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