We went to the old hospital this morning for a teaching session to get updates on HIV protocols and stats. Which for the most part was interesting but some of it went over my head. At that point, after the session, we met the reinforcements that arrived on the same plane as our luggage the evening before. (YAY! FINALLY WE HAVE OUR CLOTHES!) We met Dr. Lipsi and Dr. Vincent. They are going to be doing surgeries which will be a nice relief for Dr. Mwansa. She stayed home to rest today and hopefully feel better.
This morning I attended ward rounds and then we had tea. Afterwards I went to the under-5 clinic. After watching for a while they asked if I wanted to give the vaccines. So I finished administering the vaccines for the rest of the many children… and unfortunately made many babies cry. Nicole joined me for the last two patients and I got her to do the vaccine administration as well. We then returned to Kariba and helped with clinic until lunchtime. Nicole scrubbed in for an exploratory laparotomy and biopsy of a pelvic cyst/tumour. We helped with clinic some more and came back for supper at our house and then attended the English gospel meeting on Luke that Gordon is doing. When we got home for the night I unpacked my suitcase and tidied my things. On for tomorrow is a trip to village schools to administer praziquantel with Dorothy.//
Today was very eventful and very tiring! Nicole went to some villages with Dorothy visiting some of her chronic patients. She got to have a very African meal of nshima, little dried fish, fried pumpkin leaves, and a large fish (brine?). She was gone all day.
Fiona and I went to Kariba. We were there for ward rounds and Dr. Mwansa only wanted to do a few surgeries during theatre day as she wasn’t feeling well. I observed an ultrasound of a woman who has an ectopic pregnancy. Then in preparation for theatre JR guided me in (attempting) to insert my very first IV cannula (they are much longer here). During this time Fiona scrubbed into theatre and was Dr. Mwansa’s first assistant for a bilateral tubal ligation. It went well but Fiona had to exit and scrub out while the patient was being closed up as she felt a little warm (and close to fainting). But she did well for her first time scrubbing in.
Next up was two other patients who are expected to be fairly easy and quick. However, just then someone on staff came and got JR and told her that a patient in the men’s ward had an abdomen that essentially “exploded”. So JR and I went to investigate immediately and found the patient sitting in a chair with 2 to 3 L of beige liquid that had leaked out of his abdominal incision that had dehisced. A family member lifted the man’s shirt and the discharge bubbled/came out of a small opening in the healed wound. We told Dr. Mwansa, then cancelled the other patients and began to prep him for a laparotomy. He was stable so we had a break for tea. We enjoyed brownies and a hot drink.
After tea, we began the surgery and I scrubbed in as the second assistant standing next to Dr. Mwansa. Fiona helped Kate, Allison, and Tiffany with anesthetics. She got to push a few drugs and was essentially the respirator for most of the five hour surgery by squeezing the ambubag periodically. The surgery was quite difficult. Dr. Mwansa freed up some of the bowel around the easily detected perforation. But most of the bowels adhered to each other and it was very hard to separate. JR and Dr. Mwansa couldn’t tell which part of the bowel was the proximal end and which was the distal, to create a colostomy. We tried some strange methods to try to figure it out (NG tube up from the rectum, NG tube down the bowel to follow it, we thought of using dye but that would take too long). Dr. Mwansa asked quietly for a chair and I looked behind me and couldn’t see one, she asked again a little louder and I started to say “Fiona” – to bring her stool over and Dr. Mwansa was falling (as she fainted) JR grabbed her arms so that all the bowels and instruments stayed inside the patient and sterile. As she was falling Kate and Jack and Allison were quick to come behind and catch her as JR had yelled “Mwansa!”. JR told them to lay her on the ground and take her mask, visor, and gown off. A few seconds later she came around. They were fanning her with a book and laid her on her side. She then sat on the floor to catch her breath. JR said, “I hope you can come back to this, we need you to come back as I can’t finish this yet for you. I wish I could but I really can’t.” Once she was able to catch a breather and cool off and she re-scrubbed in quite quickly, she just said to us, “I told you I wasn’t feeling well, I didn’t want to come in today.” JR said “well, let’s get the patient to the point where I can help you close him up. Let’s save this patient. You are probably the only person in this whole province who can perform this surgery. We will help you as much as we can.” They weren’t entirely sure how to finish for this patient but decided after looking at some textbooks that a loop colostomy may be a good approach (to keep both ends of the bowel open and see which is the proximal by which is active). However, there wasn’t enough free bowel to do it so she just made two stoma’s, to colostomies for the same reason as the loop.
After five hours we successfully closed up the patient. The patient remained stable throughout the surgery. Also the scrub nurse’s instrument count was incorrect, we were apparently missing two forceps. Everyone looked high and low and couldn’t find it. So we decided that we would have to x-ray the patient and make sure they weren’t inside and we determined that the first count was incorrect. There wasn’t any forceps detected on x-ray. As we were finishing up the surgery Joey and Owen brought us all pop bottles. It was very refreshing after five hours in the theater. We were all extremely grateful.//
Got up around 6:30am again to the roosters crowing. I took my malaria pill in my oatmeal and am now going to take it at breakfast. It was feeling quite chilly out this morning so I also had some hot cocoa. We walked over to the hospital at 7:30am. I did some of the rounds and then went to the antenatal clinic. I got to listen to a foetal heartbeat. I then returned to Kariba in time for tea. Afterwards, I assisted/did the plastering of a baby and a boy age 2 who had clubfeet and learned about that standard treatment (the Ponsetti method). JR then taught us about a minor surgery kit in the theater. It was then lunchtime and we were invited to Dorothy’s for lunch.
The Spiechingers, Dr. Rodney and Margaret, and Tiffany were all there as well. It was very tasty chicken, sweet potatoes, another root potato/veggie (Makaji, I think), and a mixed veggie dish. We returned home to relax for a while and took our luggage claim papers to Chris and he told us another possible Wi-Fi password to try. So we were finally able to connect to the outside world when the Wi-Fi password was correct. We sent messages to our families.
Tiffany then came by and told us the man from Chavuma had arrived that had a possible bowel obstruction and was going in for surgery after x-rays were taken. We went to assist/participate. It turns out he didn’t have a bowel obstruction but was dehydrated and his sugars were dropping. I assisted with Fiona to keep getting the ringers lactate fluids going in him and holding him down. I was also protecting the IV sites in his neck myself when JR had to leave for a moment. Later he started crashing when we moved him onto a bed off of the x-ray table. I watched as the team resuscitated him and gave him adrenaline and atropine. Nicole was in charge of the ambubag. He recovered and then later his heart rate dropped again and Fiona and I performed CPR, and they administered more atropine and adrenaline and for the second time he was brought back. This happened one more time. Then after further assessment he wasn’t moving much anymore or responding to painful stimuli, nor were his eyes constricting once exposed to the light. The next time his heart rate dropped and breathing was stopping Dr. Mwansa had already said we wouldn’t be giving any more drugs or CPR. JR called time of death. We did quite well in our first situation of performing CPR on an actual human being. We then cleaned him up, wrapped the body, and let the family mourn.
We headed home on the back of a four wheeler as it had gotten dark and we forgot our flashlights. We also missed the first night of the English meetings Gordon is having on the gospel of Luke due to all the excitement at the hospital. When we got to our house we ate some leftovers, debriefed about the experiences today and messaged home (I registered for my courses for next semester) and we had showers (Fiona desperately needed one as she had blood that sprayed on the top of her scrub shirt and probably on her neck/face, but you couldn’t tell). This was due to an IV issue with the patient. Now, to bed we go, tomorrow is a theatre day.//
We were able to sleep in a little bit this morning. Breaking of bread starts at 9am, so after getting ready we walked over to the church building at approximately 8:45am. We discovered two minutes later that we were in fact quite early for the meeting as there was no one else there. Slowly, people began to arrive. Dorothy Woodside walked over and informed us that people are slow to come, especially in the cold “winter” months and they are also on “Zambian time”. A man wrote down our names on a piece of paper and what assembly we were from as our letters were in our checked luggage that still have yet to arrive. (Chris informed us tonight that our luggage got to Lusaka and is ready for him to pick up). The service was mostly in Lunda and Luvale. When introduced we each had to stand up and the assembly clapped to welcome us. We sang along looking at the words in the hymn books that are two different languages. It helped that the songs were familiar tunes. The singing was wonderful despite a smaller turnout and people not arriving very quickly/on time. The ministry that was given was in Lunda, however, the brother thoughtfully translated to English as a summation of what he had been speaking about throughout his message. So we got to understand the gist of things. We also figured out what the words were over the pulpit at the front. “Yesu Kristu Diyi Mwanta” equals Jesus Christ is Lord, a child later in the day told us that mwanta means chief or Lord as we understood.
After breaking of bread there was approximately a five minute break and then the Gospel meeting commenced and the same brother also spoke a few summaries in English and spoke Lunda. We realized that several of the missionary nurses were not in attendance, only to discover when speaking with Allison that they were at theatre operating on someone with a bowel obstruction. We returned to our home and relaxed, read and enjoyed the sun.
We went to the church building again at 3pm to assist with Sunday school. Only no one who could speak the language to teach showed up. Only Margaret was there and many children. Instead, we sang some of the songs they have been learning in English and Nicole taught them a new version of Jesus loves me that has clapping and a part with “na na na” and then “whooo!” The kids thought it was so great and funny and they wanted to do it again and again. After singing for a while Margaret dismissed them and we started walking to our home, with a small posse of children following us and singing the new song. They followed us right to the door and we had to tell them to go home now.
We played games and then we went to the graves at sunset to take some pictures. Later on at 7:30pm Dorothy hosted the missionaries and us visitors for a little singing and she shared a few thoughts on the topic of the Lord meeting us. Chris gave us the Wi-Fi password so that we could finally send messages home. But it wasn’t correct. We then turned in for the night.//
This morning I woke up a little later (around 6:15am) although the roosters started around 4:00am but I was able to go back to sleep. It’s Saturday so we didn’t have to go to the hospital but we wanted to join JR on rounds. We completed rounds and performed some newborn checks. This is essentially a head-to-toe assessment on the baby before discharge. Also, Nicole and I cleaned the blood that had dried on a young man’s face in the emergency room. He had been in an accident the night before (he had been drunk and was driving a motorcycle with the nurse I had worked with the day before, Patrick, on the back) when they hit another young man on a bicycle). Everyone seems to be doing alright but they are wanting to monitor the driver of the motorbike in case he has a slow brain bleed. After we finished at the hospital (we also weighed a preemie and Fiona did a toe dressing change) we came back to our house and decided to relax and read our books and nap. We had our leftovers from the night before for our lunch and later Tiffany came by the house.
She took us down to the river where we walked along and I took pictures. She paid for the four of us to cross the river and back in a sort of dugout canoe/boat. We didn’t see any crocodiles, but it was an enjoyable ride – although the boat had a small leak so we took our shoes off and our feet got a bit wet during the crossing. I also forgot to mention, before Tiffany came, Fiona and I were sitting reading in the dining room when we heard a racket. We looked up and out the window and there was Thomas chasing a goat through our front yard! We had a good laugh and would have helped him, however he caught the goat fairly quickly.
On the return from the river, Tiffany pointed out this pepper bush that had lots of little red peppers growing on it. She said we should try one but Fiona said “NO” so we figured they must be hot. But Tiffany was asking again and I said I would if Fiona did but Fiona didn’t want to. Tiffany insisted she would eat it, so she popped one in her mouth. I figured I had said that I would and I knew it must be a sort of trick or at least it was going to be very hot. So I stuck to my word, I bit half of it and spit it out immediately. Tiffany had swallowed her’s whole. Apparently if you don’t break the skin it’s fine. The tip of my tongue and lips were very hot. My eyes started to water and I started to cough a few times. Tiffany felt bad/guilty afterwards and asked if I was all right. I was fine, I insisted, I just thought that some milk would help. Her and Fiona told me not to touch my eyes, whatever I do. I didn’t touch them. It was very hot but since it was only the tip of my tongue and lips, it wasn’t too bad. My eyes and nose just watered a bit and when we got back to the house I had some milk and water and that helped. Next we went on to the market to explore (some locals, we noticed pulled out their phones, if they had them, and seemed to take our picture, ha ha!) Tiffany also bought us this deep fried bread (tasted much like a doughnut) it was delicious. We made a pork loin dinner with potatoes and carrots for supper. Then continued our routine of playing games and reading for a while. Tomorrow the meeting is at 9:00am so we can sleep in a bit.//
We woke up at 6:00am this morning to our phone alarms as well as the roosters crowing around the mission. It was a bit difficult to climb out of bed as the bed was warm and the house was quite chilly. We had a breakfast of scrambled eggs and toast. We walked up the path to Kariba (the main hospital) where the work day (day shift, known as shift A) starts at 7:00am. We met the health care team and everyone was very welcoming and quick to greet us and give us a warm welcome. We were given a tour, although immediately in the morning the doctor and missionary nurses were discussing troubling news received about another doctor at a different mission station who died suddenly. We attended ward rounds with the team and met all the patients currently at Kariba.
There were many different cases, diseases, and types of patients across the 4 wards (Men’s, Women’s Children’s, Labour and Delivery) and the ICU and Emergency room. There are many differences comparing it to my clinical experiences in Canada. JR is a nurse and midwife (the locals call the nurses here “sister”) she is very knowledgeable and asked us what we haven’t done and what we want to build our confidence in, she is being very accommodating and showing us many things. Fiona was with her in the theatre (what the operating room is known as here, it’s a British term). Fiona was able to insert an NG tube, put casts on a child with club feet and give an enema. I was with Dr. Mwansa observing clinic and I was able to see a great many clients and cases as well as some diagnostic tests. TB, malaria, HIV, varices, fractures, eye issues and maternity issues seem to be the most common diagnoses.
Also, a regular routine is that we break for tea in the “tea room” around 10:00am each weekday at the hospital. We were invited to Kate and Joey’s house for lunch with Dr. Mwansa. We had sandwiches and potato wedges and we met their little boy, Owen. He was adorable and attempting to blow bubbles, hahaha! We finished the day when we were done seeing the people who were outside the clinic.
We then walked to Tiffany’s house where she let us borrow some clothes (Kate also brought us some things after lunch). We returned to the Annex and set about enjoying the sun on our back porch for a while and waving at some children across the yard. We started on figuring out what to have for supper. We didn’t plan ahead and therefore didn’t thaw any meat. Nicole came up with the idea of a macaroni casserole with tuna. While making supper the children knocked on our door and we introduced ourselves and they told us their names. They hung around the window watching for a while and finally said, “goodbye, see you tomorrow.” Our house’s caretaker, Thomas, watches the house as well as cleans and does other chores for a steady job provided by the mission. Thomas is supposed to keep the mischievous and curious children away from visitors as well, hahaha. I nearly forgot about my malaria med and since I don’t have my applesauce from my checked luggage I added it to a bit of casserole crushed and managed to get it down along with some fresh oranges that Ruth brought over for us to combat the taste, it was a struggle to get it down. After supper the 3 of us played some games in our living room and then went to bed around 10:00pm//
WELCOME and thanks for joining me! My first series of posts are about my trip to Chitokoloki, Zambia.
I hope you enjoy reading about my adventures! I documented daily in my “travel journal” and now I have decided that I want to make my stories available and share with you my unforgettable experiences!
We endured the long 11 hour flight from London to Johannesburg. Mind you, we all weren’t that comfortable after sitting for so long and we never really got a good sleep. The delay caused us to only have approximately 45 minutes to get to our next flight, this one was going to Lusaka, the capital city of Zambia. We made it just as they were finishing boarding (we were the last ones to board). When we went through security prior to getting to the gate Nicole had half of a water bottle full. The lady asked her to get rid of it and since there was nowhere to pour the water down a drain the lady insisted she drink it. Nicole, being a real trouper chugged the water down which made the lady finally crack a smile and a fellow passenger behind us related to Nicole’s predicament saying he has had to do that exact same thing before. When we were riding the bus across the tarmac to board we met a girl named Ellie from the Chicago area who was also helping a missionary couple in Zambia. Fiona actually knew who that couple was from her past when living in Zambia when she was younger. So Fiona and Ellie were able to talk. The flight to Zambia from South Africa was a relatively uneventful 3 hours.
Upon arrival in the Zambian capital we had to wait quite awhile in line to purchase our visas and when we finally got through to the baggage area we discovered that our checked baggage had not made it. This was probably due to the delayed flight causing the short time between our next connecting flight in South Africa. We met Chris there and he led us out to his small 6 passenger Cessna plane.
At the beginning of the flight Nicole and I weren’t feeling very well so I suggested that we sleep. I had to try mouthing the words first and then ended up writing a note on my phone and showing Nicole what I was trying to say. Chris had apologized earlier that when he cleaned the plane recently he had forgotten to return the headphones/ear protection for the passengers. That’s why it was so difficult to communicate, the motor was very noisy so we couldn’t talk and therefore having cat naps along the way helped pass the time and helped us feel better. We weren’t missing much by napping as the scenery was very much the same for the 3 hours. Green African bush below and the occasional river winding its way through the landscape. Pillars of smoke broke the horizon occasionally where people were burning brush as they often do in the cold season.
After another nearly 3 hour flight the landing strip at Chitokoloki along the Zambezi river came into view. Chris put us down very nicely and all 3 of us were grateful to be on solid ground and at our destination with no more flying to be done. The Hanna’s met us at the hangar, as did Alison, Chris’s wife. They had gotten us lots of groceries and brought us to our house (known as the Annex) at the end of the road where the missionaries’ houses are located (of which, many of the missionaries are away).
Our house “The Annex”
We unpacked what we had in our carry-ons and our groceries and then went to the Hanna’s for supper. We walked down the path/road by the light of our flashlights on our phones because it had become dark very quickly and you have to watch where you walk, especially at night, so that you don’t step on a snake. We had a nice supper and had a visit in front of the fire afterwards. Us girls were able to send a quick email to our families to let them know we arrived safely from Gordon’s iPad. We then returned to our house, we decided to do some laundry as we were in desperate need and I now had a chitengi from Ruth that I would be wearing the next day. All of my skirts/dresses are in my checked luggage. The plan for tomorrow is to walk up to the hospital (specifically Kariba) and see what the doctors and nurses will have us do and tour the hospital and see how things run for our first day. Hopefully Chris will bring back our luggage on Tuesday when he is next in Lusaka. I have to admit, I’m pretty nervous about how everything will go and if I will like it here. This will be my life for the next 5 weeks!//
It’s nearing the end of our first travel day, destination: Chitokoloki, Zambia. I started off yesterday from home in Englehart, Ontario. Dad drove me the 5 ½ hours to Newmarket to stay with Heidi and Oliver for the afternoon because Dad had to get back home in a decent time. This was so that he could get up for work early the next morning and my flight wasn’t leaving until 11:00pm. Heidi kindly offered to take me to the airport from her place. So I spent a few hours with them, Ollie was a bit fussy (or a “grumpus” as Heidi referred to him) but still extremely cute! Heidi and I decided to make stewed rhubarb and strawberries for the first time. We were unsure what the exact amounts were for the recipe. I texted Mum and she replied, “I just add enough strawberries until the colour looks right.” Well, I guess it’s not an exact science but something you inherently know… Heidi ended up creating a delicious stewed rhubarb sauce, although a little soupier looking than normal. We happily had the sauce on vanilla ice cream for dessert. This was how I was able to swallow (rather, ingest, as I actually had to crush) my first malaria pill.
I then met up with Fiona and Nicole and found them quite easily when I entered the Terminal at Pearson International Airport in Toronto. We breezed through security and got settled at the gate. We made sure to take pictures, we had all been instructed by numerous people to properly document our trip. We didn’t care that we were acting like giddy young girls like it was our first time travelling. In some ways it was a first for us. It was Nicole’s first flight of any kind, crazy right? Her first flight is a 7 hour trip to London, England! It was my first time travelling to a different continent (Europe and Africa), and it was Fiona’s first time travelling without her family. Off we flew in the British Airways plane, it was massive! We flew overnight and with the time change we arrived 10:00am London time. During the flight we marvelled when the cabin crew offered us a supper meal at 12:00pm our time (EST) and 5:00am London time. We were thoroughly confused by this midnight “snack”. Fiona was quite dazed as she had been awaken out of a somewhat restful sleep. Overall, we had a safe first flight.
From left to right: Fiona, Cassandra (Me), and Nicole
We arrived at the Heathrow airport and went about purchasing tickets on the Heathrow Express train so as to reach central London as quickly as possible. We got to Paddington Station around 11:30am and made our way down the street to find the nearest Golden Trails bus office to redeem our tickets that we purchased online the evening before at Pearson. But when we got to the office we waited at least a half hour while another customer was arguing about the prices of the different tours they were interested in. Nicole thought it was strange that some people thought the prices were negotiable (she wondered aloud passive aggressively to no avail). Therefore, our frustration was evident as they finally concluded their conversation and we had watched our precious time tick away. After all was said and done at the bus office we were waiting for what felt like nearly an hour for the Golden Trails Hop-on-Hop-off bus to come to our stop. We were stuck spending the time people watching and taking in the sights and sound of a congested London street. We were thankful though in that moment. Thankful for a beautiful sunny warm day (20°C) with a wonderful early summer breeze. Despite the obstacles we were in high spirits once again and we thoroughly enjoyed our whirlwind tour of London on the top of the double decker Hop-on-Hop-off bus. We took lots of pictures and soaked in the sun, however, we didn’t quite have enough time to get off and visit the sites. We made sure to take pictures in front of the red phone booths that are nearly on every corner. They are so iconic we couldn’t pass up the opportunity, because did you even visit London if you didn’t take a picture in front of a red phone booth? We also JUST missed seeing Buckingham Palace (we were being responsible and had to return to the airport to make our next flight).
St. Pancras Hotel & Train StationSt. Paul’s CathedralTower BridgeWestminster AbbeyIntroducing: NICOLEIntroducing: CASSANDRAIntroducing: FIONAThe Royal ExchangeGlimpse of the London Eye
On the return to the Heathrow airport we took the cheaper way (6£) via the underground tube. We actually managed to navigate the known to be confusing underground train lines. We left Victoria station and transferred to Piccadilly Line at South Kensington station and took it all the way to terminal 5 at Heathrow. Once there we went through security once again. Other than forgetting to empty my water bottle we had no issues. However, Nicole discovered after we had picked up our carry-on bags we had left at a locker to keep for us while we toured London that she was missing her phone! So she went to customer services and only received minimal assistance to locate it. So they left her with a number to call later to check if they found it and a web address to fill out a form describing the lost item. We then went to get something to eat which ended up being food from an airport store. We each had a chicken tikka wrap and agreed that it was delicious and I think we were so hungry that nearly anything would have appealed to us so at least it was something of substance. Once the gate was announced for our connecting flight we made our way there. Later, it was revealed that our flight was going to be delayed 2 hours. That made us worry that we would miss the next connecting flight. //
P.S. On the tube during the journey back it was sweltering and we were hungry and tired. So much so that Nicole kindly shared her Clif bar (it was the only food that we had between the 3 of us). By “sharing” I mean that what we did was Nicole took a bite of her bar, passed it to Fiona who took a bite, and then passed the bar to me and I took a bite and so on until it was finished. We got some strange looks from people but we didn’t care, we were desperate.
Adventure Is Out There 