Hello from Zimba again!
Ben and I have had yet another crazy week here. We switched services on Wednesday, so I am on maternity and Ben is in female ward.
The 'black cloud' I carried in female ward followed me to maternity, where the postpartum and antenatal wards are overflowing and we were overwhelmed with laboring mothers all week. One morning I got a call at 0500 about a transferred patient who had been fully dilated since 8pm the night before and was having fetal distress. We took her for Cesarean and found a ruptured uterus and a baby with some kind of genetic syndrome that did not survive. This was her second full-term pregnancy ending in no baby, but luckily we were able to repair her uterus rather than take it out so hopefully she can have a baby in the future. The patient has done remarkably well despite her experience. As trying as the experience was, ruptured uteruses don't happen a lot in the US so it was a good thing to be a part of. I delivered another baby that I believe has Cri du Chat syndrome, and we are also taking care of several very premature babies, so my NICU knowledge is growing by necessity every day! Days have been long with lots of calls to come back in and evaluate another patient, but today we were thankful for some much-needed rest.
We've had several other difficult cases during our time here, including 2 deaths of my patients in the female ward one day last week, the baby I mentioned, and a few pediatrics patients as well. There was one span of 48 hours where I did chest compressions on 4 patients, I think. It's hard to see the patients dying most of all because the majority of these deaths are preventable. One of the women, I'll call her VS, was a 20-year-old with probable rheumatic heart disease and valve problems leading to heart failure who came in overloaded with fluid and then died (most likely) from an arrhythmia. There were so many points in her life where her death could have been prevented. If her strep throat was treated, she would be unlikely to have had rheumatic fever. If she did have it and was able to see a cardiologist early in her life, her valve problem would probably have been easily repaired and she could have been put on medications to prevent heart failure. If all of this failed, at least in the US she would have benefitted from cardiac monitoring that could have alerted nurses to her arrhythmia and gotten her the lifesaving CPR and drugs she needed, followed by an ablation or ICD to prevent it from happening again. My other patient RS was a 34-year-old with terrible HIV - AIDS, really - who we were treating for TB and pneumonia, but wasn't getting much better. Last Monday the infection just seemed to overwhelm her very weak immune system and she slipped away. We tried everything we could think of to prevent her death, but there was little to be done. What she needed was a decade of antiretroviral therapy.
This is the story of the wards, though: people don't come for HIV testing because there's still a stigma, or they don't know the drugs are free, or they are simply in denial or ignorant. The problem is that having multiple wives, and multiple mistresses/misters on top of that, is pretty common. HIV is still spreading like wildfire despite all the work being done to prevent it. It seems like every other day I am telling someone they are positive. The good news is that the hospital has a great ART clinic where HIV+ patients get good care, but the bad news is the number of patients keeps going up. Zambia recently revamped its HIV treatment guidelines and they treat at a higher CD4 count, meaning HIV+ patients get treatment sooner - hopefully that will help to decrease transmission. All babies born to HIV+ moms in the hospital go home on 6 weeks of medication and get tested several times throughout their first year. But we still see the babies born at outlying clinics to mothers who never had HIV tests done during pregnancy and turn out to be positive.
For better or for worse, processing the hard stuff is easier this time - though still difficult. There is something to be said about guarding your heart against despair over every loss. I found out at one point last January that it can be hard to carry on and take care of the next patient with that mentality. So overall, I think we are faring better and taking care of people better.
We have about one more week of work before a week of vacation split between Livingstone/Victoria Falls and London. Zimba has been wonderful and time has really flown. We're excited to see what this last week will bring!
Zambian dry season panorama
Eating nshima with our interpreters, from left Purity, Charity, and Mutinta