A Travellerspoint blog

By this Author: vagabundos

Stories from Zimba this week

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!

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Zambian dry season panorama

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Eating nshima with our interpreters, from left Purity, Charity, and Mutinta

Posted by vagabundos 11:56 Archived in Zambia Comments (0)

Halfway point

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.

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Riding to the bush

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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.

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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...!

Posted by vagabundos 12:05 Archived in Zambia Comments (0)

We're baaaaaaaack!

We made it back to Zimba Mission Hospital! We'll be here for the month of September doing a very similar thing to what we did in January of this year. Ben started out in the Maternity ward and I'm rounding on the female medical ward. Ben has already done 2 C-sections over the weekend, and I resuscitated the babies - who were both just fine.

I have had lots of interesting cases in the wards - lots of HIV/AIDS and the infections that go along with it. We have a lady with a weird face rash - either Stevens Johnson or herpes zoster or who knows what. We've helped out a bit in the pediatrics ward and helped care for a dehydrated baby who turned the corner and is doing well.

We got out on bicycles on Saturday and saw the area some more. There is already a lot of expansion around the town just from January. Weather here is milder than Texas even though we're going into Zambian hot season soon. It's 50s-60s at night, and highs in the 90s during the day, and very dry all the time. It's a lot less green than the last time we were here but still beautiful. It's fun to see everyone at the hospital again.

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Walking home from the hospital

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Jacaranda trees at the hospital

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Biking

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Rural huts

Posted by vagabundos 11:53 Archived in Zambia Comments (0)

Vacation!

We've had a great several days of vacation since we wrapped up our work at Zimba on Friday. There was no shortage of work before we left, though - we had our first late-night C-section of the month Thursday night (go figure). Everything turned out well, luckily. It was really a great month at Zimba. The experience reinforced in us that we want to work in that kind of setting, and that we are getting the training we need to do that.

On Friday, we headed for nearby Livingstone where we stayed for a couple of nights and explored Victoria Falls, the world's largest waterfall.

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It was incredible, to say the least. We first visited the national park in Zambia, which has closer up views and allows you to get down to the water where all the water ends up - appropriately named the Boiling Pot. Unfortunately that day was wet (from the falls and from rain) so we didn't get a lot of photos. The next day, we crossed the border to Zimbabwe and visited their national park. It's across from the falls a bit further so you can see more of them, but again, there's so much spray that it's risky to pull out the big camera. From both sides, it was easy to see why it's called a wonder of the world.

After hanging out in Livingstone, we went on to Chobe National Park in Kasane, Botswana to spend a couple of nights. The national park is home to a ton of animals and was widely recommended to us. Though the town of Kasane is very expensive for us backpacker-types, the animals were definitely worth it!

On our first day we went on a sunset game cruise and got very lucky - a huge herd of more than 30 elephants were drinking at the riverside right in front of us. It was amazing.

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We also saw lots of hippos, impalas, baboons, monkeys, Cape buffalo, and lots of unique bird species.

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This guy appeared on the bank as we pulled close and stood up to catch a glimpse of some far-off giraffes.

The next day after some swimming and braai-ing (BBQing in Southern African speak) we headed out on another boat but didn't have nearly the luck as the previous day. We did chat with other visitors from around the world, though. That night we masqueraded as Lodge guests and ate an amazing buffet too!

This morning we got up early to do the 6am game drive. After dragging ourselves out of bed, we understood why they do them so early - lots of wildlife! It was incredible to drive through the park, alone with our guide, and happen upon so many animals. We saw more hippos, tons of impalas, waterbucks, hippos, buffalo, some giraffes right on the roadside, baboons, zebras, and the very elusive lions!

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We've now returned from Botswana to our base in Livingstone. Tomorrow we fly to South Africa, and then Amsterdam. We'll spend the night there and meet up with our old friend Joe before returning home on Saturday.

Thanks for thinking of and praying for us while we're away. It has been an incredible month, from beginning to end, and we can't wait to come back... but first, home sounds pretty good. :)

Love,

Mariel & Ben

Posted by vagabundos 06:02 Archived in Zambia Comments (0)

Photo time

Well, we're starting our last week here at Zimba Mission Hospital. It has been a really good rotation, despite the hard situations. This weekend was busy but good - yesterday we did 3 C-sections (one for cord prolapse after a long transfer, and another for fetal distress) along with 2 vaginal deliveries and had 5 happy, healthy babies.

Anyway, we thought it was time to show you where we've been working!

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The chapel, where we begin every weekday with a few hymns and a message

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The delivery room in Maternity Ward

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Ben and his interpreter Purity rounding in Male Ward. The most common diseases here are pulmonary TB, CHF exacerbations, opportunistic infections (lots of HIV with CD4 counts <100), gastroenteritis, ascites, and malaria. There are a few weird ones sprinkled in too - cryptococcal meningitis, tropical ulcer, PCP pneumonia, etc.

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Dr. Joan and some nurses in Female Ward. Many of the same problems as Male Ward are seen here, plus retained products of conception after miscarriages, other vaginal bleeding, C-section wound infections, and endometritis.

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Pediatrics Ward, where we both cover at times. Mostly it is staffed by a Zambian medical licenciate. Common problems are dehydration, malaria, gastroenteritis, malnutrition, fractures, and burns.

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Ben and Purity

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A room at the Outpatient Department, where we go to see outpatients when we're done with our rounding. Here we see lots of run-of-the-mill acute complaints like diarrhea, URI, and ear infections, with malaria mixed in as well. We also see a lot of very sick people and admit frequently. The most memorable was a child who had suffered a snakebite a week before, and came in with a necrotic, tense leg and signs of sepsis. We had to transfer but heard that after amputation, he was doing okay.

More photos to come... soon of safari! :)

Posted by vagabundos 10:37 Archived in Zambia Comments (0)

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