one and a half weeks at saint francis' hospital, katete, zambia

hello everyone. here i am at this ancient computer i discovered in one of the offices, which has internet access. at 56K modem speed. yeah. anyway, it saves having to go all the way to chipata (1.5 hours away) just to use the internet. it costs 500 kwacha (zambian currency) per minute. which sounds like a lot, until you remember that NZ$1 = 2000 kwacha. so it's not too bad.

thanks for all the messages on my blog guys - it's turning out to be hugely popular! hehe :-p

anyway. so. it's 0141 here on a sunday morning. i figured i would come at this time because one, there's no one else, and two, it's been a while since i've updated you all on things.

it's been almost two weeks since i've left now, and yet if feels like i have lived through months of experience. last week, i.e. tues - sunday, were all quite good days. sure it was a shock initially getting used to everything, the system, the people and their problems, and so on. but since it was all a steep learning and cultural curve it was all sort of new, and exciting.

this last week has been a really tough week though. especially after sunday. sunday was a great day - just chilling in the african sun, eating sugar cane and mealie meal (african staple - like maize made into a thick doughie thing that you eat with curries and relishes and veges), playing football and basketball with the locals, and generally recharging the batteries and soaking up the atmosphere. monday was actually not too bad. i am on the male medical ward (st. augustine) at the moment, and was doing my ward round on my half of the patients (the other doc, ronan, a crazy irishman, here with his even crazier, 7 foot tall fellow irishman, donal, who didn't shut his punts). anyway. monday was really really good. i felt like i was diagnosing and helping people. curing them, even. pneumonias were getting better. tb was getting diagnosed. thrush was being banished away. and patients loved me, and appreciated what i was doing. i felt good, like i was making a difference.

what a bubble it turned out to be! tuesday was the big pop. the 'obvious' case of malaria who seemed to improve remarkably after a few doses of quinine suddenly became a not-obviously-malaria at all case and suddenly dropped his gcs, aspirate all the food his loving family were shoving down his throat, spike temperatures, and generally deteriorate markedly. none of us could get a lumbar puncture. the nurses didn't do the nasogastric tube. i had to sit in his faeces and urine trying to get the lumbar puncture. the pneumonias got worse. the diarrhoeas suddenly got constipated and obstructed. the lovely patient with kaposi's who was actually super well otherwise, got a chest infection, diarrhoea, and a urine infection. simultaneously.

so. from tuesday to friday - this is what it was like... people deteriorated no matter what you did, despite every possible treatment for every possible cause of their problems. the relatively healthy people, the ones you nurtured your small amounts of hope with, suddenly got worse. and people died. many, many people died. i will never forget these patients. i don't mention their names or their details here, for brevity. but i remember all their names, their histories, their families, their stories. it was demoralising. suddenly it seemed like - are we really making any difference?

slowly it's getting better. you quickly learn that you cannot, must not, put everything, all the responsibility and burden, solely on your shoulders. you cannot blame yourself for people dying. many of these poor people are almost destined to die by the time they get to hospital, and no amount of thinking 'what could i have done differently? if only i paid more attention to this symptom, or read more about this' and so on, would actually have changed anything. you also learn to not let the few terrible, awful things that do happen every day, make you forget about everything else - the smiles you can put on people's faces, the things that you do get right, the people that you do cure and discharge, the many things that you do make better in this harsh environment.

so yes. it is definitely turning out to be a character building experience. it definitely is not easy going. every moment is challenging, intellectually, emotionally, philosophically. death is every where. when someone dies there soon follows a procession where the family carries the body away, while the women wail. it is a terrible sound. it always chills me to my bones, whenever i hear it. i talked to a patient, the one with kaposi's sarcoma who was pretty well but had developed a chest infection, and had just started talking to the next patient. two minutes later, literally two minutes later - he was dead. it's really hard to cope with things. one also learns quickly that one cannot get too emotionally attached in a place like this. i do get attached to patients though. i have fun with them, laugh and make things bearable, and genuinely want to make them better. i try everything i know. and in that sense i do get attached, and if they die - a part of me aches, because this was someone i was trying to help, someone who was more than a complex of symptoms and syndromes to me. but you learn quickly that, although it is ok to ache, and feel sad - that feeling cannot persist for very long, and it especially cannot be allowed to grow into anything larger, like guilt...

anyway. what about everything else. i have been trying to soak up the culture and experiences outside hospital as well. i am a very important member now of both the basketball team and the football team. in fact i have a big game tomorrow playing football against the chipata rangers, and in the next few weeks we might be playing a professional side from botswana! the people here are amazing - so friendly, welcoming, and unassuming. what you see is what you get. there is a genuine warmth and affection for fellow human beings here. the food is great. so many things bring back memories from my times in africa. the sun, the dust, the dry grass, the fanta in old-school bottles that isn't fizzy any more, the colourful clothes, the sounds of drums and lively music everywhere, the fruits, the markets, the smells and sounds.

i am getting a 'suit' (shirt and trousers) made from chitengas (cloths you can buy, with all kind of fantastic patterns/designs, and then give to tailor who makes the clothes for you out of them) - which i am very excited about! it's yellow, and very african. should be lethal! but fantastic.

next week is a big chief's party, which apparently all hospital staff are invited to. all the big chiefs are invited, and it should be a great time. hopefully my suit will be done by then.

anyway. i don't know what else to talk about. i am sure there is so much more to talk about. but i don't want to bore you to death with allll of it. i am taking so, so many amazing photos! i will try and put a few up here, if this computer lets me (i don't even know if it has usb ports!).

how is your holiday going ilia? drunk enough chianti to last a lifetime? how is everything at home, all you lovely new zealand people? keep me updated with the happenings back home! i hardly even get to hear about the news in the world! i heard about the whole london almost-bombing thing like almost a week later when my dad mentioned it!

take care everyone, and keep in touch!

dha
p.s. rayji! congrats on winning!! wow! maybe you guys don't need me at all!
p.p.s. thanks hoon for emailing me all that stuff. i kinda sorted it all out with my dad. i ticked mps cos that's what a lot of the senior docs recommended. but i might be wrong. anyway i'll let you know if i have any probs, as i may need your help!