I hate that I didn't write this sooner, but my internet timed out and I couldn't buy more time till a few days later and then I just procrastinated... I dropped the ball and to my faithful readers, I am very sorry.
Male ward was the time of my life. I can't say enough about how much I appreciated their light-hearted jokes, their kindness, and their faith in my medical knowledge and skills even when I second guessed myself and double checked with my handy dandy iphone apps of medical knowledge.
As much fun as it was, it was also (obviously) a full time job with several of my patients needing frequent check-ins and not enough daily staffing to oversee each step of treatment. So these men all became my babies- I really can't describe it any better than an almost motherly role spread out among 13 patients at a time.
I'll tell you about a few, unfortunately I couldn't get pictures of all of them because I just didn't feel right taking pictures when they weren't feeling up to par even if they would have let me.
I've told you a little about Box- he's the one who had the uncontrolled diabetes and had been admitted 2 weeks before I took over his care. I have never seen diabetes that was more resistant to stabilization than his was. He would be nearly stabilized for 2 days and then have a hypoglycemic attack one night and the next day his glucose would be sky high again on the same amount of insulin, any tweak in insulin levels would inevitably welcome another huge swing in blood glucose. We had a long talk about his diet and finally I think had a break through that a small helping of rice and tomatoes could not be treated with the same amount of insulin as his bigger meals and that whatever way he might be able to afford, he needed to get some protein in each meal. This was not an easy fight for a man that hates beans but can't afford to have eggs or some sort of meat each day. He agreed to try, anyway, and noticed a big difference in his symptoms other than feeling dizzy and occasional blurry vision which had been written off as hypoglycemic symptoms. On a whim, I sent him to IVV (our eye specialist center) before he left, just to be certain, and Box came back walking with a strut and a smirk he couldn't hide.

I pat myself on the back a little too much for this case and don't know why I consider him to be such a big victory, when I have seen much more miraculous recoveries and when I know it is through no power of my own that Box can now see clearly- but I can't deny that for some reason I feel some bit of pride when I see cute little Box with his glasses on. Maybe its just sheer giddiness to have seen such a difference in what I assume to be self confidence. Love him and wish him the best.
As much as I would love to go on and tell you about all the rest of my patients tonight I will have to leave you with just this quick update and write about the rest another day.
We leave Zambia for good tomorrow and if anyone wants me to be able to function as we take on London tomorrow they'll need me rested. Hope you're doing well and I can't wait to tell you more about the week in male ward and my week in Lusaka.
Love Julie

This is the beginning of the 4th week and I'm in male ward. If you know me well, you know this is about to be my favorite week. There is something about old men that is just adorable, plus, here in Zambia, its just nice to be liked and appreciated and I find that the men here are much more responsive as about half of the women here can't decide whether they like you or not.
Today I started out with 5 in-patients and by the end of the day ended up with 10+. My patient diagnoses this morning were a broad range:
1. Uncontrolled diabetes
2. A survivor from a land-mine explosion who just had some of the shards removed from his left arm, leaving the ones in his skull and right leg that weren't causing any problems
3. Cryptococcal meningitis, TB, HIV, sepsis, IRIS
4. TB, HIV with treatment failure, Chronic diarrhea, severe dehydration
5. Uncontrolled hypertension 200+/100+ with prior stroke

After rounds in male ward, it was another Monday in OPD which just means absolutely packed up until 6:30p.m. with the constant question of when to admit and when to allow home treatment. 

There is a lot of sickness around Zambia now in it's cold season and we get more and more patients every week. Today I saw cases of the mumps, flu, parotiditis, bronchitis, gastritis, hematuria (urinalysis pending), and infected wounds. 

I'll elaborate on these patients tomorrow when I can finally put pictures up and give their story, but I can tell you now that God is working and doing amazing things daily. There is no other feasible explanation. I count myself fortunate that He would empower and allow me to witness and occasionally have a part in the treatment and healing of His patients. I am awe struck at His faithfulness in each day that I go to work and His provision of presence of mind, a joyful disposition, and receptive patients.

Today was incredible. I think the best day I've had yet.
I am back in OPD this week and today saw around 20+ patients. I know I've said this in every post but I really have had the most amazing patients with great attitudes and so much personality.
What made this day so much better than the last you ask?
Three things:
1) getting '5 stars' today from the other C.O (equivalent to a PA here) for working quickly. I thrive off of encouragement I guess, because that confirmation was just what I needed.

2) This guy! In my top 2 favorite patients of the day/ever. He giggled every time I touched him with the stethoscope. Apparently he was adopted- meaning I'm too late :( 

3) Doing my first paracentesis all on my own... no numbing medicine or anything on a 20 yr old boy that I almost verbally mistook for a pregnant female.-Glad my translator kept saying "he". She knew exactly what I was thinking. She's kept me out of so many messes here. Anyway, the boy didn't even flinch as I bore this catheter through his abdomen wall to get rid of all the fluid he had accumulated. When I later asked Dr. Joan about this patient she said the only reason they can come up with is that he had severe liver scarring after a losing battle with schistosomiasis, a parasite that lives in the liver, and therefore caused some serious portal hypertension from the backup of blood behind the liver scarring. Its amazing how common schistosomiasis is here- 

I saw another kid this week who's only complaint was blood in the urine- urinalysis showed the parasite and we were able to treat him. Even so. it had been several months before his family brought him and now I'm praying that sweet 5 yr old doesn't develop the same problem.

Yesterday, we went on community outreach where we went out into the bush to do family planning education and AIDS awareness, vaccines, birth control, and antenatal care, it was only 4 hours but I've never felt so exhausted. I felt like a factory worker, where I would draw up the thick depo provera shots, check Blood pressure, and give the shot to what I assume was 100+ ladies and then oral birth control for others. The nurses warned me that it's important to check when their last menses was because if some ladies think they're pregnant then they will try to get the shot in hopes for abortion.

<- lime cookies and fanta as payment for some hard work- A deal I can't refuse!



Time outside of the hospital has also been so refreshing this week. Its so nice having Meg here.  Meg has been volunteering at Zimba for the past 6 months and sadly is heading back home next Monday. She will be missed! On the weekends we've taken trips into Livingston, only an hour away, to stay sane and visit a few of the surrounding countries just another hour away from Livingston. So far we've been to Namibia, Botswana, and Zimbabwe. I may complain in the moment of frustration and when I start feeling defeated but don't let me fool you- I'm really living here; life is full and abundant. God as always, is good!

Thanks for your love, support, and your continued prayers,

Goodnight from Zambia!

Last week was bitter sweet in the women's ward. I couldn't have had better patients but just maybe a less stressful week adjusting to the ins and outs of the hospital and Zambian culture


In the women's ward patients come and lodge until they get better. There are a few feet between each bed making just enough room for one family member to stay with them throughout their stay.

Gertrude, one of my favorites, would pop her head off the pillow as soon as I walked into the room with a big smile on her face waiting patiently for her turn to tell me how she felt like new. She had been   in the hospital for nearly 2 weeks for TB, HIV, anemia, and abdominal complaints likely due to an opportunistic infection as her CD4 count was very low. Her joyfulness and sweetness made the ward a brighter place. It was hard to send her home but she was ready and you can't help but celebrate with her.


Mainess, was a patient of Robin's the week before, she had CHF, A. fib, and gross anasarca (excessive fluid loss into tissues it shouldn't be in). She lost over 8 liters of fluid over 12 hrs via diuretics. and lost over 25lbs in the period of a few days. She looked significantly thinner and back to her smiley self within a week and a half. Her sister stayed with her the entire time in the ward attending to every need; her love and support was so awesome to witness day in and day out.

<-- Mainess and her sister ready to go home!

Beatrice was in women's ward being treated for possible malaria, never confirmed, on the Saturday prior to my week in women's ward. I decided to get acquainted with women's ward that day and she was begging to be sent home since she was feeling so much better We sent her home and I found out Monday morning she was readmitted the next day with a fever above 102 and extreme fatigue. She didn't look like the same person. A little background story on Beatrice is that she is a a paraplegic after a spinal injury after back surgery in 2006 and developed large burns on her left extremity over a heater since she could not feel her flesh burning. Since she has been readmitted, her complaints are vague but responded well to a third generation cephalosporin antibiotic, so we went with it until we could figure out the cause of her infection. Though her wounds are healing well and do not look to be infected, with good granulation tissue, we still suspect this must be the source as we have virtually ruled out everything we can think of. Either way, she was joking with us the other day saying she is ready to go outside and play soccer as soon as we would let her.

Sampson, was my baby, meaning he was my admit in OPD last week and therefore I was his best bet for continued care, so I ordered all his tests and made his treatment plan. Sampson came in with complaints of off and on diarrhea for 3 years with occasional episodes of 10-12 stools per day. He was also told he had "water on the heart" the last time he was admitted at another hospital and had a 50 yr history of alcohol abuse but finally managed to quit smoking and drinking 3 years ago. On the day of admission he complained of excessive diarrhea, abdominal pain and distention, as well as worsening pedal edema, weakness, and shortness of breathe with lying down. This treatment plan started looking more difficult with every question. My suspected diagnosis was CHF and chronic diarrhea which could actually be a result of chronic pancreatitis from his drinking days causing malabsorption and therefore frequent  watery stool. The diagnosis was far from certain but the big problem was that he was retaining fluid in third spaces (abdomen, legs, and thorax) yet also dehydrated- which makes for a difficult balancing act. Either way he was still able to breathe while lying down and was much more concerned about his growing abdomen so we ran some tests including a chest and abdominal x-ray, as well as stool culture, exam, and guiaic  (for blood), a urinalysis and full blood count. Amylase and lipase are not available tests here.
After being admitted on Wednesday of last week we waited for 2 days for his lab results to finally be finished- I say waited, but what I really mean is I went back and forth to and from the lab, harassing them to get each test done so that we could treat poor deteriorating Sampson. He became more distended by the day. When all of his labs finally came back Friday afternoon, nothing was a pertinent positive, meaning nothing stuck out that could lead us in making a diagnosis and no further in treatment. He continued to get IV fluids and after a trial of hyoscine figured out he couldn't tolerate the medicine that was supposed to help relieve his abdominal pains. Finally, I ordered an HIV test (even though he had one only a month ago at a clinic closer to his home) just to know what kind of illness we could possibly be dealing with, and of course that was left for follow-up and never done without me there to nag. That afternoon the girls and I were leaving for Livingston for a  weekend safari and camping so I left a note for the M.O. (medical officer- a zambian equivalent of a doctor) that would be taking over his care for the weekend and filled out a referral form and encouraged them to visit Livingston Hospital if the family decided they needed more urgent care as I can only imagine how worried they were for Sampson. The M.O. that was to take over his care had been out half the week sick, so it didn't look promising. I was told Sunday night that Sampson was sent to Livingston earlier that day and that he was started on antibiotics just before leaving in hopes that it might help.

I had the pleasure of taking care of many others while in the wards. I learned a lot about medicine and the Zambian culture. Both things I like and things that will never make sense to me. For one that Zambians hate giving bad news- so they don't- I had a woman with a 2nd trimester incomplete abortion scheduled for a D&C that afternoon ask me if I could hear her baby's heart beat when I put my stethoscope to her abdomen and had to talk through the results of each of her tests and what they meant as well as what was going to happen later that day. My sweet translator wanted to give her hope and I had to explain that she needed to know. A similar situation happens with alcohol abuse and smoking- most Zambians health care providers will not approach the topic of drinking or smoking and act like you're being rude if you confront your patient and define it as a health issue. Finally. the issue of time, there is no sense of urgency when someone's life is in the balance, especially with lab work. It's maddening!
Somehow in each situation God provides and I'm still, as far as I know, sane. I love my patients and realized today, my first full day back in OPD, that I'm well prayed for and excited/thankful for another day to be here, learn, and love more than I know how.


<--  A regular Monday in OPD, afternoon crowd dwindling down slowly.


Photography: courtesy of my friend Meg

Sorry friends!

Last week was a long, yet short, and stressful week... I'll explain further later, anyway I wanted to apologize for not keeping you updated on what is happening here at Zimba but know I'll be all over it tonight! 

My prayer this morning is to be renewed:

To have His eyes and ears so I am not fooled by my own obvious observations but can see and understand what the real problem is. (Patient's aren't very forth coming here with their complaints and it feels like it takes a lot of prying to pull out the reason they are seeking help... it's really annoying)

As obvious from the last statement, I need a new perspective one of perseverance and love: I would be lying if I said I don't dread the long line of hundreds of patients waiting outside my exam room door on Monday morning or having to harass the lab or pharmacy for pending tests and medications that makes efficient medicine almost impossible. My patients could die before I even have an idea of whats going on with them. I'm already tired of it, yet its only a taste of what Joan and Dan do every day--- maybe some coffee would help as well...

For capable hands and willing feet, a spirit of obedience not of rebellion and resentment.

There is nothing good about me today, I surrender this day to Him that is higher and stronger than I am and trust that he will work like I've never seen.