Three more days have passed here at Zimba and I'm still loving it. I've completed my last day in OPD today and on Monday I will begin doing rounds in the women's ward. Today was a half day and I was thankful for it, not because it's unbearably difficult but because I have a lot to learn for the more critical inpatient cases.
Side note: in the out-patient clinic, a part of the hospital, I see the patients after getting vitals and if needed send them out for tests, which are done in a different area of the hospital, and have them carry their results back to me when they are finished and I explain the significance of the results and decide further treatment from there,
This week I saw a lot of expectant mothers, some who did not know they were pregnant to which I was able to give the good news and others who didn't know they were miscarrying to which I had the responsibility of letting down gently and scheduling them for a D&C... fortunately for me, my patients remained relatively stoic although you could see the distance and disappointment in their eyes. I can't help but hurt with them but I also have to keep it together, and so far thats been possible but not without some serious teeth clenching and pleading with myself.
I would like to say that everything went smoothly in OPD and that I had no regrets, but I did send a 13 year old boy away without proper treatment. The rule here is not to order a test unless you think it will change your overall treatment which makes plenty of sense but this is a whole new take for me on the mindset of "treating the patient" (where one focuses on treating the patient by finding the underlying cause and basically doing whatever you need to in order to make sure your doing everything in your power to treat them effectively). Instead of being only concerned with treating your current patient, here, you have to also be concerned with having the resources to treat your next patient which may be a more critical case. So sometimes effective treatment may be forfeited at the cost of being efficient especially in the case of the newbe (me).
Anyway, this sick appearing boy came in with bilateral crackles and somehow had no fever (maybe it broke earlier that day) and knowing he had a history of asthma I knew an albuterol inhaler was probably a good option for him even though I didn't hear any wheezing, asthmatics don't have inhalers on hand here like we do in the U.S. So, on conferring with Dr. Dan, he said if I wanted to keep him in-patient (aka if I thought the kid had TB) then I could by all means get an X-ray. However, the patient didn't look bad enough for in-patient care to me. He even said he was feeling a little bit better that day. So instead I gave him some medicine for his cough and some albuterol and sent him on his way. Later, talking about the boy with Dr. Joan, she enlightened me that here in Zambia we empirically treat for pneumonia without a chest X-ray as some patients travel hours to days for treatment at the mission hospital. I don't know why that didn't pass through my head, frustrating to think about it. Anyway, before the boy left that day I urged him to return if his cough were not to get any better and he started to develop a fever, I can only hope the boy lives close by and will be back this coming week if he hasn't already returned. If so, you better believe I'm putting him on antibiotics stat and more than likely splurging for a chest X-ray.
I saw several other cases such as what I believe was a facial lipoma, a large non-reducible indirect hernia, musculoskeletal injuries, a domestic violence case complete with bite marks on the cheek and scrotal trauma (would you believe he had two wives? I wanted to tell him his obvious offense but decided I would conquer that issue another day), STI cases where so far I've had the pleasure of telling patients their HIV status is negative, thank you Jesus! (dreading the day when its positive, because often it is here in Zambia), plenty of viral infections with nausea, vomiting, diarrhea, cough, low grade fevers etc. Even these viral infections require more clinical judgement with more differentials of TB, malaria, parasitic infections being a possible culprit.
Today I got a sneak peak at next week in the ward and met 2 ladies I will be treating and went over their files. Its going to take a lot more detective work and know-how to care for these ladies and again I'm both excited and slightly overwhelmed seeing 6+ working diagnoses for each patient including both TB and HIV, opening up a world of possible infectious agents and complications. Prayers for my patients please and prayers for a sharp mind would be much appreciated.
Thanks friends! Hope you're having an incredible week.

Mulibuti!?

This is day 3 at Zimba Mission Hospital (zmh). Since I wasn't able to keep you updated I'll give a quick rundown of the first few days.

The first day we arrived at 4:00pm or 1600 Zambian time and took a quick tour of the hospital before dinner and then returned to the mission to help with a few cesareans (c-sections) before being told that our jet-lagged bodies weren't welcome in the OR (or the theater as they call it here) until we were rested - smart thinking. Instead we helped with some of the renovations they are doing to the male in-patient ward.

Yesterday, we set out for chapel before our first day working with Dan and Joan Jones at the hospital. From the gates of the mission house we're staying in you could hear the beautiful synchronized singing of the Zambians in their native Tonga language leading us to the small white church on the hospital grounds. When we arrived, the pastor gave a short sermon with a very simplistic Biblical approach. reiterating the same points over and over and just changing the words around. I didn't think much about it till today when I realized how life giving the words he spoke were, reminding me that God is the healer and I am only a tool through which He can work. It made today, my first day on my own, much less stressful and more efficient. But I'm getting ahead of myself, back to day two- I shadowed Dan around the maternal ward, pediatrics, and isolation room for rounds and then to OPD (outpatient clinic) for the remainder of the day where we saw many patients for ART (anti-retroviral therapy- for HIV+ pts) counseling. It was great to see what Dan and Joan do on a daily basis which pretty much means seeing each and every patient that is either in the hospital or registers to be seen on an outpatient basis, sending not one person home without being treated even if it takes all day and night. However, most of what I saw the first day was unrelated to what I would be doing the next day as I was to be in OPD and would not be seeing patients for treatment of HIV unless the issue was unrelated.

Today was awesome! I had my own patients as well as some help from Purity, my new friend and Zambian translator. We saw 9 patients in the morning and 3 more in the afternoon. It was slow in the afternoon which gave us a chance to get to know our translators a little better. The patients I saw had diagnoses of arthritis, hypertension, pharyngitis, heart murmurs (one being a very serious congenital defect that will need to be surgically repaired), GERD/H. pylori, anxiety, threatened abortion, and diabetes- some presenting with only one complaint and others with a myriad of vague/telling symptoms.    After each patient, I would find Dr. Dan and have him confirm that I had an appropriate plan of action and wasn't missing anything with my treatment goals and patient eduction. I hope to get a little faster each day if the following days' patients are anything like they were today. I can tell I'm going to learn a lot in the next 5 weeks about all things medicine.

It's hard to believe that in less than a week I will be in Zambia! Not gonna lie, I'm everything along the spectrum of excited--terrified! In no way am I prepared or qualified for this appointment. I go back and forth between the joy-filled acceptance of knowing that I get to love on so many forgotten people with  horrible diseases and bleak prognoses and then squirm at the realization that I will also be treating them- me- lacking both knowledge and resources. So, how does this sound like a plan for success? Fortunately, having been to Uganda 6 years earlier I know that this isn't my show, I'm not in control, and I'm in for a wild ride. My comfort is knowing that God is in control and for every remarkable thing that happens involving my hands or my spoken/written orders for labs and treatment plans it is His doing as I have and will continue to daily surrender my patients to His care. 

I feel so fortunate that I get to share these experiences with everyone (family, friends, acquaintances) at home and will be so dependent on your prayers. I would also love to hear your insights so please feel free to comment, advise, and encourage wherever you see fit. 

Here is a link to the mission where I will be working, if you're interested. zimbamissionhospital.jp. I'll try to keep you updated as often as I can, so keep checking back!