Settling in

Hello again friends and family,
Things here are going great- sorry for the whining about the birthday last time (but thanks for all the subsequent e-mails!). Work continues to be very busy and I’m learning a ton- both about diseases I’ve never seen before and managing with minimal resources. I was feeling a bit like a shadowing med student at first in this new environment but finally am starting to feel at least a little bit functional. Dr Johnson and I have about 40 patients on the wards (10 kids, 5-10 women and about 25 men). A typical day is that I show up and make quick rounds in the male, female and children’s wards, mostly just to check if there are any new crises or new admissions we didn’t hear about at night. Next is the “theatre” (what they call the operating room) where we do a mix of basic stuff from reducing and casting the many kids who fall out of trees and draining abscesses to larger procedures like bowel resections. As a sample, the cases in the last 3 days included a dental extraction and partial mandible resection in a girl with a tumor the size of a grapefruit in her jaw, fixing a little boy’s urethra after it was torn by having a ring stuck on his penis for several days (we couldn’t quite get a straight story on how that happened), draining a leg wound of a girl with TB osteomyelitis, resecting a sigmoid volvulus and numerous adult circumcisions. I tend to prefer the quick cases over the big ones- I guess there is a reason I picked Emergency Medicine.
Theatre is scheduled to go until about noon daily but we have yet to stop before about 13:30. Usually around this time someone will arrive after a 6 hour bus ride from their village in pretty bad shape. Today the sick new one was a 9 year old boy with AIDS, TB, renal failure and a bowel obstruction. He is probably the sickest pt I’ve seen here so far and it is pretty sad seeing a child with end stage AIDS. We saw as many as we could of the 30-50 patients waiting to be seen for clinic (“review” as it is called here if they have been seen before) while the theatre got ready to take the new boy. After the emergency case(s) we see the leftover folks from clinic who have waited around since 8 am and then round on the wards. Needless to say, the amount of documentation is a bit more scant here than at home given the amount of people to be seen (and absence of significant medical-legal paranoia).

Ok, enough work talk- I know all you non-medical people are thoroughly bored and at least my roommate Nora is probably trying not to vomit. What non-medical adventures? I made my first trip into town yesterday. We miraculously finished before it was dark out so I went to go check out the market and town (i.e. three block strip with shops on it). The market was mix of booths with stuff like foot long knives and hair scrunchies, an obvious combination, to tomatoes, grilled maize and enormous piles of my favorite tiny dried fish. It was weird being in a really crowded area after just spending time in the hospital and my quiet residential area. Everyone calls me Madame which I find amusing. I keep finding myself in a bit of a dilemma because I probably know 3 people’s names other than Dr Johnson. a) they get introduced as Mr or Mrs 5 syllable last name I’ve never heard before which I immediately forget and feel increasingly dumb when they repeat it and I still have no idea how to say it b) I met about 75 people my first 2 days when I was a jetlagged zombie and now they remember me but I have no idea who they are c) Zambians are super friendly and may talk to you like they know you even when they don’t. Yesterday on my walk 4 different people who looked vaguely familiar came up to me and said “Hello Dr Clark/Melissa- how are you?”. All of this has left me a little confused and waiting for the inevitable embarrassing moment when it is clear that I have no idea what the names are of the people I talk to 10 times daily.

The neighborhood kids continue to crack me up. When I got home last night from the market there were about 30 of them outside of my lodge. I thought it was a different place than usual for them to play but didn’t think much of it. We did our usual round of “hello”’s and “how are you”’s (that’s the extent of most of their English…my inability to speak Chitonga is a whole other story) and I walked for the door. They didn’t look quite satisfied but we had done the “how are you” refrain about 10 times each and my dinner was waiting inside. Finally as I was just stepping in the gate one of the older boys yelled “Photo!” and they all started squealing. A toddler mosh pit ensued as they all fought to be in front for the next 75 pictures you poor souls have to sit through when I get home.

Adios (perhaps by next time I'll be able to say good bye in chitonga)