New House

As requested, here are some photos of my new house and garden, where I'll be living for the next 6 months. 

The building is split into two rooms, one house on the left and another (mine) on the right. Inside is one big room with a kitchen area at one end, a bedroom area at the other, a living area in the middle and a walled off bathroom. 

Because the previous occupant moved out the same day I moved in I was able to keep all of her kitchen stuff

I've got some tinsel in an attempt to feel Christmassy!

Generally it's quite nice, but there's a big problem with the water. Most of the time it doesn't work at all and often it's just a dribble. I've only managed to get the shower to work twice (at a dribble), so the easiest way to wash is with a bucket. You just have to be organised enough to remember to fill it from the sink when the water's on. One great thing is that I've got a kettle in my new house, so I can have warm water (there's no hot water from the taps).

Bucket shower

Round the back is the garden:

I ordered some manure for the garden and this is how it arrived! How brilliant is that?!

The garden is a bit sparse, but I've started digging some beds to plant my vegetable patch. My neighbour Whyson (also one of my O&G regs) came to over while I was working and wasn't very impressed with my digging skills, so very helpfully did a lot for me! The ground is very hard and dry so it's hard work, and can only really be done in the evening or early morning as it's much too hot in the day.

The garden actually belongs to both houses, but since there's no one living in the other house I've taken over it all. Hope whoever moves in doesn't mind!

I've inherited 3 chickens from the previous house's residents, which makes me extremely happy! They have actually been promised to someone who's on holiday at the moment, but apparently it was quite a loose arrangement, so I'm hoping she'll forget!

I've called the black one nkuku (nkuku, with a silent n, is Chewa for chicken), the white one Martha, and the brown one Chicken Licken! Chicken Licken is a free range chicken who wanders around the garden and neighbouring area, but always comes home! I think possibly the other two are mean to her, because she spends v little time inside the coop, where as they spend very little time outside of it.

I've been waking up at 5.30 most days, partly because it's so light, but also because there are a lot of cockerels around that start crowing at first light. The Zambians believe that chickens won't lay unless they have a cockerel, so they all have one. Now all mzungu know this isn't a thing, so when my chickens previous owners found one of them was a cockerel they got rid of it, and apparently the exact same day they stopped laying! It's taken them 3 months to start again, and only one of them has.

Weekend Fun

I wasn't working on Saturday so a bunch of us drove to Chipata, the nearest town. There's a supermarket and most excitingly a hotel with a swimming pool! So while I hear it's been frosty at home, and you've been sat around the fire with your cups of cocoa, I have been sunbathing! 

It really doesn't feel like December... although it is rainy season, so it's not clear blue skies all the time. 

But really that's a good thing, cos it's already 30+ degrees everyday, and apparently was much hotter in October.

On Sunday I shadowed James my O&G reg for his on call. We had a very sick patient in the morning who had had an antepartum haemorrhage (bleed before giving birth). Joop one of our consultants came in and took her to theatre. Initially she had a c-section, where they found a HUGE clot behind the placenta, but she had an atonic uterus (won't contract properly) due to having had 7 prev pregnancies and the prolonged labour so they did a hysterectomy. She lost about 3L of blood (out of 4 or 5L total blood in your body) so none of us were very optimistic that she'd survive. 

We had the same problem as before of not having enough blood available. She had the only 2 units available during the operation, and as they were closing her up her BP was 62/35, HR 140 - really really bad. I knew she was the same blood group as me, so I tried to donate some blood for her, thinking this was the only chance of keeping her alive. We don't have the reagent to test for hepatitis C here, but I figured the very very small chance of me having it and giving it to her was worth it since the other option was likely death. The lab technician really didn't want to let me, and when I told him she would die without the blood he somehow managed to find a third unit in the fridge... So she had that third unit, her BP picked up a bit and so far is actually doing very well, all things considered. I don't like to make promises, but it's looking like she'll survive.

I found out afterwards that it's actually illegal to donate blood on the spot, because it all has to be screened centrally. This being said, apparently when it was the matron's relative who would have died without an immediately donated transfusion, this was temporarily forgotten... It's difficult - obviously you don't want people to die needlessly from lack of blood, but giving someone a blood borne virus from a blood transfusion is a very big deal, so you can understand why they have the law to protect people. It just doesn't work in emergencies.

Then on Sunday afternoon, in an attempt to feel more Christmassy, we celebrated Sinterklaas. This is a Dutch tradition where Sinterklaas (v similar to Santa Claus) comes and gives you all a present and a poem bought and written by another member of the group. As well as about 8 British expats there are 5 Dutch.

Joop my Dutch consultant dressed as Sinterklaas

James, one of the medical doctors, hearing what Sinterklaas' helpers have found out about him

There's a distinct lack of originality in names among expats - we have 2 James', until last week 2 Sammy's and 3 Alex's, out of about 14 of us! I think the Zambian's must think we only have about 5 names to choose from. They can't really talk though - literally about 50% of people have the surname Phiri or Banda, which makes life very confusing!

First Week in the Hospital

Overall I'm really enjoying living in Zambia so far, but the hospital is a bit of a mixed bag. In many ways it's very similar to the Baptist Medical Centre that I worked at in Ghana, although it's about 2-3 times the size and has a lot more longer-term doctors.

I have a really great team of largely Zambian doctors and friendly Zambian midwives, so it's been fun getting to know them a bit, even if I'm struggling to remember everyone's names! I've been able to do a lot more practically than I would do back home, which mostly is great, but I'm a bit anxious that they will expect me to do things independently too early. This week I've been the primary surgeon (i.e. the main person doing the operation, start to finish) for one c-section for breech and one bilateral tubal ligation (female sterilisation), both with a lot of help from my registrars, and have assisted in a few more c-sections and other cases. In England I only did one c-section start to finish in my whole 4 month block on O&G, so it's fantastic to get to do one in my first week.

But there are also a lot of frustrations. The biggest problem on O&G at the moment is that we don't have enough blood. Most of our patients have haemoglobins of 3-5, some even 2, and a lot of the time we don't have any blood to give them. Haemoglobin should be between about 12 and 15. In the UK (in Exeter anyway) we give a transfusion to all patients if they symptoms below 8 and without symptoms below 7... So I've literally never seen such low Hbs in the UK - it's insane. On the whole they tolerate it surprisingly well, I think because they tend to be chronically anaemic, perhaps from recurrent malaria or poor nutrition, so the additional drop is less significant. But there have been women who have died because there isn't any blood to give them, which is so frustratingly unnecessary.

At the BMC, and I think probably many African hospitals, blood was sourced from the relatives at the time it is needed. This is a fairly good system as it generally means the blood is available, but can often take some time. For better or worse, we have a different system. While a quick check for HIV and hepatitis B + C can be done locally, the most sensitive testing is with a PCR machine, which costs hundreds of thousands of pounds. Unsurprisingly we don't have one here, so all the blood that is collected has to been sent for testing to Chipata, a town about an hour's drive away. After testing this then gets put into their general store which gets shared between all the local hospitals. It seems we're giving them a lot more blood than we get back, so although some is coming back it is no where near as much as we need. Even when there's blood to be had it can be a very slow process - today the testing reagent had run out, yesterday there was some other problem... 

As well as needing blood for emergencies, the lack of blood means a lot of our elective surgery is getting cancelled. We can't risk having a large bleed and not being able to transfuse them for a surgery that wasn't an emergency.

I hear there are similar frustrations on the medical wards. A lot of patients are dependant on oxygen therapy (e.g. if they have pneumonia), but the oxygen here comes from oxygen concentrators - machines that need electricity. At home we have oxygen taps on the wall, which if I'm honest I have never thought about how that works, because it's ALWAYS available so you don't need to think about it. But here when there is a power cut that means the oxygen concentrators don't work... There is a back up generator, but this takes time to come on, often time that patients don't have. Patients literally die when there's a power cut. The alternative would be to have oxygen cylinders, which don't need electricity. I might look into buying some as a back up, but it isn't really a long term solution as they will run out and need replacing very quickly... I had a long chat with Tim, a British GP who's here for 3 years about the politics of doing something like that - it would likely be a lot more complicated than it sounds.

Working in a hospital like this really makes you appreciate the care and resources we have available at home - that we all too easily take for granted.

Temporary House, Temporary Garden - Pictures

This is my temporary house. It's HUGE compared to my new house, probably about 6 times as big. I'm really looking forward to moving though, so I can settle in and start my garden. And have a fridge!

If anyone ever wondered how mangos grow, this is one of my mango trees! Yesterday I caught a man stealing them. I didn't really mind (I'm sure he needs them more than me and I have far more than I could ever eat), but what was hilarious is that when I went to talk to him about it he then tried to persuade me to hire him as a gardener and his wife as a cleaner. I'm not sure that catching someone stealing is really the best advert for employment!

And this, unexpectedly is how papayas grow! 

I have literally no idea what this is, but they look cool!

While I was sat in the garden writing this two women came and asked me if they could take some mangos - much more polite! I asked if I could take their photos in exchange ("asked" is a bit of an exaggeration on both parts, it was mostly sign language!)

The mega sticks live in the garden, presumably left by one of the many people who've been helping themselves!

I better go - it's getting dark and the critters are coming out. 

Oh and I had my first day at the work, which was a whole lot of fun, but I think the hospital is a blog for another day! Sorry, I'm sure no one really cares about my garden, and would much rather hear interesting stories... 

First Couple of Days

I've made it to the hospital! I had a bit of a confusing time in Lusaka, where Isaac kept changing his mind over when the hospital driver was coming to pick me up. This resulted in me sitting around for half a day waiting for them and then being told it was actually coming the next day. Instead of sitting around any more I made friends with some people in the hostel and we went horse riding and out for a drink, and then came back to find an angry driver who'd been waiting for 4 hours... He then insisted on driving the 7h drive in the dark, something I'd been told under no circumstances to do, so we got to the hospital at 2.30am. It's very dangerous to drive at night because the animals wander into the roads and there are random ox carts lying around, on roads where the speed limit is 100km/h... They were actually much better quality than I expected, proper tarmac for 80% of the way (much better than any I've been on in Ghana and Kenya), but this probably makes them more dangerous as people drive really fast, with no fixed central division. But we survived and the horse riding was really fun! 

It was so peaceful out in the woodland area - hard to believe it was only 20min drive from Lusaka

I've had a quick look around the hospital, but don't start work til tomorrow, so have been able to relax a bit, which is great. I'm staying in this huge house for a few days until some Scottish doctors leave. It's a bit bizarre because there are 4 rooms with virtually no furniture, just a bed, one chair and a desk. The house I'm moving into is much smaller, just one room that has a kitchen at one end and a half walled off bedroom area at the other, but at least it has a fridge and plates and bowls and things, unlike this one. I'll put up pictures when I've moved in. The new house also has a reasonable sized garden in the back which is completely bare at the moment, but I'm planning on growing lots of things. The current tennants have chickens which is GREAT although they are probably going to someone else when they leave, but I'll get to keep the chicken wire fence, so I can get some more =) Which as anyone who knows me well will know makes me very happy!

Not a great picture of the hospital, but you get the idea...

That's the front, then there's this big round about which you can see in the foreground and then behind me there are about 100 houses where various members of staff live.

I think I'm going to really enjoy living here. It's obviously a very different life to back home, but I think once I've moved house and settled in a bit that it'll be really nice :-)

Welcome to Zambia!

As many of you know, I am about to take up a post at St Frances Hospital, Zambia, for 6 months in obs and gynae. SFH is a 350 bed rural hospital, just outside a little town called Katete near the Mozambique and Malawian border.

If you're wondering where Zambia is on the map:
https://www.google.co.uk/maps/place/Zambia/@5.8455545,4.191689,3z/data=!4m5!3m4!1s0x1940f4a5fcfc0b71:0xf19ff9ac7e583e45!8m2!3d-13.133897!4d27.849332

And cos maps are fun, here's the hospital:
https://www.google.co.uk/maps/place/St+Francis+Hospital/@-13.6390326,25.0713965,6z/data=!4m5!3m4!1s0x191874bfce385f8b:0xe04b2a85046ced0c!8m2!3d-14.0657035!4d32.0147556


I arrived in Lusaka, Zambia's capital, last night after about 24h of travelling (via Johannesburg) and stayed the night here before the 7h drive to the hospital today. 

I was picked up last night by Isaac who works for the Zambian Anglican Council, the people I'm being sponsored by (I think it's them anyway). 

About 5 min into the drive from the airport to the hostel I witnessed my first head on collision about 20m in front of our car. It didn't look too horrific but the cars were going reasonably fast (maybe 30mph) and there was this awful time while we sat there waiting to see if the drivers would get out of the cars. One did but the other didn't. I was really torn - as a doctor obviously I wanted to check he was OK and if necessary offer some first aid, but having literally just landed in Zambia I had all my possessions with me including a considerable amount of money for the next 7 months. It was dark and didn't seem incredibly wise to leave everything unattended in  the car so Isaac went to check he was OK while I waited, ready to join him if there was a problem. Luckily he was alright and we kept going.

I'd heard a LOT of far worse stories about road traffic accidents here so wasn't surprised, just thankful everyone was OK. Isaac told me the reason they have so many accidents is because Zambians drive v aggressively. He said if someone is overtaking and is coming towards you on the wrong side of the road or cutting you up, Zambian drivers will speed up as though to prove a point that they are in the right, even though this obviously risks their life. About a minute after saying this we had an example of this - there was a parked car ahead in our lane and to avoid hitting it he indicated to move over into the next lane. Instead of letting him in, the car behind us in that lane accelerated, flashing his lights, forcing us to brake. 

But I don't want you to worry (mum!), I'm sure it'll be fine!!

I had a good time in the Lusaka backpackers lodge. One thing I LOVE about travelling is all the people you meet. I met this American family - a midwife who's working in Malawi for 3 months with her 3 kids in tow. Since they're only here for 3months they've been going to the local primary school, which I'm sure has been an experience they'll never forget. The only thing her 10 year old seemed to have to say about it was that it was great they had a lot more time off for break and lunch than back home!

Anyway I should probably go since my lift will be here soon. I'll put up some pictures of the hospital when I get the chance :-)

The Final Push

I'm writing this last blog post from the comfort of my bed in chilly England. It's good to be home!

The last couple of weeks were filled with the usual level of stress and excitement - I had my last week at the BMC then one week travelling in the south.

On the Monday after my last blog post (16th Sept) I went out with public health for a change of scene. They were doing vaccinations in the local schools, so we stabbed about 600 children that day:

Whenever I (or any of the doctors) walk out of the compound we're greeted by shouts of "salminga salminga!" (white person, white person) by all the local children in the village, who come running out to gawp at us. You can imagine the level of excitement then when a salminga went to their schools. I thought at one point I was going to get bundled, but the nurses I was with were very firm and kept shouting at them. Instead they played a game of chicken - who could touch the white girl the longest before getting in trouble.

Despite this they were (as usual) the most well behaved population of children I've ever met when it came to receiving the vaccine. Out of the ~600 kids to be stabbed only about 3 cried, all of which were under the age of 4. The rest came up willingly with their sleeves rolled. I've had grown men faint on me in England from smaller injections than these kiddies were jostling for and grown women cry - shame on you England! Hahahaha

On Thursday Zaato supervised me doing my first circumcision:

Then in majors we had a patient with a massive ovarian cyst. She was about 12 weeks pregnant, but looked term because the cyst was so large. Lisa + Lynn meticulously removed it and let me dissect it afterwards. I won't show pictures of the inside cos it was really gross - we found two teeth, meaning it was a teratoma.

Lisa with the teratoma

Friday was my last day at work and certainly lived up to the usual craziness. After rounds I cut off a melanoma:

(Edit: I wrote this because that's what the doctors in Ghana said it was, but having done 4 months of plastics back in England, I'm pretty sure this isn't a melanoma. Still not sure what it is though!)

Then I went to maternity to check on the 3 labouring women, hoping to catch some babies on my last day. While I was there Michelle came in with a premie baby that had been discharged the previous week. The baby had been doing really well in hospital but the mother was desperate to get home, so Dr Coppola had said she could go on the condition that they came back to clinic on Monday. They didn't show up to clinic until Friday, when the baby was barely breathing, with neonatal sepsis. Michelle and I bagged it for about 2 and a half hours in total, as it had a very poor respiratory effort but a good heart rate. Eventually we decided it was fruitless, as it had fixed and dilated pupils and hadn't improved at all over that time.

But for every death there is new life... shortly after that baby died it was decided two of the labouring women needed C-sections so I got to scrub in on one of them and help bring the healthy screaming baby into the world.

After lunch I said my goodbyes to the nurses and then finally got to clinic.

Paeds nurses (sadly Matthew insisted on taking the photo)

Me and Zaato

On Saturday I left for Accra. I spent 4 days living with a Ghanaian family, friends of one of the docs. This was a really fun experience, although I found Accra a massive culture shock coming from the Gu. Nalerigu (where I spent 9 weeks) is in the rural north, where the majority of people are farmers who live in mud huts. On my first day in the capital we went to the largest, most swanky mall I've ever been to in my life. I found it a bit overwhelming. Then we came home to hear the news of the Westgate shopping mall.

On Wednesday I took the bus to Cape Coast, which I had heard was the most beautiful coastline in Ghana. If I'm honest, my first impressions weren't great. The town is pretty run down, full of derelict buildings. It didn't help that when I first arrived the sky was full of dark clouds making the ocean look grey and gloomy.

This building is still used as a church despite only being half build and half collapsed.

But then the clouds cleared and the sun came out and I could see, on the coast at any rate, why it was classed as being one of Ghana's beauties.

In the mornings the local fisherman can be seen pulling in their nets along the beach

I met a load of other travellers there, mostly from Germany, who were all really friendly. Almost everyone had been there for work placements like me or volunteering. It seems Ghana has very few (pure) tourists.

Me and Neele - a German medical student who'd been on her elective in Accra

On Friday I went to the Cape Coast slave castle - a slightly surreal experience. The castle was used to store captured slaves before being shipped across the Atlantic.

This is the 'door of no return' - all the slaves would pass through here to leave the castle to get onto the slave ships, never to be seen again

In the afternoon I met up with Michelle who'd just finished her month at the BMC. She very kindly let me share her room at a fancy hotel in Elmina for the night. When we got there, looking rather bedraggled, they asked if we'd come to use the pool (you can pay 10 cedi just to use the pool for the day). They looked a bit shocked when she produced a room reservation - I don't think we fitted in with their usual clientele of smart businessmen!

Getting home wasn't too stressful, except for a few minutes at immigration in Accra. Turns out my visa expired 2 weeks ago... at least I bought a 3 month visa but when I arrived in Ghana they'd written (illegibly) 60 days on it. Since no one told me and it clearly said 3 months on the original, it didn't occur to me that it might not last that long. For a few minutes I was worried they might not let me fly, but turns out I just had to pay a fine. Since I only had 10 cedis left on me (about £3) that's all I paid.

So finally I made it home after a long and stressful 10 weeks, but also incredibly rewarding, beyond my expectations. In that time I saw many children die, many get born, did many procedures a lot of junior docs haven't done and held more responsibility than I ever have in my life... not to mention get covered in more bodily fluids than I ever have in my life! But it was an amazing trip and one I'd definitely recommend to anyone currently planning their elective. I definitely plan on going back, hopefully in the not too distant future - hopefully before the current long termers have left! It's been fun writing here, hope you've all enjoyed it =) Looking forward to hearing about everyone else's electives in a couple of weeks!

(Sorry this is a bit of a mammoth blog - more like 3 rolled into one due to lack of good internet/time recently)