We've almost hit the halfway mark for our time here at Zimba - crazy! Time has flown.
This past week I had the chance to go to a rural outreach in a village about 1 hour away from Zimba with the maternal-child health team (a few midwives and nurses). They did education of the mothers and babies that came out, talking about basic hygiene, improved latrines, and childhood immunizations. Then we saw lots of pregnant ladies while others did under 5 clinic and gave shots. Later in the day we did family planning clinic and I gave some Depo shots. The clinic was held in a mud brick building with a dirt floor and unfinished roof, all of which made for a long and hot day. We rode out in a truck and my interpreter Mutinta and I got the bed of the truck - it was really dusty! All in all, it was fun to get out and see more the areas the patients come from.
Riding to the bush
Inside the improvised clinic
Joan had to travel to Lusaka this week so for several days I had the responsibility of both male and female wards, rather than just the female ward, which was actually already in overflow! I had about 25-30 patients to see each day so rounds went pretty long. There are a few clinical officer (like PA or nurse practitioner) students working in the wards, so I am also doing teaching rounds with them on select patients. It's fun to work with them but also a bit exhausting! They are really improving every day, though. We have lots of interesting patients in the wards. As always, there are several patients with AIDS and pulmonary TB, esophageal candidiasis, etc. Yesterday I diagnosed a patient with bacterial (or cryptococcal?) meningitis - no LP needed, her neck was stiff as can be and she was completely out of it. Luckily today after antibiotics she is perking up and actually talking to family. There are another couple of young ladies who came in in florid heart failure with probable heart valve disease, maybe from rheumatic fever in childhood. The best we can do for them, unfortunately, is control the heart failure symptoms - there are no cardiac surgeons to do valve replacements. In the midst of rounds Friday we got a 17 year old in serious respiratory distress - breathing 60 times/minute with O2 saturation of 75% - who scared me. We got him on oxygen immediately but there was not much more to do. Luckily it brought his O2 sat into the 90s, but he continued to breathe just as fast. I was worried he was going to tire out - in our ICU (a hard one to get into, mind you) this guy would be intubated and placed on a ventilator for sure. After we finally got him looking a little bit better, that night the nurse called to say the family wanted to take the boy and leave. When we came in, they were frantic talking about the O2 monitor and the oxygen concentrator and Foley catheter. These things scared them, they told us, and they wanted them removed. Joan explained to me that people have come to associate these things with death (rather than the disease process necessitating these interventions) and people here are very superstitious. After much discussion we agreed to turn of the monitor and take out the catheter if the family would keep the patient there and keep the oxygen on. Luckily they agreed and remain there tonight, and he is looking much better.
Ben has been busy in the maternity ward as well. He and Dan have done 5 C-secitons so far. They had a difficult case this week: a woman was transferred from a rural health center late at night after supposedly being completely dilated for 6 hours or so. When they put on the monitors, however, they found the baby was not alive. By the time the mother arrived she was showing signs of septic shock as well. Ben and Dan decided to transfer her down the road to Livingstone (luckily this is an option). The C-sections they have done have gone well, and the babies have done well. When we arrived there were 3 very premature babies being cared for, and Ben took over their care as well. Despite all of his best resuscitation efforts, one of the 29-week premies died this week of probable pneumonia. We also lost a 31-week premie during one night. One other 29-week premie remains in the warmer with mama looking after it day and night. We pray this baby does better.
Today we had a chance to venture out into the bush again. An old man was in the male ward for about a month being treated for TB. He is bedridden and weighs about 70 lbs. It became clear that we was never going to leave the hospital without a ride because the family is very poor, lives far away, and he could not ride on anything seated because his legs are very contorted. So today we rode with the hospital driver as he brought the man and his wife home. He lives off the main road down several winding, bumpy dirt roads in a very spread-out village. We helped carry him into his hut on his mattress. The house was about 10 ft x 10 ft and just had a simple bed with a hay-stuffed mattress and some blankets and sewed-together rice bags as carpet. I hope he will be okay out there.
Cabbage field near our patient's village
This week after Wednesday Ben and I will switch assignments, so I will start maternity and he will move the wards. Stay tuned for more...!