Letter from Benson

Isn't he the sweetest? Thought I'd put this up here to keep it safe since there's a high chance of me losing this at some point.

Looking Forward to Looking Back

I have no idea why I didn't post this before, but I got nostalgic (New Year?) and was looking back at my blog and found this unpublished post from the end of my time working at Saint Francis. It's a bit soppy, but also kinda fun, so I figured I'd add it to the collection, even though no one is going to read it!

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It really doesn't seem long now until I go home. In an attempt to mentally prepare myself for that I've written a list of things I'm looking forward to when I get home:

• Being able to go to the supermarket and buy whatever I want any time of day or night with minimal effort and being able to get really good food in local restaurants without having to drive >1hour and then wait >1hour for the food
• Seeing all my friends and family. Yes you are second after the food :p - my replacement friends here are much better than the replacement food!
• Not feeling like a minority the whole time - not being a spectacle in the street and living in a culture that I grew up in and am therefore totally familiar with
• Having consistent senior support and not being expected to do things that are way above my level of competence. Whilst I've been very careful not to do things that I don't feel I should be doing, but I've been constantly at the edge of my limit and have a few times had to do things I didn't feel comfortable with due to lack of anyone else available to do them - like the first time I did a ventoux delivery independently, which was only my fourth time of ever doing one, because my supervisor was unreachable and there was fetal distress.
• Cheese (it deserves a bullet point of its own...)
• Not having so many bugs everywhere! Although I'm so used to them now it'll probably seem a little strange not to have them.
• Buying a car and the attached freedom.

Things I'm going to miss about living in Katete:

• How incredibly friendly everyone is here. I know sometimes it can be annoying being such a novelty as the white girl but that aside, it's so nice how incredibly friendly everyone is. Whenever I take the bus or go to the market strangers always stop for a chat/hand me their baby/offer me a lift or directions
• The huge amounts of practical experience I'm getting here. Whilst working at the limit of what I can cope with is both mentally and physically exhausting, I know when I go home and am just going to be putting cannulas in and if I'm lucky being allowed to close the skin at the end of the operation, I will be totally bored.
• The relaxed lifestyle - things are much more basic, but that's a good thing.
• The crazy projects, how easy it is to decide to build a fire pit and spit roast a goat or skin and gut ducks for Christmas
• How cheap and tasty seasonable fruits and vegetables are - it's so awesome that in mango season you can buy a huge bucket full of mangoes for 40p and in avocado season there are the best avocados readily available and how cheap lemons are right now so we can have home made lemonade every week, and the novelty doesn't wear off because soon enough we're onto the next season
• My main girl Jess Cat, of course! It's funny how obsessed we've all become with cats despite the fact that none of us have them at home or were even that keen on getting them in the first place. Almost all the English doctors have a kitten here and there has been a lot of discussion on the possibility of taking them home. Turns out that's a very lengthly and expensive procedure so one I won't be pursuing...
• Living on campus with so many good friends and being able to hang out with them any time with no fixed plans/scheduling and all the spontaneous shenanigans that come with that

The main thing stopping me from moving here indefinitely is how stressful it can be working in the hospital. The hours generally are OK, but there's always that underlying level of anxiety that I may be (and frequently am) put in a position of far too much responsibility at any given moment. I definitely plan on coming back to work here or somewhere similar in the future when I've got a few more years experience under my belt, so hopefully some of that anxiety will be reduced.

I was chatting with one of the student midwives about what a great time I've had here the other day and he was saying people back home are going to start calling me "When I was in Zambia" because I'll be saying that so much. Probably true, but I'll try not to be too annoying!

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Not sure that I avoided the last point! But luckily after a slow start my new job in England has been totally awesome - tonnes of experience and not too much responsibility. 

Last Few Weeks

I started writing this blog post months ago when I first got home, but never got round to finishing it. I realise this is incredibly out of date, but I'm attempting to finish it for posterity! So here are some highlights from the last few weeks (or months, since I got a bit lazy towards the end!) in Zambia:

In April/May two really good friends I met in Ghana came to visit me. Jim is an A&E consultant from Texas who works abroad a lot. He was on his way to a hospital in a war-zone in the Middle East and spent a couple of much more peaceful weeks with us in Katete, working in medical outpatients.

We managed to find time to nip over to South Luangwe one weekend

I also met Jennifer, who's from Minnesota, in Ghana. She came for a couple of weeks too, but they were mostly spent on safari and visiting the Victoria Falls.

This involved an absurd about of bus travel - it's about 15h from the hospital to Victoria falls, and the same back again! At least buses are a bit more interesting in Zambia than the UK! Firstly people are so much more friendly so happily lend you their baby to play with. And then there's the interesting combination of television. There's the blaring loud gospel music on loop, with hilarious music videos (I think my favourite is the military gospel choir with overweight women dressed in camo breaking some sweet moves!), and then the most ridiculous, extremely violent action films, also on full volume.

This cutey belongs to a female police officer who was sat next to us and kept us entertained for a good while.

We went to the Victoria falls, which were stunning, but very wet!

We stayed in a great place called Tabonina guest house, recommended by my friend Sinan who worked at SFH last year. There we made friends with a fab couple called Lorna and Andrew. Andrew being a local lad took us to some great places we definitely wouldn't have found on our own. Since Jennifer hadn't ever been on safari, Andrew said he could find us some giraffes and zebras. We thought he was pulling our leg, but went along for the fun of it and guess what we found!

Unfortunately the white water rafting was closed as the water was so high - the rainy season was super long this year. Instead we went on what was advertised as a horse riding safari, although, perhaps for the best we didn't come across anything too exciting!

We had high tea at the Royal Livingstone Hotel which looks out over the river Zambezi, just upstream from the Victoria Falls. You may not be able to see, but there are zebras grazing on the lawn!

Then we took the 15h bus back to the hospital where we chilled out for a few days and Jennifer watched some babies getting born. While we were there we spent some time in the local village with my good friend Benson.

Me and Benson with some village children, including his grandson Benson (one of many!) who I'm holding in the upper picture

Benson junior junior, Jennifer, me and another village boy who's name I don't remember

The following day we were invited to the funeral of the local chief. We weren't allowed to take any photos of the event, but did get a selfie with some women who thought we were celebrities! (Nothing new!) 

Carrying Gloria, Benson's adopted daughter (her mother died at birth and her father couldn't look after her so Benson's family took her in) with Daniel and Christa

Local tailor we met on the walk home

Jennifer had brought some balloons with her for the local kids, so on the way home we gave them to some very excited children. Balloons and bubbles - loved by children everywhere! I wouldn't let her give them to the kids on the hospital compound (children of the hospital staff) because they know where I live! They already came knocking on my door asking for biscuits most days and didn't want them to come any more often! 

We also walked past one of Benson's fields where his sister was harvesting ground nuts, or as we call them peanuts. Ever wondered how they grow? The peanuts are little nodules of the root system. It's a very labour intensive process - first grow the plant, then dig them up and leave the in the sun to dry for a few days, then they can either be boiled, dried further on the roof, or (my absolute favourite) dry roasted. Benson made the BEST charcoal roasted ground nuts which were probably my favourite food in all of Zambia. Such a treat!

After a few days in Katete we went to South Luangwe for safari. I'd planned to go by bus, but in true Zambian fashion a passing businessman stopped for us and gave us a lift for the cost of the petrol. 

I won't put up too many pictures because I went of safari a LOT and at this rate we'll be here all day.

Selfie with some lions fighting over a buffalo kill

And now for few random photos that I can't think how they fit into this timeline!

We (the expats) had a summer fete with a cake competition, garden produce competition and performance from the resident recorder group! There was very little to do in rural Zambia, so we had to get creative to keep ourselves entertained!

The judges - Raqib, a lovely couple Raqib met on safari who were staying very near the hospital (I can't remember their names), and Tim. I didn't make a cake as I was on call.

Doctors and medical students watching the judging

The surprisingly good recorder group (Nicola, Becky, Adam and Raqib)

The chicks grew up

Yazzy (new girl who I tricked into looking after my cat when I left!) and I hiked up the mountain

Then I had my leaving party. Following the success of the goat at Easter I decided to spit roast some chickens.

Benson and his family came and Benson's daughter Christa sang us some songs

Memory and Adama - two of the nurses from York (gynae ward) who I was good friends with

Some of my favourite nurses and midwifes plus a couple of the doctors

I then took the bus back to the capital where I met my mum for a mini-adventure. Only halfway there I got this picture from Nicola:

My faithful flamingo Pinky got left behind, so was carefully looked after by Jess and Bernie until Nicola got back to the UK!

Mum and I went camping in Chobe, Botswana where we saw many animals:

We went on a river cruise

Itty bitty baby elephant!

Rare sighting of a leopard

And we went to Victoria falls:

And had high tea at the Royal Livingstone Hotel:

Then I went white water rafting:

And had an elephant ride.

A bunch of other stuff happened, but I'm officially bored of writing this insanely long blog post so I'm going to stop there! If anyone made it this far I'm seriously impressed! This really could have been about 10 different blog posts, but due to laziness here it is all lumped together! I realise this is just a collection of pictures with a bit of narrative and maybe I should have written something a bit deeper reflecting on the very challenging time I had in Zambia, but this will do for now!

Zambia, you were intense! Until next time... xxx

Termination Services in Zambia and Beyond

Warning: potentially upsetting discussion on terminations

This morning as I was coming to the end of a very busy on call shift when a young girl was wheeled onto the gynae ward on a stretcher. She was bleeding heavily and had a worryingly high heart rate and low blood pressure suggesting she had lost a lot of blood and that her body wasn't coping. Reading her admission notes it appeared she had been bleeding heavily like this for 2 days. She was in early pregnancy and had taken some home-made drugs to induce an abortion. Whilst this had been partially successful she was now having a life threatening bleed. On examining her I found an intact gestational sac sitting in her underpants, with two tiny babies floating in the amniotic fluid. Their placentas however remained within the uterus, and until they came out (with quite some difficulty and a long, painful procedure) she continued to bleed. 

Had this school girl not been able to get to the hospital this morning I am confident she would have died from a catastrophic bleed. I do these 24h on calls approximately 1 in 3 days, and most shifts I see a patient who I am highly suspicious has taken something to induce a termination, although she was unusual to have admitted it. Most often they come in bleeding heavily and I am able to stop that bleeding with an MVA procedure, but we have had a few young girls die because they have perforated their uteruses and bowels by sticking sticks inside...

Unsurprisingly, something that I am really pondering at the moment is the ethics of terminations. When I get back to the UK I'll be starting the obs & gynae training program and one of the services gynaecologists provide is terminations. So I need to get my head around what I do and do not want to do before I start on this program.

When I was a teenager if you asked me whether I would ever perform abortions I would have said absolutely not, black and white. However having seen similar cases to the above during my elective in Ghana I began to realise nothing is quite that straight forward. Whilst terminations are actually legal in Zambia with similar laws to the UK, access to them is very poor and education about safe sex is distinctly lacking. Having been founded as a mission hospital, Saint Francis does not provide this service.

At one point during my time here I came to the conclusion that while it makes me a little uncomfortable, a termination service alongside better sex education is essential for preventing the deaths that I have seen and that this girl was lucky to have avoided. But I don't want to be a hypocrite. If I think it is necessary for this service to be provided then I ought to be willing to provide it. And that makes me uncomfortable. So I have really been grappling with these ideas.

After a lot of discussion with friends on the subject I have come to the following conclusion. Before I state that conclusion, I'd just like to say that I reserve the right to change my mind in the future. I don't think I should have to state this, since it should be obvious that anyone who is using any kind of analytical reasoning will naturally be open to coming to a difficult conclusion if their exposures change, but our society often seems to be unwilling to recognise this. And secondly I would like to state that in saying all of this I in no way condemn anyone who has come to a different conclusion to me, who has made the difficult decision to have a termination, or who performs them; I'm merely showing my current, personal thoughts on the matter.

My conclusion is this: you have to decide, do you think a termination is removing something that is just a bunch of cells or do you think it is a baby? Because if you think it is just a bunch of cells, then it's no different than having your gallbladder or appendix removed. No one is protesting against the right for gallbladders to live. It is a woman's right to have her appendix or gallbladder removed, so if that fetus is just a bunch of cells I can see why many view it as a woman's right to have those cells removed. But if you believe it is a baby then really ending that baby's life is no different than ending any other humans life. There's obviously a lot more to this debate, slippery slope argument etc. etc., but what I'm talking about is personal conviction, not legislation. And from a personal conviction point of view, I think this really is the crux of that matter.

And right here and now, on 21st May 2017, my thoughts are that it is a baby. So I don't want to end its life.

However things do get a bit murky. What about the morning after pill? That has been described as some as an abortive form of contraception as it prevents implantation after fertilisation has already happened (really the whole point of it, being the morning after). As do some other forms of hormonal contraception. Full disclosure: I have twice in the last few weeks prescribed the morning after pill, for a 13 year old girl and a 15 year old girl who had both been raped by older men. At the time I had no qualms about this: the idea of either of them falling pregnant seemed abhorrent. Although I suppose my ethics shouldn't be prescribed by my emotions? 

You could argue that that is no different than doing a termination at, for example, 10 weeks gestation. Should gestation make a difference? If so, where do you draw the line? One small difference, I suppose, is that in these cases they may not have ovulated and therefore conception may not have happened, whereas at 10 weeks you have a confirmed heart beat. But ovulation may well have happened or I wouldn't have prescribed the drug...

Then there's the case of a ruptured ectopic we had a couple of days ago where the fetus was confirmed still alive by ultrasound scan. The baby would have died shortly anyway and the mother most likely would have too, so there is very good reason for my colleagues to have performed that operation, and I don't think there are many who would disagree, but it is still ethically challenging when you think about what's really happening.

So I have a lot of questions and not many answers. But I do think there is a lot more to this 'debate' than people often give it credit for. One of the purposes of writing this, as well as simply to provoke thought, is to hear your opinions on these questions. I'm a little nervous, because internet discussions about these things can be a little risky, but I value your opinions and really do need to come to some firm conclusions before October. If you do want to weigh in on this, please remember - approximately 1 in 4 pregnancies ends in a termination, so many, many people you know will have had one - 1.6% of 15-44 year olds have a termination each year, so please be kind.

Edit: the morning after pill is not an abortive contraception, it postpones/prevents ovulation, so only works if the patient has not yet ovulated.

Chickies =D

The chickens haven't laid in my garden for the last few weeks, and I couldn't find where they'd moved. Turns out the visiting cockerel hadn't just been coming for the scenery and now we have chicks! They're super cute! Chicken Licken has 5 and Nkuku has 2. They used to get along well, but now Chicken Licken is definitely dominant and squares up whenever Nkuku gets near the feed.

Day 1:

 Day 10:

Their father unfortunately was never able to meet them as we ate him on Easter Sunday... Name suggestions welcome. Running with their father's coq au vin theme, ideas so far include Tandoori, Peri Peri and BBQ.

Jess has been surprisingly unmurderous with them, but does eye them up.