It's a small world at Chongwe....

  For the second day in a row I find myself on the road and feel ever so fortunate that I am escaping the urban sprawl that is Lusaka! We headed East along the aptly named Great East road. It isn't all that far and it is refreshing how quickly the built up concrete houses and shops and incessant traffic become wider expanses of green fields full of tall grasses hiding the plentiful crops of maize in the fields behind.

We pass little villages hidden under trees and rows of farmers selling neatly arranged mini towers of tomatoes, corn, monkey nuts and mushrooms. Clearly all in season currently. That and the tell tale blackened earth which preceeds the piles of charcoal all neatly packed into white bags ready for purchase.

Tall grasses with maize fields behind outside Lusaka

Upmarket village shop

Bags of charcoal ready for purchase along the road near to Lusaka

We make good time as the traffic is mostly in the opposite direction and get to Chongwe District Hospital, which is easy to find right at the beginning of town. We follow the visting protocol rigidly and set off to find the Medical Superintendent - who, after sitting and waiting for 10 minutes is then discovered not to be in. This means we must now wait as they contact the 'second in command'. She is currently at a meeting and won't be available until 3 hours time. So we are given the go ahead to find and speak to the anaesthetist and then return to see her in retrospect!

  We get to theatres and meet Jackson the clinical anaesthetic officer.  In fact the ONLY anaesthetic officer for the whole hospital of circa 300 beds. He tells me if he is away then all the patients needing operations get diverted to UTH in Lusaka. He is quite a superman though - imagine being on call 24/7 fort eh past FOUR years! We are ushered into his office and I can't help but notice the row of empty Halothane bottles standing on the windowsill edge - very artistic I say. However he is very concerned that I don't interpret this as him only giving general anaesthetics. He stressed that he uses spinal anaesthesia a lot (I have no doubts as he seems incredibly competent) and then shows me the meticulous records that he keeps for each case and how rightfully proud he is that over 60% of his cases are done under spinal anaesthesia. However for me, I think the collection of opaque brown bottles on the windowsill (to prevent breakdown of the contents in direct sunlight into unpleasant substances) is pretty cool!

10 brown bottles sitting on a wall....

Just as we are about to embark on the follow up interview process there is an urgent message .... an emergency caesar (caesarian) for foetal distress. Oh dear he says, "you'll now have to wait at least an hour and a half - is that ok, the surgeons here are very slow!" "No problems", I say,"but actually could we come to theatre with you to see how it runs and give you a hand?" That was indeed well received, so from nowhere myself and my colleague/accompanist Mebby (also a clinical officer in anaesthesia) are whipped up some blues and a hat and shown through to theatre.

Theatre - in the far distance on the wasll a laminated copy of the WHO Surgical checklist. Also in the foreground a resuscitaire in theatre for neonatal life support - unusual. These are usually in a different room out here, but Jackson feels this is better as it means he can help with resuscitation whilst also keeping a close eye on the mother.  

  Much the same as many other Zambian theatres the lady is already in the operating room, lying on the bed shouting with each contraction. She is 39 years of age and this is baby number 8 for her - of which she has 6 children at home. Wowzers, that must be one noisy house!  However, Jackson meticulously goes through his emergency drugs (that he has already prepared) and places the monitoring on the patient with the aid of the theatre porter/assistant. Once he has placed an intravenous cannula and attached fluids he is now content with the situation and asks the surgeon to carry out the WHO Surgical checklist. She does this fairly quickly by taking the laminated copy off the wall and reads through it. It seems quite fluid which makes me really believe that this is pretty standard for Chongwe. Fantastic! Once the checklist is complete Jackson asks us all to take a minute and pray. I was a little taken aback I have to be honest. It is the very first time I have ever witnessed or been part of a prayer being said out aloud in theatre as a part of the checklist. But everybody (including the patient) seems to think this was a logical step and so a quick 5 minute prayer and blessing by Jackson ended the checklist and put his mind into the frame for a spinal.

Surgeon conducting the checklist whilst the midwife (back) attends the patient on the bed. Jackson the anaesthetist listens intently and there are students at the foot of the bed.

Well, the prayer must have done wonders  (or maybe it was the gospel music in the background) as the woman is moving around the bed like a whirling dervish but Jackson darts in the spinal in double quick time (with a proper spinal needle - not a cannula) and before the blink of an eye we have an anaesthetised patient who, despite the table not tilting as its broken being wedged to the left with the placement of a few bags of fluid. The anaesthetic block is satisfactory and the surgeons begin. Soon the baby is extracted. There is no sound as she is carried to the resuscitare. I walk across to observe the midwife who is busily drying and rubbng the baby in a clean warm towel and with that the baby starts to wail. Good strong healthy lungs! A healthy little girl to go home with Mum to join her 4 sisters and 2 brothers. The causative agent for the distressed baby and slow heart rate is soon found when the cord is cut. A knot in the umbilical cord. A lucky baby that she got to theatre quickly. 

Knotted umbilical cord

Theatre porter recording vital signs for the patient as Jackson
 prepares some antibiotics and oxytocin
(hormone to contract the womb)

 As we get to the end of the case  (which has been long as they were tying off the tubes too). Jackson is now busying himself with drawing up further drugs. I go over to investigate what he is planning. He informs me that he is preparing to place a TAP Block (transversus abdominus plane block - essentially a nerve block in the side of the abdomen that targets nerves that cause pain in the area of the operation). This is commonly used in the UK after Caesarians though usually with ultrasound (though using anatomical landmarks is also common). However to do so you require a regular supply of plain Bupivicaine (local anaesthetic). This has been a real stumbling block during my whole time here at UTH and also elsewhere as it seems that it is very difficult to get onto a hospital ordering system for some unknown reason. On further delving into how he has some in Chongwe he tells me its donated. In fact a team from Mothers of Africa (a Cardiff based charity) come out at least twice a year. More details of Mothers of Africa here:
http://medicine.cf.ac.uk/mothers-africa/

Jackson keeps all the donations of Bupivicaine so that he can do either TAP blocks or some other specialised blocks such as axillary blocks for arms. He is now on his last 4 vials (2 left after this case) so he is very relieved to tell me that the Cardiff team are on their way to visit next week and also as he has run out of the Ephedrine that they also have brought him and taught him how to use, he is now currently using adrenaline like everybody else in Zambia!  Now I know that Mothers of Africa come to visit as a friend of mine, Dr Cerys Richards went to Chongwe not long after I had returned to the UK in Feb 2014. I recall her telling me that she had taught Jackson the merits of putting in the TAP blocks post operatively. However he told me himself that he was eternally grateful as in his own experience he notices that those patients that do have the block are ambulatory far quicker and get discharged home sooner than those that do not.  Interesting to hear this statement of observation  from Jackson (despite knowing it's true myself). My colleague Mebby was very interested in the block having neither witnessed or heard of it. What happened next was amazing.
   I witnessed Jackson talking and teaching the purpose and procedure of the block along with the anatomy (and marking it correctly on the patient with a red marker pen). He has clearly done a lot of his own reading up on the block also. He then proceeds to show and teach Mebby how to do the block and allows her to do the other side. I am watching quietly and completely impressed by the lack of me having to step in or help out such was his correctness and confidence in the subject. A truly wonderful event to witness. It just goes to show that education can truly give others the tools to improve healthcare themselves. Mebby was overjoyed to have learnt this new technique and very thankful for the unexpected opportunity. Its a shame that the lack of pharmaceutical supplies will be the rate limiting factor on her using it in the future as it stands.

Mural on the hospital wall from Rumney Primary School

After the theatre duties were complete we reported back to the medical superintendent's office, several hours after we first came! Whilst waiting to meet the deputy I spied a mural up o nthe wall and could see it was actually a peice of artwork created by children from Rumney primary School, Cardiff - it really is a small world after all!

Follow-up day 1: Kafue

After much to-ing and fro-ing I have managed to start the follow-up of the Lifebox and SAFE Obstetric courses at long last. Ok, its not very far out of Lusaka but it is a start! Basically I was getting fed up of waiting to start - the plan was/is to do so at the very South, in Livingstone but the past fortnight there has been a promise of starting but basically not, so I bit the bullet and started locally. At least then there is some forwards momentum!

I'd also forgotten that when you arrange to meet at 8am in Zambia that means anywhere between 8-9.30am! However as I was kindly getting not only a lift but assistance from one of the clinical officers Mebby I couldn't complain. In fact it allowed me to sit at the cafe a little while and read through all the paraphenalia I had with me whilst sampling a pretty decent Cappuccino (from the best barrista in Zambia for the third year running no less!). So I wasn't too short changed!

  On our way South to Kafue through the rush hour traffic we took a back route and detoured past the hospital at Chilenje - which is currently a Level 1 hospital (has wards for surgical and medical problems and some obstetrics but no operating capacity). However they are upgrading it and turning it into a more substantial building that will have theatre capacity. And this will be the base hospital that Mebby will work at when it's done early next year the hope. So that was an interesting sight past all the scaffolding and mud due to the torrential rain. In fact that torrential rain stayed with us for the hour and a bit we drove to Kafue. 

En route Kafue - rain!

The plus was that the road was certainly in better nick than it was when I was last here. In fact the surface was pretty decent throughout and I think I only counted two pot holes. The other major plus of driving in pouring rain is that the police checkpoints all seem unmanned and we sailed right through them unhindered. I suspect they were all inside sheltering from the rain and the usual interest in the driving licences were waiting to be satisfied on a sunnier day!

Map to locate Kafue - second dot down from Lusaka!

 As we get close to Kafue (50km south of Lusaka), Mebby then turns to me and asks if I know where the hospital is. Ummmm, negative! This is a sprawling industrial town made famous by a hydroelectric dam across the river Kafue. I'd been through it en route elsewhere in the past but never really looked for the hospital. Never mind, we thought, there is a petrol station here so we'll stop and ask directions. So Mebby gets out and asks the three guys there for directions. She is clearly getting conflicting advice. I follow a little bit of the conversation - not by using Nyanga but by their dipping into English... blah blah blah cw Right blah blah straight on, blah tenga cw left. I now know how English people feel when Welsh speakers lazily use English in their sentences!! So poor Mebby, and by now, confused Mebby gets in the car not really much the wiser apart from the fact we've learnt the hospital is behind us! However by complete fluke I look in the mirror as she reverses and I see a parked land rover emblazoned with MoH (ministry of health) Kafue District Hospital. Quick, I said. Let's ask them. So we zoomed backwards across the forecourt in a reverse and screech to a halt in front of the very much amused driver. He nods at our predicament and calls over to a man in a white car filling up with petrol. It seems we are now to 'follow that car'! So that's what we did and slightly embarassing as we crossed the road we see the pretty obvious hospital signs! So we get there in one piece!
 
 The next task is to meet with the Medical Superintendent of the hospital. It's the protocol. We must meet the head of the hospital before speaking to staff. So we find the office and wait - she is on a ward round! She eventually arrives, reads through the official letter that we have (signed and stamped from the permanent secretary of health) and is happy with that! We also give her a recruitment poster which we've made to promote the MMed Anaesthesia programme to entice more applicants to come to train to become physician anaesthetists at UTH. She was very happy to put this up on the wall which is great. here's hoping some budding anaesthetists will see it and apply!

Recruitment poster for all hospitals and will also feature on the Ministry of health and the University of Zambia websites soon

 And then, we get to meet with one of the two clinical officer anaesthetists that had attended the courses we had run in the past. So I conducted the interview and asked all the questionnaire relevant questions, discussed problems and tried to answer any further queries. It all went smoothly, so I thought! At the end of the interview I asked where her colleague was and could I see him next. Ah, yes, he's working in Lusaka today part time. Wait a minute, I'll ring him.
 So she does and finds out he 'knocks off' (finishes at 13.00) so she advises us it would be better if we drove to meet him at the clinic where he was working part time. We set off in the car, back in the rain. I ask if we should double check before setting off. No, apparently not, we should wait til we get closer. So we got closer, ie the outskirts of Lusaka and pull across and ring him. He asks where we are, it seems he had got straight on a minibus after the phonecall and made his way back to Kafue. Well, was actually en route within 5 minutes of Kafue. Arghhhhh! Oh yes, there it was, the beauty of communication, communication, communication!
  There was only one option! We turned around and headed back to Kafue in the rain!

Heading to Kafue - mark 2!

 We meet with the candidate and pick him up at the bus shelter. It seems he makes more money as a basic medical officer clerking in patients for medical problems such as malaria or HIV or respiratory tract infections than he would working as a part time anaesthetist in UTH. So he does this on his days off to 'make ends meet'.  A soberingly interesting fact. We conduct his interview in the theatre rest room not the superintendent's office! This is great as it gives me the opportunity to look through the remarkably green theatre! And also to note the anaesthetic machine. It is an old donated one from Italy which they have had to revert to as their actual anaesthetic machine (also donated) is now broken and sits in the rest room as the local hospital electrician (and general maintenance guy) cannot fix the leak in the oxygen supply. It's been out of action for a month now. This is one of the reasons so many donated equipment stay in their boxes or are collected in a 'graveyard of mechanical objects' that cannot be fixed. Donating the latest spangly piece of kit is all well and good but if it cant be fixed locally then its going to be pretty useless in the future. However the new, but very old machine is a draw over (basically a machine which allows the patient to breathe and draw the air or oxygen that drives it through the machine themselves and doesn't necessarily need a supply of pressurised oxygen or gas to drive it). This is a great piece of kit and is widely used in many low income settings, however the fly in the ointment here so I was informed is that only one of the 4 clinical officers had ever been taught how to use the machine and so the others were 'sort of learning' on the job... It certainly puts the old adage "see one, do one, teach one" back on the agenda!

An all green theatre...

The draw over anaesthetic machine

The theatre restroom (thankfully not so green) with the defunct anaesthetic machine that cannot be fixed and the dummy baby ready for a neonatal life support skills station.

During both interviews it became apparent that the teaching of the neonatal life support had markedly changed these anaesthetic practices and that they have really taken on board the teaching and stressing that ventilation of the ban with rescue breaths is far more important than the constant suctioning that seems to still be taught amongsts the midwives here. In fact, these clinical officers have taken it a step further and have run their own teaching sessions for midwives about just that. Which is phenomenal! What a great thing to hear, that the course has not only taught and changed the practice of anaesthetists but is being dissipated to other healthcare providers and really making a difference to the outomes of the next generations of Zambians. Fantastic and worth every extra mile we travelled back and forth to hear that!

Preparations a go-go!

Another reason for me being in Zambia on top of working at UTH is to collect follow up data on both the SAFE Obstetrics and Lifebox courses that we conducted over the past year. These include one a year ago and one 6 months ago. The idea is to contact and visit the course participants to see how much they have remembered and how they have instituted the course into their everyday practises and also to hear their stories and gain their feedback about the course too.

  So where does one start with this task.... Well of course there is a list of names and places. Most of these mean nothing at all until visualized fully. However having seen the extent of the geography covered (each pin denotes a candidate that is working in this area that has attended a course) it is impressive that there is this spread of (hopefully) well trained individual anaesthetic practitioners throughout Zambia. Bearing in mind that most of the anaesthetics in Zambia are conducted by clinical officers (non doctors, non physicians who have literally trained from school for three years as a general clinical officer before spending a further 2 years training to do anaesthesia). They are really the crux of anaesthetic delivery Zambia wide. The map, however was also a sobering sight as this really is not an easy task to try and tackle fitting all of these places in especially with the poor road infrastructure but always keen for an adventure I signed up for the task! 

Candidate from courses home hospital base map 

 As well as sorting out where to visit I've had to sort out an array of paperwork. Follow up questionnaire's to see what the recall is like. Questionnaires to see how the course has affected practise/changed practice/had an impact (or not). Questionnaires to see how the equipment is functioning and if there are any faults that need to be repaired or attended to and questionnaires finding out how the hospital is supplied and how delivering an anaesthetic in that particular hospital is carried out. All in all it involves a considerable amount of paperwork! I have had to invest in a 'filing' system such is the extent of the questionnaires lest I travel to the border of Tanzania and forget the very piece of paper I needed!

The multicoloured foolproof filing system....

But paperwork isn't all I am having to sort out. As part of the SAFE Obstetrics there was a skills station to undertake - randomly selected from CPR, Neonatal life support, rapid sequence induction and seizures. These are also being re-tested (I'm using tested in a soft way here. Its not so much a test but its a repeat of the skills that was tested previously pre and post course to see whether the retention of knowledge remains at either 6 months or a year). So that essentially means I am carrying a large blue bag which houses not only a baby but a decapitated head and a dismembered body. I do hope the regular police checks by the road side are not too thorough checking through bags!!! I dont think my Nyanga is quite up to explaining all this lot below!

Dummies and equipment for skills testing

So, there we go. I think I'm ready. In fact I know I'm ready and have been for a few weeks! Unfortunately at present I am having to use an attribute that I am not synonomous with: Patience! In fact it is something working overseas continually teaches me. When I was working in the Antarctic we had the saying "Hurry up and wait". That basically covered most things but especially the 5 days of getting up each morning in the Falklands with your bags packed ready to get on the plane to the Antarctic only to be told the weather window wasn't right or the wind was wrong or something and then you'd down tools, do something else and repeat the next day.... Similarly here. The wait for the official letter from the Ministry of Health (with the signature and stamp on it) to allow us to do the follow-up. Now we have to wait for the go ahead for transport and visitations and a few other 'technical' problems.... So, I am patiently waiting.... Honestly, I am!!!

But meanwhile, I am still working in UTH and feeling lucky that we have some of the Lifebox donated pulse oximeters ( the yellow box in the picture) that is placed on the finger/toes of the patient to allow recording of the oxygen levels and also the heart rate. It is used in the recovery area in UTH as we have oximeters attached to the monitors in the theatres. We are really fortunate, in some hospitals they depend on the pulse oximeters in theatre for monitoring and it's a sad thing to think that in some places they don't even have one in the hospital at all.  It is also highly useful as it is portable so can be taken to a ward situation if there is an emergency and it also has different sized probes for child or adult sized fingers!

Lifebox monitor in use on a child in the recovery 

I am also trying to promote the use of the WHO Surgical Safety checklist at UTH during my time in theatre. This is to increase not only communication and teamwork but also making surgery safer as we ensure the correct patient is operated on. The correct procedure is carried out, the correct equipment is available (crucial to check out here). It allows any difficulties to be highlighted to the team and is basically a pretty easy list to rattle through before starting each case. Getting buy in from staff and surgeons is proving just as difficult here as it is in the UK at times, though having returned I am buoyed by the fact that there are pockets that are making positive noises about it from both sides of the table (anaesthetists and surgeons). So there is hope!

WHO Surgical Safety Checklist hanging from one of the theatre lights to encourage use

So basically at the minute i am chomping at the bit to get out and see what's going on in the rest of Zambia. I hope that there will be further updates on this project soon!

Lumps and bumps – its not all brain surgery mind!

Following a good time at the casino the weekend before last I thought I’d play Russian roulette with what specialty I’d end up working in today. So I wondered in to work and got soaked in the downpour. I could easily have stayed in bed and listened to the raindrops hammering against the tin roof, but alas duty called! 

Raining!

Anyway as I walked towards theatres one of the trainees who was leaving after the night shift of the weekend informed me of the desperately sad news that a lady that I had been a part of looking after had passed away on the intensive care unit overnight. Sadder still, as she came to hospital in labour with her first child. Amongst the emergency casearian section for shoulder dystocia the baby didn’t make it. She bled and was stabilized with a hyseterectomy and moved to the intensive care unit only to bleed for the second time the following day (when I got involved in the case) and did remarkably well until last night when her kidneys that had been failing stopped working over the weekend and her lungs filled with fluid and she eventually passed away. Tremendously sad story and leaves a husband and family bereft. Incredibly sad and frustrating that this continues to happen despite all the courses and the advancement of medicine here.  But it makes working here all the more important. So that shook off my Monday apathy and I strode purposefully to theatre.

  When I got to main theatres it was a pleasant surprise that there were a few hands on deck so to speak. And the ship seemed to be sailing in the right direction for once! So whilst looking around at who was where and what was going on I happened across a few interesting cases. Now to many medics in the UK – when one mentions that one is going to do a ‘lumps and bumps’ list – it generally means a few little excisions of cysts, lipoma’s or abscesses or sometimes even a hernia is counted in this. Basically small fry operations (not to the patient or surgeon of course).

 

However here, lumps and bumps take on a whole new meaning! And not just any type of lumps and bumps – but neurosurgical (brain surgery!) lumps and bumps.

We started with a patient who had some of the largest collections of lumps I have ever seen. They had a condition called von Recklinghausen’s or Neurofibromatosis. These cause loads of lumps and brown skin stains (café au lait patches) all over the skin. This patient has a textbook entry of them all over her body but had come as there was the largest neurofibroma lump I have ever witnessed covering her hip and thigh. So large that she had trouble doing up her Chitengi (which is not unlike a sarong skirt) – which was the reason she presented for surgery. However this passed without too much of a hitch and she will soon be able to go about her normal business wearing her normal clothing.

Cafe au lait spot and a neurofibromatosis on back of knee

The second had two of the largest bumps I have ever seen growing out of a skull. To begin with we thought they were just fatty tissue under the skin lipoma) but on looking at the x-ray we could see that they’d eroded through some of the skull. In fact the neurosurgeon decided to do what the red Indians did – a scalping in order to get at them easier (under anaesthetic of course!). Anyway it turns out that these were not lipomas or cysts but they decided that they were secondary metastatic cancer spread from somewhere else as they extended into the skull. I have my doubts that this is the correct diagnosis but then again these are the first lot of these bumps that I have ever witnessed so it may well be true…. I hope to find out before I leave!

2 large bumps

 So having warmed up nicely (well actually with the new aircon blasting down on us it was rather cold) the surgeons decided to press ahead with the first patient on the list. A brain tumour. A meningioma to be precise and a very large one at that in a chap that is a year younger than myself (yes that does make him 20! Ahem!). The scan is remarkable for two reasons – firstly its size and they are operating with no clever technology (stealth) but also that it is an MRI scan not a CT. Now anybody who’s a part of the NHS or even had a scan knows how long they had to wait to get a CT scan let alone an MRI scan – so how on earth have we got them for a brain tumour…. Well, it seems when the CT scanner in the main university hospital in Zambia hasn’t worked for about 4 years, and the back up CT scanner across the car park at the Cancer diseases hospital has also stopped working as of 3 months and the Military hospital cannot deal with the now increased influx of CT scans (even being taken from our ICU in an ‘ambulance’ – well a van with a cylinder or oxygen in the back) then all these cases will get an MRI scan at the cancer disease hospital instead (the MRI in UTH is of course… out of action!)

Massive meningioma 

Anyway at 12.30 a craniotomy for meningioma (basically taking the skull off to shell out the tumor) is not what you want to hear, bearing in mind that the standard operating times in Zambia is until 13.30…. It was going to be a long one…. It was also going to clash with the afternoon critical incidents meeting and teaching session that we’d organized. However there was a need to do the case and so we proceeded.

 We started off with the pleasing aspect of getting everybody in theatre doing the WHO Surgical Safety Checklist as led by one of the anaesthetic trainees. This is to prevent operating on the wrong person/site or missing vital information such as allergies or problems and also encourages good communication and teamwork. It isn’t used well everywhere but the neurosurgeons are one of the better surgical disciplines at doing it.

Mmed trainee leading WHO Checklist

 Then the surgeons buried themselves in their work and I dashed out to the ‘canteen’ to get food. I usually take in a packed lunch but this morning in my lazy state I decided I’d not bother. Whilst standing in a long queue to pay for some food I then recalled why I usually bring my own. Nevertheless I got to the front only to be told I had stood in the wrong queue and this one was for doughnuts and scones. So I decamped to the other one where I paid for my Chicken and rice (not brave enough to have caterpillars in the hospital – have tried at a restaurant previously!). Anyway 20 minutes later as I get to the front of this queue there is nearly a revolt as they run out of chicken ...Seriously, the only thing that could have been worse would have been the news of no more Nshima – so furious were the crowd! Thankfully thought it was a misunderstanding and they just required re-stocking of the chicken and order was restored!

 I get back to theatre and think its odd as my colleague Papari and Dave were both missing. It turns out that whilst I was desperately trying to secure some lunch they were desperately trying to resuscitate an emergency on intensive care (which is next to the main theatres). Turns out it was my trauma patient from a week ago (the one with a fractured pelvis and no chest x-ray who later turned out to have a fractured neck, fractured ribs and haemopneumothorax blood and air outside his lung), fractured lumbar spine and pelvis). He had also developed kidney failure from rhabdomyolysis (muscle breakdown) over the weekend. He also sadly didn’t make it despite their best efforts. Sadly another frustratingly young death to be involved with.

DIY Drill

Hand saw / cheese wire drill

  By the time I got back and look closer at what the surgeons were doing it seems that they hadn’t actually removed the skull at this point in time. It seemed inordinately long to me but the flip side was that the blood loss was very minimal (just as well as we only had 2 units of blood available anyway!) They then broke out the ‘brain drill’. This sounds like some serious piece of kit. It is sadly however a basic Black and Decker drill (a la what you use on a Bank Holiday Monday to hang pictures on the wall!) wrapped in a sterile drape. Thankfully today the batteries were charged and it made the requisite 5 holes it needed. They then painstakingly hand saw the bones between the drill holes to remove the bone flap.  This was interesting to watch at least as it was something that I could actually see and not just the constant digging around in the head that continued for the next 4 hours after this!

2 anaesthetic charts stuck together is a sign of a long operation!

  They got as much tumour as they could out. At some stage one of the porters arrived with quite a few polystyrene boxes of chicken and chips and a bright orange (teeth dissolvingly sweet) fizzy drink called Miranda. Apparently if the staffs stay past 13.00 then the surgeon/hospital is bound to provide them with lunch. So credit where credits due the surgeon did look after his staff – thought the poor scrub nurse’s one was stone cold by the time the operation finished! It also meant I could have avoided the hour of my life at the canteen queue system! Every day’s a school day I guess!

 Anyway after a painful/painstaking (depends on whether you are looking from an anaesthetic or surgical perspective!) 6 and a half hours they decided they’d got as much tumour out as they could today. On further clarification I was told that they weren’t going to get the rest and anyway it would grow back in due course!!! 6.5hours later!!!! So we took him over to ICU where we woke him up and he’s ok if not a little groggy after all that Halothane! I am crossing every fibre in my body that this remains the case overnight, as my current ICU statistics are looking a little grim. Though not as bad as the realisation that my own oxygen saturations are way lower than the patients - even on ICU at times! Well.... it was a long case, I had to find something to do!!

All work and no play....

All work and no play….

  Whilst working at UTH, putting in the hard yards there is an inevitable need to let off steam and enjoy life as well. At the minute it’s a great time to be in the anaesthetic department  (with one honorary medic!) as there are lots of us here all working on different projects but with one common aim – to try and drive forwards the standards of care. However we also have another common aim – which is to make the most of our time here and have some fun!

 Last weekend was the starting point of this with a Friday night foray into the world of the casino in order to farewell with two consultants that were leaving after teaching on the Lifebox and SAFE Obstetrics course. It turned out to be a profitable evening for me – with a grand total sum of £8 won on the blackjack table! I wont be giving up the day job any time soon!! This was measly however compared to our medical colleague Simon who swept the floor with a £400 win. No wonder they shut the table before midnight as he was well and truly on a roll so to speak!

  Nevertheless, always the gentleman he treated us to a bottle of champagne and a kebab and the nearby Club! He then managed to undo his good deed by dragging two of us to a further classy establishment as modeled by Helen: Klub Vegas. As the only three Muzyngo’s there we were treated as royalty and given a decent introduction to some ‘interesting’ African dancing! Anyhow arriving home as dawn was breaking was beautiful and certainly more of a highlight than watching the Wales v Scotland match on the TV at O’Hagan’s pub up the road later on that day. I guess a win’s a win!

Simon and Helen with the Casino spoils!

Helen outside Klub Vegas!

 This weekend though saw the 9 of us (well 8 and a baby!) head off early doors to Lilayi Lodge on the outskirts of Lusaka. It was great to get out of the city for a bit and walk through the greenery, bushes and trees surrounded by nature. It is a created reserve but does have a large amount of roaming wildlife. Sadly the antelope were distant spots but we did stumble, unassumingly upon 4 baby elephants! These belong to the elephant orphanage programme and they were walking towards their shelter, so it was great to see them interacting in the wild before heading back to be fed by their wardens. It’s a great project that rears the orphans of either poaching, disease (anthrax) or relocation to enable them to be reintroduced in the wild of Kafue national park when they are old enough. It does this by enlisting the help of many local communities and supports not only education but agricultural development as well as anti-poaching measures. The four of them were all under the age of 2 and a half and behaved very much like children of that age group. It was fascinating to see the youngest of all copy his new siblings. Here’s hoping they will be successful in their reintegration.

Feeding time at the orphanage

Brotherly love!

  The rest of the 10km walk yielded a very exciting discovery of some dung beetles. They were working very hard in moving their ball of dung along the path. Amazing skills of balance and of strength. Also fascinating watching them push in a handstand position! Ok, so they weren’t one of the big five’s but hey they are pretty amazing to watch!

Amazing dung beetles

Dung beetle handstand

 After a timely lunch to shelter from the large resounding thunder clap above our heads and torrential downpour we headed home to shower and change ready for the evening’s festivities. We ended up at the British High Comission no less at the Caledonian Society celiidh. A few dances in and the old Dawnsio Gwerin routines of primary school kicked back in! Fantastic fun and  a great way to spend the evening, especially as the bar was amongst the cheapest in Lusaka! We have all stocked up heavily on our quinine levels! Half way through the exhausting dancing sustenance arrived in the form of fish and chips in newspaper! Delicious! And then a wee dram of Whiskey to help us all back in the mood for the finale of the reels!!

Papari and Anna tucking into fish and chips!

Simon and Jane enjoying mid reel!

    This morning was surprisingly good, considering! And what better way to wake up properly than to go for a 10 mile run on empty(ish) streets before the heat of the day. The afternoon was spent chilling at an establishment called monkey pools. This is a housing complex outside Lusaka which has a large grassy expanse and a swimming pool.  A quick game of football and a picnic before a swim was very welcome again before the torrential downpour that seems to happen like clockwork in the afternoons!

Monkey pools

  A bit more exploring actually showed us the reason its called monkey pools – a few natural pools filled with fresh stream water and plenty of fish swimming around. Seemed rude not to join them for a bit! It was certainly more refreshing than the actual swimming pool and more interesting sharing with some fish and a frog than other grown ups!

 

Blue waxbills

Follwing arrival home a cup of tea  on the verandah looking out on the beautiful garden now glistening with drops of sparkling rain in the sun. Watching the amazing birdlife flying in for the seed including the blue waxbills, finches and firebirds.

  So all in all a pretty great weekend that was just the ticket before the start of a new week…..