Wednesday, July 17, 2013

My Trip to Zambia






Last month I went to Zambia, Africa.* Each day, well, almost each day, I posted a short summary on Facebook. The response was heartening. Once I left Lusaka (for safari ! ), I no longer had even spotty wifi, so I ceased FB postings rather suddenly. Here are my posts, with some follow-up and pictures. Safari pictures follow.

*With Surgicorps International, www.Surgicorps.com 
Mission: provide free surgical and medical care  to
disadvantaged individuals in developing countries.

Day 1
      The smell of a wood fire permeated the air the minute I walked out of the airport in Lusaka. As I inhaled the sweet smell, I thought fondly of campfires and Christmas.

“Mmmm, smell that?” I asked a more seasoned traveler as we waited to load our bags and medical supplies onto the bus.

 “This is the third world,” he told me, “cooking and heating with open fire is the norm.”
 

Day 2
Full day if screening.  Mostly kids. Snake bite scars, or more often, burn scars from fires and cooking oil. We saw congenital anomalies like cleft lips and syndactylies--an abnormal connection between adjacent digits--as well as aggressive scarring. One man had a keloid—scar tissue that heaps up into mounds—the size of a grapefruit hanging off the side of his head. The surgeons, two plastic surgeons and two hand orthopods, plan to repair these skin problems, the majority of which limit function, over the next five days. Our team will basically take over the hospital’s three operating rooms (or theaters, as they’re called here).

Screening
Saddest case during screening was that of a six-year-old with ambiguous genitalia. This is caused by congenital adrenal hyperplasia, which comes from disorderly hormones before birth, and is not something our team can fix. When the child was born, the doctors told the mother her child was “both a boy and a girl,” and suggested she “raise it as a boy.” So, that’s what she tried. Her husband left them when the child was six months old. But the mother, god bless her, let the child be who she was. A girl. The community couldn’t accept the change from boy to girl though, so Mother has since had to change villages.

Because the testes are up inside, or undescended, they are more likely to lead to cancer and should come out. There are pediatric urologists coming to Kenya next fall, but this family can't afford to go to Kenya. In addition, the mother knew nothing of hormones her daughter will need. With her testes out, she won’t make testosterone, so her voice won’t fall when she hits puberty, which is good, but to develop breasts, which she’ll want, she’ll need replacement estrogen. Today, all we could offer was information and support, which, I recognize, was huge. Surgicorps will see if/how they can help. They are a really good organization.

(One of the plastic surgeons, Deb Johnson, has since contacted the traveling urology team, and they plan to go to Zambia this fall… good news for that young girl. And a good start on a lifelong problem.)


bandaged bed rails
Day 3
lawnchair--> wheelchair
Great day to be in Africa. We had all three operating rooms running, and the team functioned well. I am amazed how much can get done with so little. The ORs have what they need, and no more. Bed rails don’t always work, and the lights go out intermittently, but it is a good and functional hospital. Check out (https://www.facebook.com/BeitCureZambia), where there are a few photos of Surgicorps' trip.


Deb Johnson, operating in the dark
...flashlights helped!


This morning I was pulled to teach in the first Certified Nurses Aid course in Zambia. We discussed vital signs, and talked about the need for basic life support skills, also new to this country. I’m willing, and happy, to step in where asked, but feel underprepared. When I asked them (about 35 women and 3 men) to introduce themselves and tell me why they were taking the six-month-long course, I found it was difficult for many, if not most. After watching them stammer or giggle their words out, I realized how very, very shy they were (they call it “respectful”). They were so brave to still do it, and I realized I still have much to learn.... Tomorrow I’m to teach contraception!

Day 4: no wifi.

Day 5
I couldn’t be happier. I’m honored, lucky, and humbled by this experience.

Contraception talk went well yesterday; they asked questions despite their reserve (courage!). That gave me a chance to clarify some significant misconceptions, like, “don’t condoms cause cancer?” or “if you don’t have periods (on some forms of progesterone), where does the blood go?” I wouldn’t have thought to cover those things in a lecture.

In the theater today, we corrected scars that have prevented people, mostly kids, from elevating their arms, or extending their legs, or fingers. After the original injury, usually a burn or snake bite, the new skin, or scar, contracts over time. Sometimes they hold the limb or digit so still that it heals contracted—an upper arm to the chest, for example, or fingers flexed and stuck together. The surgeon opens the contracture, and then takes a skin graft from the thigh or abdomen to cover the gape in the wound. We have an O.T. with us who makes splints (so the patients don’t create the same problem), and then hopefully, six weeks down the line: fully functional.


burn scar contracture

snake bite contractures: knee and ankle
syndactyly

syndactyly, repaired and splinted


One girl, ten-year-old Eliza, has walked on her heel ever since a snake bit her on the top of her foot when she was five. Her contracture was so tight, her big toe nearly touched her shin bone (hard to even imagine, right?).  



Eliza: snake bite contracture
Thanks to Jack Demos, a plastic surgeon and founder of Surgicorps, Eliza'a foot is now at 90 degrees. But here’s the best part: I spoke with her today, post-op day number two, and found out she had thought she was going to lose her foot altogether. Boy was she happy when she woke up!


 See what I mean? I’m so lucky.

repaired and splinted
 
As I tried to get permission from Eliza’s mother to use her daughter’s story with her name and photo for the Surgicorps blog, and she had no idea what the internet was… let alone a blog or FB. She honestly couldn’t conceive of it.

Eliza

Justin, Eliza's nurse and our interpreter for this session, helped us communicate. While English is the most common second language, there are 70 some dialects spoken in Zambia.

Using his third language, Justin kept tapping his finger on the screen of his phone. “On here,” he'd say, then, spinning his hand in the air, “and then around the world. Is it okay?”
Eliza's mother looked perplexed. “On the radio? In the newspaper?” she kept asking.

It took a while, but once reassured it wouldn’t be in her local news [please honor], both Eliza and her mother agreed it would be fine.

I thanked them with two bottles of lotion from my hotel room.
Eliza, smiling with nurse, Justin and Matt O'Conner, who took patient stories for Surgicorps' blog

During the conversation, I noticed Eliza, a preadolescent on day three post-op, seemed cranky and antsy. I wondered if she was in pain, and asked Justin.

In return, Justin, who, by the way, had abundant patience—his face kind and soft, and his words gentle during the ten minute repetitive internet explanation—said, “Oh, no. She’s not in pain… the ward has been quiet all morning.”

I’m beginning to see I have something to offer here, it's going to be very hard to leave tomorrow.

Day 6
I got up my nerve to discuss pain control with Justin. He is actually training to be an advanced nurse, online, in a school from the UK.

After tripping on my words, “I’m not trying to tell you what to do," or “I don’t want to sound arrogant, judgmental, but..." I began, "yesterday, you mentioned that you didn’t think Eliza was in pain, because the ward had been quiet--meaning no one had called out in pain. Do you think they might still have pain? Moderate pain that can be treated?”

“Yes,” he said with a half nod.

“Well, I brought some information on pain in children, would you be interested in reading it?”

Before coming here, I had had a brief communication with a local doc, and she had suggested I give an in-service to the nurses on pain, adding, “but we don’t have IV pumps or anything.”
I had read ahead about pain control, but not doing any in-patient medicine, let alone in-patient pediatric neurosurgery, the hospital’s main function when visiting doctors, like our Surgicorps docs, aren’t here, I felt incompetent to the task; I had no idea, then, the context. The reason. The need. But there it was, on Justin’s face. The only way he knew to recognize pain was a child moaning or calling out.

Justin gratefully and gracefully accepted my articles on pain in children, as well as copies of pain scales for preverbal children. He told me he planned to share the information with others.

Before we left the hospital at the end of the day, (when the women –mothers and nurses— sang us out! **see video below), I stopped by to give my stethoscope to Justin. He already had one, I knew, but I suggested he give it to the person who would follow in his shoes.



Upon returning home:
My time with Surgicorps was incredible. I would do it again in a minute. And hope to. It called on a deep part of me. Yes, I’ve lost sweet nostalgia at the smell of a wood fire. And yes, I made mistake after mistake (like the entire day I recorded mean blood pressures thinking I’d been recording heart rates, or the time I had to break scrub in surgery because I almost passed out--probably due to nerves or a too-tight mask or because I held that limb up in the air for too long given my fitness level). But I kept at it. I met the challenges to the best of my ability. I made a tiny little difference in a world full of big fat problems.  

And that made a big fat difference to me.



**



video

eliza, front and center, as the women sing to our team on our way out

3 comments:

  1. Hi Janice!

    Your trip sounds amazing, and what a great experience. I love hearing about your travels! It looks like Pat came with you too! What an eye opening and life changing experience.

    Katie

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  2. I loved reading about this, Janice, and I hope it becomes the basis for other writing. (And that you go back!) Thanks for sharing! I esp liked learning about the specific medical conditions that are devastating there but that the team can repair fairly easily. The dramatic difference between a snake bite injury that you can repair and other injuries is impressive.

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  3. Thank you and thanks to Marla for directing me here. This was very interesting. We do not think of things like this in our insulated world where at 71 I choose to remain insulated and ignore NEWS. God bless you for your participation in this effort.

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