African Adventures

Once again, our plans to blog more frequently have been thwarted by internet access technical difficulties. Our last day at Mukinge was on Friday. It was sad to say goodbye to our new friends, but we are thankful that we were able to be helpful, even if briefly. It is an honor to be an answer to prayer and to experience God's perfect timing in how we came to Mukinge at a time when both Jeremy and I could be of most use.

Although we initially planned to fly back to Lusaka Saturday morning, we were forced to make alternative arrangements as Zambia Airways is now bankrupt. We were expecting to take a bus from Solwezi to Lusaka, but fortunately, our friend Kingsley just happened to be planning a drive to Lusaka and we were able to go with him instead. Although the drive across the Zambian countryside was quite long (there is no direct route due to poor road conditions), it was nice to see a few other Zambian cities and to get a glimpse of the Copper Belt.

On Sunday, we flew to Livingstone via Proflight, a chartered plane company. Although the plane was small compared to most standards, it looked like a jet compared to the bush plane used to get to Mukinge. Livingstone isn't the most impressive of cities, but our accomodations at Maramba River Lodge were delightful and Victoria Falls was spectacular! In spite of getting drenched by the mist, we braved the bridge over the Eastern Cataract and trekked down to the bottom of the falls to admire the view looking up. Incredible! We also had our first encounter with baboons and bartering in the marketplace. The tourism industry near the falls is suffering secondary to the violence in Zimbabwe and the slumping economy worldwide, so it seemed that the market vendors were especially eager to get our attention as Jeremy & I were frequently the only tourists around.

On Monday, in addition to further exploring the falls, Jeremy & I went on an elephant "safari". We enjoyed riding the elephants, but it was a bit more commerical than we wanted, with videographers around every corner "capturing the experience". We regret to inform you that we did not buy the video, although I'm sure you would have all been amused.

Today, we safely crossed the river to Botswana where we plan to spend the next two days. Chobe National Park is gorgeous and we enjoyed our morning game drive and our afternoon boat cruise. We have lots of pictures to share and have seen some amazing views of the lush African countryside and the numerous animals. We're hoping to see some cats tomorrow! Tonight at dinner, three hippopotami (one was even a baby) meandered into the garden of our hotel and started munching grass. It would have been a perfect photo opportunity, but we didn't want to frighten them with the flash from our cameras as hippos can become mean & nasty if frightened. We can't wait to see everyone soon!

Conquering Mukinge "Hill"

Our Nshima lunch wasn't so bad. Nshima is basically cornmeal mush that is rolled with your hand into a ball, then dipped in "relish", which could be a variety of options such as beans or stew with meat, or cooked pumpkin leaves (kind of tastes like cooked spinach or collard greens). Since we didn't use silverware, it got a bit messy. Nshima by itself is rather tasteless, but the relishes were mostly enjoyable (Jeremy liked pumpkin leaves much better than me). We had planned to hike Mukinge Hill on Saturday after lunch, but we were rained out by a very impressive thunderstorm.

We should have thought twice about hiking up the hill anyway. First of all, the path started out as a tiny hint of dirt amongst waist-high grass. By the time we got halfway up, there was no path at all, and when going back down, we basically blazed our own trail through grass (very difficult in a skirt). We also think that hill is an understatement as we were all very breathless nowhere near the top. In spite of our certainty that we would land on a snake the very next step, we luckily saw nothing bigger than a few spiders and a few bright orange mushrooms that are supposedly edible. Although the leafy trees made it difficult to get a perfect view, we were able to appreciate the scenery, making our adventure worthwhile.

Sadly, the premature baby died yesterday. Apparently, several of the incubator bulbs burned out in the middle of the night and no one caught it until morning rounds. By that time, the baby was very cold and not doing well. In spite of scavenging for new bulbs and rewarming the baby, he continued to do worse and the parents decided to take him home rather than continue medical care. Although it was incredibly frustrating to find a freezing baby in the morning with everyone oblivious and to think that this problem could have been easily fixed, I'm glad the parents were at peace in taking him home.

Hippo Hunt?

We intended to post yesterday, but after a big thunderstorm, we were experiencing technical difficulties. It has been an exciting few days. From a work perspective, Paeds 1 has become a NICU. A woman came via bus from a village several hours away with a baby that was supposedly "6 months gestation". According to our Ballard score (hooray for Cincinnati pediatricians!), the baby is approximately 29 weeks gestation and was amazingly breathing on its own. It's oxygen saturations weren't the greatest though, so we pulled out the CPAP machine (thanks Dr. Schubert!). On Thursday, Michelle, one of the awesome missionary nurses here, and I were casually walking into the ward when we were greeted by a frantic nurse who told us the baby stopped breathing for 10 minutes. Although I'm sure this was an exaggeration, the baby definitely was not breathing and was looking dusky. By the time we reached him, his pulse was in the 50s, so I started doing chest compressions while Michelle tried to find a bag valve mask that actually worked. Miraculously, the baby started to breathe again on his own after about 3 mins of resuscitation and seems to be doing okay. Needless to say, we're going to do a neonatal resuscitation lecture next week so that everyone knows what to do next time rather than panic and leave the ward looking for help rather than actually take care of the baby. Since my previous post was so depressing, I thought I'd also share a few pictures of kids who get better after treatment for malnutrition. There's nothing quite like watching a child on the brink of dying from starvation perk up and start singing and playing. It definitely makes the frustrations and feelings of helplessness all worthwhile.

In addition to work adventures, we've also had some interesting encounters with the people who live in the surrounding villages. Several women come to our door selling us vegetables and we bought the biggest cucumber we've ever seen! It was quite delicious. There was also a man who attempted to sell us bush meat...warthog to be exact. Jeremy & I couldn't quite picture eating Pumbaa and didn't know the best way to prepare warthog (we can't even fix popcorn!), so we respectfully declined. Plus, I think it may have been poached rather than legal. Today, Jeremy was also invited to go on a hippo hunt. Apparently, a hippo swam up the river nearby and is now destroying many families' gardens, so the people are getting permission from the government to shoot it. The meat is going to be used to feed people here at the hospital. And you thought our cafeteria food was bad.... The local residents claim that hippo meat is really good, but the missionaries here say that it's very tough so I think we'll pass on that one too. Not to be snobby Americans though, we are going to try Nshima tomorrow for lunch, which is the local staple. It doesn't look that appetizing as it's basically cornmeal mush/porridge, but we'd be remiss not to at least try it once.

Have a great weekend everyone!

Jeremy Started the Fire

I am obviously missing the luxuries of home. After dinner last night, Melissa and I decided that making popcorn would be a good idea prior to watching Ocean's 13. Unable to find microwave popcorn in the grocery store in Lusaka (we actually have a microwave in our home), we resorted to whole kernel popcorn as we were assured by our liaison that we could pop it using the burners on the oven. Neither Melissa or I had ever popped popcorn in anything other than a microwave (or electric popcorn popper), so we began our search on the internet to determine how to determine the correct method.

After searching the internet for a few minutes, we found a site that told us that we needed cooking oil, popcorn kernels and a large pot. Unknowingly, I turned the stove top control to medium heat and started heating the cooking oil which layered the entire bottom of the pan. Once the cooking oil became hot, I dropped in two kernels (based on the instructions) as a test to see what would happen. Both kernels popped, but quickly turned black and inedible. After failing with two kernels, it was back to the internet to see what went wrong.

Melissa and I walked back into the living room where the computer was set-up, but upon entering the room, I heard a whoosing type sound coming from behind me. Instinctively, I turned around and retreated to the kitchen to determine the cause of the sound. Upon turning the corner into the kitchen, I saw the pot I was using to cook popcorn and 2 – 3 foot flames protruding from the top of the pan.

I yelled to Melissa and hurriedly ran to the stove. Without a local fire department, fire extinguisher or even a simple garden hose, I knew that it would be trouble if things anything else caught fire, so I picked up the flaming pot to throw it outside and away from the house. Upon thinking this through further I remembered that unfortunately, the manual slashers they use to cut the grass here do not have a mulching / bagging function like the mowers at home so the dead grass lays in the yard and accumulates creating a less than ideal place to throw a flaming pot. Not wanting to set the yard on fire either, I returned to the stove and set the pot back down. Regaining composure, I remembered that I could suffocate the fire if I could cover the flaming pot. Now thinking clearly, I grabbed the lid we were preparing to use and smothered the fire.

By this time, thick smoke filled the kitchen and required the fan to finally clear the room. After this entire ordeal, we attempted making popcorn a second time and were much more successful. Needless to say, we will not be attempting to make anything which requires heating quantities of oil the remainder of our trip. Please enjoy these pictures of our first (and final) night of making popcorn at Mukinge!

The Real Starving Children of Africa

We're already at the halfway mark in our time at Mukinge, which is difficult to believe. I took call yesterday evening, and it was much more intense than the first night. Unlike at home where call consists of nothing but admitting kids, kids, and more kids, call last night involved a bit more. It started with a C-section at 0100 in the morning for twins! I'm so used to being on the receiving end, waiting at the incubator for the babies, but this time, I scrubbed in with Dr. Friend, the surgeon. Unfortunately, I had to leave before everything was finished as one of the malnutrition babies, Enny, was not doing well. The first time I met Enny, I knew she was really sick. She was the epitome of a starving child in Africa, with her tiny face and peeling skin and barely enough energy to keep her eyes open. Although we were already at the end of our rope in treatment options, I was really hoping that she'd pull through. Of course, on my second day here, when I rounded on my own for the first time ever and was feeling quite clueless, Enny's mother thanked me for coming here to help take care of her baby. It made it so much worse last night when there wasn't anything I could do. I've never ran a code by myself before, and I don't think I can even count this one as my first. I didn't even have a bag valve mask that fit her emaciated face. There was definitely no epinephrine. We didn't even do compressions as the force would have crushed her fragile body for no long term use. I felt incredibly helpless as I listened to her chest to find no heartbeat and to hear her mother start to wail as the rain was pouring down outside. That's the tragedy of practicing medicine here. And it doesn't stop with Enny. On rounds yesterday alone, I wished that I could have ordered a CT scan on a child that continues to deteriorate neurologically, a calcium on a baby that has facial and extremity twitches, even a simple renal panel! We take so much for granted at home without even thinking about the cost or the alternatives to not having all of modern medicine at our fingertips. And yet, there is still hope here, there is faith in God so openly expressed that it makes me embarrassed of my own suppression of faith when we have so much more to be thankful for. Success stories do happen here. Children who are swollen and lethargic from starvation can get better and it's so amazing to see these apathetic skeletons wake up into playful smiling children. I am honored to be here and pray that I can somehow be a blessing to those I see every morning. Although I will not cure AIDS or find a solution to world hunger or even prevent malaria, I hope that my brief time here helps someone somehow, and that I in turn can become a more compassionate, wiser physician and human being.

Snake!

The pediatric ward had an official mascot the other day, although only briefly. A snake was found inside the building by one of the women who happened to be mopping the floor. Luckily, she was intuitive enough to break her mop handle in half and stab the snake before it either hid or got close to the patients. We've been dutifully carrying our flashlights, or torches, with us at night, but we're a bit more paranoid now because this happened inside during daylight!

Today, we walked to the BOMA, a shopping center of sorts in Kasempa, the closest resemblance to a town near Mukinge. We took the back roads and enjoyed the scenery of the beautiful green countryside and the villages scattered about the hillside. We were frequently greeted by children who would repeatedly call out "Muzungu (white person)...how are you?" over and over again. After exploring a bit, we enjoyed a refreshingly cold Coke Light (much better than Diet Coke!). We also bought a few vegetables at the market just for the experience. Miranda, our fearless leader, was quite firm in her bargaining, but we were more wimpy and tended to pay full price. It doesn't feel like getting ripped off when it's just a US dollar & the people have so much less than we do, but maybe we'll try harder next time, just for the cultural experience.

We can't believe how fast the time is flying here! Thanks to all who have kept in touch regarding life at home. It's great to hear from you!

Settling in at Mukinge

We've officially been in Zambia for an entire week and are finally settling into a routine including a few changes to our usual, including ensuring that our filtered drinking water container is always full so that we don't run out, and tucking our mosquito nets in at night. For the first time since we've been here, we didn't crash & burn after work last night and actually feel adjusted to this time zone!

Work continues to bring its challenges. Melissa is still adapting to her new role that extends beyond just being a pediatric resident and learning new protocols and the treatment of diseases that typically don't occur at home. Unfortunately, she experienced the deaths of two of her patients in the past day. Although it is not a surprise to have children die under the circumstances of malnutrition and inadequate medical resources, it's still quite sad. To make matters worse, grief is frequently expressed through wailing, which is a heart piercing sound that makes one wonder if there was anything else that could have been done. She did get to act as first assist in the theatre (aka OR) today and helped with the drainage of some nasty osteomyelitis (bone infection for those of you not in the world of medicine) and skin grafting for a burn patient. She takes her first call tonight, meaning she'll be the initial doctor called for issues regarding any of the patients, from pediatrics to maternity to adults. Jeremy continues to help guide the staff of the business office in organizing various financial issues. Mukinge is currently experiencing a bit of a financial crisis as they have recently lost a government grant and bank statements are 1-2 months behind, making budgeting challenging.

Although it was sunny our first few days here, the rains have finally come, making the temperature much more comfortable. We are definitely not missing the snow we hear is falling at home! We send our condolences to our fellow Buckeyes fans, but hope that everyone is doing well! Miss you and love you!

Just Another Manic Monday

Now that Monday has arrived, we are in full swing. Melissa is in charge of the oversight of the two pediatric wards at the hospital and also helps in clinic, which means she has to remember how to treat adults too. Monday was Jeremy’s first day in the business office. He is currently working to enhance the method the hospital uses to bill electric / phone charges to those who live in the area covered by the hospital’s grid. Both of our experiences so far have had their challenges as both the way medicine is practiced and business is conducted are different than we have experienced in the past.

Today was also the first day which we hired local help to perform house work and outside chores. It is encouraged to do so while staying at Mukinge as it helps the local economy by employing those currently without a job. It is an interesting experience to have help doing tasks we’re used to doing on our own. However, the individuals work very hard while they are here and are greatly appreciated.

Sunday at Mukinge

Sunday here at Mukinge was surprisingly similar to Sundays at home. There did not appear to be a lot of other activities outside of church service and chapel. We attended a local church about 1/2 mile from the hospital. The majority of the service (singing, scripture reading, etc.) was conducted in the local dialect; however, the sermon was translated. The harmonies created by the different choirs, especially the women's choir, was amazing!

After church we returned home for lunch and both decided that we miss non-stick cookware as cooking pancakes was quite the adventure regardless of how much cooking oil was used. Afterward, we took a brief walk to continue to orient ourselves to the area and take some pictures.

There is a pool at the facility and can be used by the hospital staff. It was nice to swim for a bit as it has been rather hot here since our arrival. We have been told that it is unusually hot as it has not rained since our arrival at Mukinge.

The staff at Mukinge was gracious enough to invite us to dinner for the first three nights of our stay here. We attended dinner the last of the three dinners on Sunday and attended chapel services afterwards. It was nice to return back to our house after chapel and go to sleep. While we are somewhat adjusted to the time, we tend to wake up in the middle of the night often. We hope that this post finds everyone well as you start to re-enter your routine after the holiday season!

Flight Pics as Promised

Arrival at Mukinge

Good Morning All -

Sorry for the delay in posting. We did not have internet access in Amsterdam, Nairobi or Lusaka, but we have arrived safely at Mukinge Hospital in Zambia. Our travel here went surprisingly well. We had three checked duffel bags (47.5, 47.5 and 48.5 lbs respectively thanks to our bathroom scales at home) all of which were waiting for us upon our arrival. In addition, we somehow managed to avoid any checked baggage fees at the ticket counter which was excellent.

Our flight was initially delayed from Cincinnati to Detroit; however, we were able to make it in plenty of time and grab one last "American" meal prior to our departure. The flight from Detroit to Amsterdam lasted between 7-8 hours followed by an 8-9 hour flight to Nairobi and a 2-3 hour flight to Lusaka. Needless to say, we were ready to get off the airplane upon our arrival in Lusaka.

Upon arrival in Lusaka, we were met by a member of SIM Zambia and were taken to the guest house for approximately a 24 hour stay. We were able to take a nap and a warm shower in the afternoon prior to eating dinner with the SIM representatives in Lusaka. Sleeping that night was different as we kept waking up due to the time difference (and roosters which crow between 1 -2 a.m.).

Upon awaking on Jan 2, we drove to the supermarket for groceries and an ATM for cash. The exchange rate is approximately 5,000 Kwacha to $1 USD so it was odd paying 1,200,000 Kwacha for groceries and withdrawing two million from the ATM. After buying groceries it was off to Lusaka International Airport for our flight to Mukinge.

We flew in a 6 seat light aircraft (picture to be attached later) for 1.5 hours into the bush of Zambia. It was amazing to see that much undeveloped land with either nobody living there or sporadic indigenous people living in very small establishments along the country side. Believe it or not, the landing we had on the grass runway at Mukinge was the softest landing of all of our flights combine.

Upon arrival we were greeted by Lynn and Michelle, both of which have been here for quite some time. We were shown our guest house where we will be staying for the month (the corner house or house closest to the hospital for those who are familiar with Mukinge). It is a two bedroom house with a bathroom, kitchen, dining room, living room and pantry. We were both excited to unpack and stop living out of suitcases / backpacks for awhile. We were invited to a weekly potluck dinner which the hospital staff holds. It was a good environment to meet people and also eat some good food.

That is pretty much our last few days in a nutshell. Now that we have access to wireless internet, hopefully the posts will be more frequent in nature (daily). We hope 2009 is going well for everyone!