpy dirt road? And if they miraculously are able to make the journey back home, how will a paralyzed woman survive in an environment that necessitates walking? Walking to bathe, walking to wells, walking, walking, walking.

Today I am angry. How do we allow such injustice to exist, to prevail? The frustrating part about all this is that I am, by nature, a problem fixer, the problem being INJUSTICE. LET ME FIX THE INJUSTICE! Just tell me what I have to do, please. Just tell me the answer and I’ll do it.

...if only it were that simple.

I have been able to negotiate a few days with Albertine’s family to buy some time for me to source her a wheelchair. I am determined. I am a lady on a mission. I will not let her leave here without one. The hospital only has a few (very old) donated wheelchairs in circulation – precious commodities, like everything seems to be here. (Oh, what we take for granted back home.)

On another note, I am moving this weekend. My flatemate left this morning, back to the UK to start her final year of medical school, so I am being kicked out, reshuffled, to live with – dramatic pause – a couple of Australians…! Yes I discriminate against Australians. But unfortunately (?fortunately) these girls are just lovely. Their names are Mel and Steph and they are two paediatric nurses from Melbourne; they arrived last week and are here to volunteer for five months.

With Hayley gone and my having to pack (to shift house) I am feeling quite conflicted. I have had a lot of hands-on exposure in theatre these past couple of weeks, getting increasingly confident handling my instruments and with suturing, but at the same time I could quite easily leave right now. Not being one to quit anything before in my life I know that I won’t, but I still can’t escape the sense of not knowing what I’m doing here. I guess time will tell… I hope.

‘Till next time,

-A

P.S. On Monday I had to get my passport re-stamped by an Immigration Officer so we headed to the closest one to Kalene, at the border with Angola. ANGOLA! Yes, I had a Portuguese Fanta in Angola. The precise border is halfway across a bridge over a river, which they have split in half. After all our “official” business was conducted one of the Immigration Officers kindly walked us down to the bridge and, upon hearing how I was craving any sort of fizzy drink, took us to a small what is equivalent to a dairy shop in Angola proper. He even introduced us to a couple of the border army officers, the District Officer and the Immigration Officer! They only spoke Portuguese and the tribal dialect so our guide interpreted, but they were all very welcoming. Unfortunately no photos from Angola proper as per their national law (despite my attempted sweet-talking the Officials). 


Mel (left in photo) in Angola, myself and Steph in Zambia!