Reflections Before Flying

Today is the day we leave Africa. In many ways it feels as though we've already left. Nonetheless we know we have not yet arrived at home. It remains to be seen how this experience has affected and changed us. Although we are very ready to be home, there is some apprehension about the transitions ahead. Perhaps that is a good sign, evidence that we were really here and engaged in life.

Leaving Macha seemed a bit unreal, as though, after a couple of days we'd surely find ourselves on a bumpy ride up the Macha road once more. Even though our time there was only about six weeks we had grown used to being there. As we were preparing to leave many friends asked us when we would be coming back. One friend taught us a Tonga phrase appropriate for this transition: "Akabwenene taabuli kuswangana." Loosely it means, "Those we have met we will meet again."

The Match

Match Day is one week away! It's amazing how much seems to hang on just one day and how great the anticipation can be. I will certainly not miss having this question mark looming overhead.

worried

Today was my last day working at Macha Mission Hospital. It was a pretty busy day, but it went well. It's hard to believe that my time here has already come to an end. To mark the occasion, here's a reflective quote from Elaine Wynne, a Canadian physician who makes regular working visits to Macha: "At home I take care of the worried well, but here it's the unworried sick."

Sew What?

In the States we don't teach FACS at the elementary level. It's too bad, really. I've enjoyed teaching some sewing and crocheting to children grades K - 5. And you should see how proud of their bags they are! Last Friday was "open house" for the parents and caregivers of the students, and I had all their bags displayed. Not all the bags were finished but the parents/caregivers were able to see their child's progress. I'm proud of the students for all their hard work, and I'm so glad they enjoyed the project. When Mrs. Krause and I first discussed what "home ec" skills I could teach, we talked about crocheting. Due to some difficulty procuring the hooks, I decided to teach some basic sewing skills that would enable the children to sew a bag. In retrospect, I really think it all worked out for the best. I've begun teaching some crocheting to students who have completed their bags, and it's more difficult for some of them to get the hang of it. I'm very glad we didn't start out with crocheting. Now it's a fun, challenging addition to sewing bags. Pictures to come later!

What's in a Name?

Tonight we had dinner at the MIAM cafeteria and got into a discussion about local names. Some of our favorites have been: Hairness, Loveness, Sameness etc. I've always liked my name and checking my email after dinner I found out that I will actually be allowed to have it printed on my med school diploma. Apparently there was a policy against first initials on diplomas (not middle initials). But now, after several trans-Atlantic emails and "a lot of deliberation and several conversations with other campuses around the system" the policy is (apparently) a thing of the past. It will read: J. Daniel Hess.

Busy

Last week was one of the busiest weeks I've had here in Macha. Part of the busyness was because several visitors came to Macha. First was a Nobel Laureate named Peter Agre who is the head of the Johns Hopkins Malaria Research Institute (JHMRI) with which Malaria Institute at Macha (MIAM) is affiliated. On Monday afternoon we were all invited to a lecture at the MIAM campus and enjoyed Dr. Agre's lighthearted account of his humble roots in North Dakota and his serendipitous discovery of the "Aquaporin" water channel molecules which lead to a momentous call from Stockholm. Woven throughout was a message of the importance of education, research and discovery and a call to young Zambian researchers to work hard and make the most of opportunities they have.

Wednesday evening I was called to assist with a C-section at 1:30 in the morning. Because the woman was somewhat unstable it took a while. The baby (2nd twin) was not alive when delivered, but the mother eventually recovered and has been doing fine. I went back to bed around 4am.

Later in the week a team, led by the British orthopaedic surgeon Allan Norrish (Cure International), came to evaluate and treat the patients we thought could most benefit from such a specialist. Thursday afternoon they saw at least 50 patients and scheduled ten relatively major operations and about the same number of minor procedures for the next day. Some were asked to travel to Lusaka where they would undergo free hip replacements or other procedures. On Friday more patients were added to the list as needs arose (e.g. patients from OPD) and a fairly solid 14 hours were spent in the operating theatre. (The day also included a laparotomy and bowel resection by Dr. Spurrier for a man with necrotic bowel and a symphysiotomy for a woman in labor whose pelvis was too small for the baby's head). It was a busy end to a busy week, but I felt like I saw and learned a lot. I'll try to post some pictures soon.

Death

A couple of weeks ago I was on call with Elaine Wynne, a Canadian physician volunteering here for a couple of months. At the start of our evening rounds we found the clinical officer absent (delayed) and a queue of children waiting to be evaluated for admission. When I was calling the next child back, a man waiting with a child wrapped onto his back (as mothers typically do) said, "No doctor, take this one. This baby is very sick." We walked back to the waiting room and the child he laid on the table frightened me - sunken eyes, emaciated face. Its body was warm, but it was not breathing and there was no heart beat or pulse; it was too late.

During the rainy season there are often shortages of food. They have outlived the previous harvest. The number of children we see here at the hospital with severe protein energy malnutrition (PEM) is disheartening. It's even worse if you hear that the fathers are well fed, or that the mother believes maize porridge is enough for children (never mind that the family has beans, groundnuts or even chicken). Money and years have been spent on rural nutrition education, and yet marasmic children are still brought to the hospital. But what good is nutrition education if there truly just isn't enough?

Today, on Sunday morning rounds, I saw a patient admitted two days ago for PEM and gastroenteritis (namely, bloody diarrhea). When I saw it this morning at 9:00 the child seemed no worse than at Dr. Thuma's evaluation yesterday. It was now getting fluids (ReSoMal) via a naso-gastric (NG) tube instead of the initial IV fluids and had been started on the hospital's severe PEM protocol. I didn't think there was much else to do at the moment. However, upon returning less than two hours later to evaluate a different patient, the nurse asked me to review this child. She said, "It seems to be collapsing." The child was not breathing. There was no pulse. I felt helpless.

The child may have died because of some electrolyte abnormalities caused by the infusion of IV fluids. You could also blame the pathogen causing the bloody gastroenteritis. But the bottom line is, this child died hungry.