I may have mentioned before that things move fairly slowly here. When I first travelled from Lusaka up to Katete I had bought myself a ticket for the ‘7 o’clock’ bus. Arriving at half six I loaded my bags, the engine was running already, bus two thirds full, happy days I thought the seven hour journey will begin on time. Of course not. Over the next few hours I sat impatiently, the engine kept running, various people got on and off the bus, hawkers selling air time, biscuits, torches even wigs. From time to time the driver would rev up as if to move, but no. Workers from the bus company hassled any intending traveller trying to get their custom and not loose out passenger to rival bus companies.
At about half ten the bus was full and it left. For the three and a half hours waiting in the hell that is Lusaka inter-city bus terminal I fidgeted, looked at my watch frequently, got up several times to look around for signs of movement. I was the only white person on the bus and also the only one impatient for its departure. The Zambian people sat patiently just letting the time pass.
It is a Sunday afternoon working in the hospital and I stop for a moment to look around the ward. Yeah there were thirty sick patients there but the place is a sea of tranquillity. Most of the patients are lying on their beds. Each bed had a bedsider, a relative staying with the patient to provide care including changing, washing and giving oral medications. Looking through the ward all of the bedsiders and the patients are just sitting there waiting patiently, just like the people on the bus.
Trying to compare to similar experience at home I couldn’t see any relatives just sitting by the bedside waiting and waiting. Remembering Sunday’s in Castlebar hospital the relatives might by watching the TV seeing Mayo loose in Croke Park again, or reading a newspaper or magazine. There is no TV on the ward here and nobody is reading. I can’t help wondering what are they thinking about, what is going through their minds. I try to find out from some of the patients and bedsiders that speak English. There isn’t anyone about to translate and my Chewa doesn’t extend beyond medical terms.
Kenny has been in hospital for about a week. He has renal failure either due to sepsis from his pneumonia, his HIV meds or recent treatment with gentamicin from a rural health centre. Unfortunately I can’t offer him dialysis so all I can do is stop his HIV meds and hope his renal function improves. He says he passes the time talking to his wife who is by his bedside, usually about their children who are at home. ‘I am always encouraging them to be strong and to be realistic in everything that, one must be convinced in mind to say I am sick’ Kenny says. His wife explains that she just spends the time nursing her husband, she needs nothing else to occupy her mind. Kenny adds that when he is awake they chat and crack some jokes.
Meck has very little English but explains his main thoughts is fear of relapse of nose bleeds which have been cauterised a few days ago (medically it is the least of his worries). He inquires what my name is, in the hecticness of the past few days I obliviously haven’t formally introduces myself to him. He then adds that he wants to go home and see his children.
Further up the ward Edison’s dad sits by his bedside. Edison is 19, has just been diagnosed HIV positive, has a pathetically low CD4 count of 3 and is also in renal failure. His dad has really good English. He says he feels sick himself at present and spends some time thinking about that ‘otherwise I think about the young boy, most of the time when I am here I consult the bible and read and get courage out of the readings’. He stays each night in a boarding house next to the hospital while his sister sleeps on the floor beside Edison.
He likes the boarding house, fifteen to twenty people are staying there ‘the place is good, we always take prayers there’. He swaps shifts with his sister at visiting times, that is six in the morning and half past four in the afternoon. What does his sister do during the day time? ‘She goes back to prepare some breakfast, she remains there washing clothes for Edison, doing other things’. He explains that his wife is at home with their six other children and he thinks also of them. He thinks especially of Edison’s twin brother who is well ‘but right now he can’t go to school as I am here and need some money so I can’t afford the fees’.
I commend him on his English and enquire did he acquire this through his work. I expect him to say he has some government job or has worked in the mines or Lusaka. ‘I am just a peasant farmer, I got my education before this modern education’. I ask him how he feels about Edison’ illness ‘I don’t feel right, I can accept it because he is a human being and my son, I can not decide how he might have got that illness’.
Some of the patients and bedsiders are outside sunning themselves. I find Frank stretched out on the ground. He was just admitted today, diagnosed with HIV yesterday. The lumbar puncture I have done today has found Cryptococcal meningitis a serious opportunistic infection found in advanced HIV. ‘I feel better’ he says looking relaxed and at ease.
Samuel’s mother is outside also. He has been admitted quite sick with diarrhoea and vomiting. He was in hospital in January, was diagnosed with HIV then but didn’t attend for follow up and has not been taking treatment. Samuel is among those men that present here like images from a live aid video, gaunt with sunken cheeks, wasting away. His mother is an upbeat and resourceful woman. She doesn’t leave the hospital instead she gets food here and does the washing in the bathroom. She says the bedsiders pass their time discussing patient’s conditions. ‘We encourage each other, encourage them (other relatives) not to feel lonely in the hospital’
Perhaps it is this positive attitude and outlook to life that allows people here to remain so patient, knowing things will happen when they will and that not everything is under their control be it what time the bus will depart or when or if their loved ones will get better.
Sunday, September 19, 2010
Sunday, September 5, 2010
The Big Smoke
Having been working hard for the last couple of months and given some new Doctors have arrived from the UK I decided to take a few days off. First thing to do was go down to Lusaka to pick up my work permit. Like everything else here the process of getting this has moved slowly. Many months ago a whole multitude of forms were sent to the Zambian Medical Council (including a translation of my degree from Latin to English). Only once registered with them could a work permit be applied for.
The head office of the department of immigration is in a leafy relatively affluent area of Lusaka. Inside it looks like any public service building at home, various desks computers and large numbers off staff who appear to be doing very little. Despite all the computers I have to check myself through various hand written books to see if the permit is ready. On seeing that it is I am passed through various desks until I find the one from which to pick it up, most of the staff are sitting down looking around or taking calls on their mobiles. Anyways I get the permit go to a further desk to get my passport stamp and get out of there.
I have travelled the five hours to Lusaka with some others from St Francis. Sabina a Swedish nurse who has been here for a few months and is going to spend some time in an orphanage in the Copper belt and a Canadian couple Steph who is a nurse here in St Francis and Ben who is on a placement in Katete from Engineers without borders. We decide to go to a movie that evening.
While lots of people in Lusaka live in poverty there is wealth here, a couple of shopping centres similar to what we have at home and a cinema. The entry fee of K14,000 (about €2.40) is cheap compared to home but beyond the reach of the vast majority of Zambians. It is nice to see a movie and relax but several times the surreal-ness of the previous day being working in an isolated hospital and now being in a fancy modern cinema hits me.
There isn’t a lot to do in Lusaka so having completed our business we leave the next day. I have a couple of more days off and hit to Malawi. Whilst most people might go to Malawi to relax by the lake, swim or dive, my interest is in seeing Lilongwe’s famous tobacco auction floors. Malawi’s capital is considerably smaller than Lusaka but is a much shorter distance from Katete even allowing crossing the border and temporarily importing the car (I discover on the way back I should have temporarily exported it from Zambia, but this offence is overlooked on showing my newly acquired work permit and mentioning I work in St Francis).
The public are allowed to come see the tobacco auctions by appointment. I have arranged to get a tour at 9 am and after much getting lost in Lilongwe’s industrial area arrive about ten past and subsequently have to wait around, African style, for an hour and a half. Ronald from the communications department is going to show me around. He a short man, very neatly dressed friendly and cordial. He explains we have little time as he is busy preparing for a launch the following day of a company wide HIV/AIDS policy. There is a certain irony in a company involved in the business of selling carcinogenic tobacco taking an interest in their employee’s health but it is encouraging in many ways.
Ronald leads me onto the floors. We walk past a sign stating ‘To all our Customers, Please do not bribe our members of staff: It is unnecessary, It is Costly, It is evil’. We enter a massive shed the size of several playing pitches, there are bales of tobacco over the entire area and the whole place is a frantic hive of activity, people are hurrying here and there, buyers inspecting bags of tobacco, workers literally running with barrows bring new 200kg bales onto the floor. It is an impressive sight all the more so because all the people here are African, this is not some white dominated industry or a remnant of colonial times, it is indigenous commerce.
Ronald explains that in all ‘Auction Holdings Limited’ the company which runs the floors employs 4,000 people. The company is 42% government owned with the remainder in private ownership. The government he explains are keen to protect and promote the industry which accounts for 70% of Malawi’s foreign exports and 15% of its GDP.
The auctioneer proceeds along the rows of tobacco at an alarming pace selling each bale. He chants out words and prices at an incomprehensible speed, someone behind him takes note of the ticket on the bale and the buyer. About 10,000 bales are sold each day
I am interested to know who is buying and selling the tobacco. ‘80% comes from small farmers who produce 5-10 bales per year and can expect to get about $200 per bale’ outlines Ronald. The small farmers don’t come to Lilongwe to sell the tobacco themselves but instead sell to agents who then bring the tobacco to the auction. There are only five buyers, representatives from tobacco companies here in Malawi. These buy the dried leaf from the floors, process it and then export it to tobacco companies in China, the US and Europe where it is made into Cigarettes and other tobacco products. A few more steps along the chain someone in Ireland is forking out whatever it is, over eight euro for a pack of fags.
I guess the average smoker at home is spending about €3000 per year if smoking twenty per day. The tobacco farmer in Malawi has to survive on $1000-$2000 per year to support him and his family. I am unsure on the maths as to how many smokers’ habits his 1000-2000kg of tobacco feeds. It’s hard to know what view to take on this industry. On the one hand it provides valuable employment and capital into the country from export revenue. On the other hand tobacco is a harmful product the health effects of which I see everyday when working in General Practice at home. In addition there are reports of child labour in Malawi’s tobacco industry.
Perhaps the mission statement in Auction Holdings Limited reception sums up my confused thoughts on it ‘To play a leading role in improving and managing the best systems for handling and marketing tobacco and other products and services which are user friendly, fair and provide value to shareholders and other stakeholders.’
The head office of the department of immigration is in a leafy relatively affluent area of Lusaka. Inside it looks like any public service building at home, various desks computers and large numbers off staff who appear to be doing very little. Despite all the computers I have to check myself through various hand written books to see if the permit is ready. On seeing that it is I am passed through various desks until I find the one from which to pick it up, most of the staff are sitting down looking around or taking calls on their mobiles. Anyways I get the permit go to a further desk to get my passport stamp and get out of there.
I have travelled the five hours to Lusaka with some others from St Francis. Sabina a Swedish nurse who has been here for a few months and is going to spend some time in an orphanage in the Copper belt and a Canadian couple Steph who is a nurse here in St Francis and Ben who is on a placement in Katete from Engineers without borders. We decide to go to a movie that evening.
While lots of people in Lusaka live in poverty there is wealth here, a couple of shopping centres similar to what we have at home and a cinema. The entry fee of K14,000 (about €2.40) is cheap compared to home but beyond the reach of the vast majority of Zambians. It is nice to see a movie and relax but several times the surreal-ness of the previous day being working in an isolated hospital and now being in a fancy modern cinema hits me.
There isn’t a lot to do in Lusaka so having completed our business we leave the next day. I have a couple of more days off and hit to Malawi. Whilst most people might go to Malawi to relax by the lake, swim or dive, my interest is in seeing Lilongwe’s famous tobacco auction floors. Malawi’s capital is considerably smaller than Lusaka but is a much shorter distance from Katete even allowing crossing the border and temporarily importing the car (I discover on the way back I should have temporarily exported it from Zambia, but this offence is overlooked on showing my newly acquired work permit and mentioning I work in St Francis).
The public are allowed to come see the tobacco auctions by appointment. I have arranged to get a tour at 9 am and after much getting lost in Lilongwe’s industrial area arrive about ten past and subsequently have to wait around, African style, for an hour and a half. Ronald from the communications department is going to show me around. He a short man, very neatly dressed friendly and cordial. He explains we have little time as he is busy preparing for a launch the following day of a company wide HIV/AIDS policy. There is a certain irony in a company involved in the business of selling carcinogenic tobacco taking an interest in their employee’s health but it is encouraging in many ways.
Ronald leads me onto the floors. We walk past a sign stating ‘To all our Customers, Please do not bribe our members of staff: It is unnecessary, It is Costly, It is evil’. We enter a massive shed the size of several playing pitches, there are bales of tobacco over the entire area and the whole place is a frantic hive of activity, people are hurrying here and there, buyers inspecting bags of tobacco, workers literally running with barrows bring new 200kg bales onto the floor. It is an impressive sight all the more so because all the people here are African, this is not some white dominated industry or a remnant of colonial times, it is indigenous commerce.
Ronald explains that in all ‘Auction Holdings Limited’ the company which runs the floors employs 4,000 people. The company is 42% government owned with the remainder in private ownership. The government he explains are keen to protect and promote the industry which accounts for 70% of Malawi’s foreign exports and 15% of its GDP.
The auctioneer proceeds along the rows of tobacco at an alarming pace selling each bale. He chants out words and prices at an incomprehensible speed, someone behind him takes note of the ticket on the bale and the buyer. About 10,000 bales are sold each day
I am interested to know who is buying and selling the tobacco. ‘80% comes from small farmers who produce 5-10 bales per year and can expect to get about $200 per bale’ outlines Ronald. The small farmers don’t come to Lilongwe to sell the tobacco themselves but instead sell to agents who then bring the tobacco to the auction. There are only five buyers, representatives from tobacco companies here in Malawi. These buy the dried leaf from the floors, process it and then export it to tobacco companies in China, the US and Europe where it is made into Cigarettes and other tobacco products. A few more steps along the chain someone in Ireland is forking out whatever it is, over eight euro for a pack of fags.
I guess the average smoker at home is spending about €3000 per year if smoking twenty per day. The tobacco farmer in Malawi has to survive on $1000-$2000 per year to support him and his family. I am unsure on the maths as to how many smokers’ habits his 1000-2000kg of tobacco feeds. It’s hard to know what view to take on this industry. On the one hand it provides valuable employment and capital into the country from export revenue. On the other hand tobacco is a harmful product the health effects of which I see everyday when working in General Practice at home. In addition there are reports of child labour in Malawi’s tobacco industry.
Perhaps the mission statement in Auction Holdings Limited reception sums up my confused thoughts on it ‘To play a leading role in improving and managing the best systems for handling and marketing tobacco and other products and services which are user friendly, fair and provide value to shareholders and other stakeholders.’
Wednesday, September 1, 2010
Kulamba
While working in Geriatrics at home I once commented to a colleague how our image of elderly people was quite skewed. From experience there I sometimes thought all elderly people were ill, suffering from various degrees of poor mobility and dementia and needed high levels of care. Only when working in General Practice did I get to see that the majority of elderly people lived quite healthy and independent lives and continued to make a valuable contribution to society.
Occasionally here in Zambia after long hours and days on end working I get a similar view of the people. It comes to seem to me that all Zambian children are malnourished or currently seriously ill with malaria and that all Zambian adults are suffering from TB or some HIV related illness and that most will die before forty. In reality thankfully most Zambian children whilst underprivileged by our standards are well nourished and many have the opportunity to go to school. Most Zambian adults are not HIV positive, have jobs, families, relationships and interests.
Time spent away from the hospital on weekends off helps give me a fresh perspective of life in Zambia, gives me an opportunity to see the beautiful countryside and to experience local culture. The people of this part of Eastern Zambia mainly belong to the Chewa tribe. National borders in Africa were mainly decided by European colonists so the Chewa people occupy much of Malawi, the Eastern part of Zambia and northern Mozambique. Every year in August they hold a thanksgiving ceremony called Kulamba (worship) close to Katete.
One of the nurses from St Augustine, John Banda (the quintessential Chewa name) takes a group of us along to the last day of the four day festival. The overall set up reminds me most of the ploughing championship at home. It’s down a dusty (rather than muddy road) there is lots of traffic, throngs of people are coming and going and there are all manner of stalls and hawkers pedaling their wares. The centre-point of the festivities is however quite a bit more entertaining than comparing one furrow to another.
In the middle of the area there is a raised circular platform for dancing and entertainment to take place. Overlooking and right beside this is a thatched shelter housing the Undi Paramount Chief of the Chewa people on his throne. Next prime viewing position goes to a viewing stand containing dignitaries including the president of Zambia. The general public are formed in a circle around, those at the front sitting, more standing towards the back other further back perched on trees to get a good vantage point of proceedings.
When we arrive the colour of our skin pretty much guarantees us front row seat and our cameras get us into the press area right beside the chief’s throne. Various people are introduced from each of the three countries of Malawi, Mozambique and Zambia. These then proceed to the chief with all manners of gifts in thanksgiving to him including several mattresses, a chest freezer and a washer dryer interspersed among many wrapped unidentifiable objects. The gifts are given as a form of worship to the chief
The chief is sitting on his throne (an armchair like one from your grandmother’s living room) receiving these items. He is surrounded by ivory and a leopard and lion skin, though I am unsure these are real. Several men in brightly coloured dress carrying bows and arrows surround him, John explains these are the subordinate chiefs.
After each presentation of gifts, there is dancing. Many of the dancers are people (or two together) dressed in the form of an animal and believed to be transformed into such for the festival. John explains this is called the Nyao and that nobody is to know who these people really are or to disclose their identity. People who perform the Nyao are taken out into the bush for two months initiation and training by elders. John tells me later that previously almost every male Chewa had to undergo that initiation before they got married. Others dance with fire or are dancing up along tall poles, it is an amazing spectacle.
The whole experience is a fascinating mix of traditional culture and the modern commerce required to support such festivals. Despite the fact the signal is fairly rubbish here both the major mobile phone operators are out in force as are the banks. Outside that there is of course the mass commerce of food stalls, clothes sellers and just like festivals back home alcohol. Indeed the main sponsor of the event is Chibuku. This is a cloudy beer (called shake-shake) sold in milk carton type containers that is extremely popular. Whilst it’s advertising slogan promotes ‘taste the goodness’ my main encounter with it is in frequent alcohol related medical problems such as liver disease (again much like home).
Front row seats guarantee photoparama for us. In typical Zambian fashion at one point we are told not to be taking photos unless we fork out for an official press pass and then a couple of seconds later one of our groups request to meet the president is enthusiastically granted. We file up to meet ‘His Excellency’ Rupiah Banda (himself a Chewa, from this area and extremely popular here).
We get a brief handshake the chance to say where we are from, I utter something ridiculous like ‘I am from Ireland our countries are great friends’. Sadly we don’t get a photo op nor do I get the opportunity to ask him what kind of a country is he running that we often have no blood supply for several days or that the country ‘ran out’ of Insulin a few weeks back or why aid agencies withdrew hundreds of millions in assistance due to fears of irregularities in the department of health or for that matter why is it taking so long to process my work permit. Nonetheless it is of course a great honour to meet him before he leaves in his motor cavalcade.
It was strange to see the president being subordinate to the chief at the event and while he was being whisked away back to Lusaka I was comforted to think that the Undi Paramount chief would be staying locally providing community leadership. Not so unfortunately. John explains that the chief lives in Lusaka and because of this ‘is not nicely connected with the people, I think it would be better if he stayed in the area’. Whilst political leadership in Zambia often serves self interest it is truly heartening to see and experience the richness of the local culture and the pride the people have in that culture.
Occasionally here in Zambia after long hours and days on end working I get a similar view of the people. It comes to seem to me that all Zambian children are malnourished or currently seriously ill with malaria and that all Zambian adults are suffering from TB or some HIV related illness and that most will die before forty. In reality thankfully most Zambian children whilst underprivileged by our standards are well nourished and many have the opportunity to go to school. Most Zambian adults are not HIV positive, have jobs, families, relationships and interests.
Time spent away from the hospital on weekends off helps give me a fresh perspective of life in Zambia, gives me an opportunity to see the beautiful countryside and to experience local culture. The people of this part of Eastern Zambia mainly belong to the Chewa tribe. National borders in Africa were mainly decided by European colonists so the Chewa people occupy much of Malawi, the Eastern part of Zambia and northern Mozambique. Every year in August they hold a thanksgiving ceremony called Kulamba (worship) close to Katete.
One of the nurses from St Augustine, John Banda (the quintessential Chewa name) takes a group of us along to the last day of the four day festival. The overall set up reminds me most of the ploughing championship at home. It’s down a dusty (rather than muddy road) there is lots of traffic, throngs of people are coming and going and there are all manner of stalls and hawkers pedaling their wares. The centre-point of the festivities is however quite a bit more entertaining than comparing one furrow to another.
In the middle of the area there is a raised circular platform for dancing and entertainment to take place. Overlooking and right beside this is a thatched shelter housing the Undi Paramount Chief of the Chewa people on his throne. Next prime viewing position goes to a viewing stand containing dignitaries including the president of Zambia. The general public are formed in a circle around, those at the front sitting, more standing towards the back other further back perched on trees to get a good vantage point of proceedings.
When we arrive the colour of our skin pretty much guarantees us front row seat and our cameras get us into the press area right beside the chief’s throne. Various people are introduced from each of the three countries of Malawi, Mozambique and Zambia. These then proceed to the chief with all manners of gifts in thanksgiving to him including several mattresses, a chest freezer and a washer dryer interspersed among many wrapped unidentifiable objects. The gifts are given as a form of worship to the chief
The chief is sitting on his throne (an armchair like one from your grandmother’s living room) receiving these items. He is surrounded by ivory and a leopard and lion skin, though I am unsure these are real. Several men in brightly coloured dress carrying bows and arrows surround him, John explains these are the subordinate chiefs.
After each presentation of gifts, there is dancing. Many of the dancers are people (or two together) dressed in the form of an animal and believed to be transformed into such for the festival. John explains this is called the Nyao and that nobody is to know who these people really are or to disclose their identity. People who perform the Nyao are taken out into the bush for two months initiation and training by elders. John tells me later that previously almost every male Chewa had to undergo that initiation before they got married. Others dance with fire or are dancing up along tall poles, it is an amazing spectacle.
The whole experience is a fascinating mix of traditional culture and the modern commerce required to support such festivals. Despite the fact the signal is fairly rubbish here both the major mobile phone operators are out in force as are the banks. Outside that there is of course the mass commerce of food stalls, clothes sellers and just like festivals back home alcohol. Indeed the main sponsor of the event is Chibuku. This is a cloudy beer (called shake-shake) sold in milk carton type containers that is extremely popular. Whilst it’s advertising slogan promotes ‘taste the goodness’ my main encounter with it is in frequent alcohol related medical problems such as liver disease (again much like home).
Front row seats guarantee photoparama for us. In typical Zambian fashion at one point we are told not to be taking photos unless we fork out for an official press pass and then a couple of seconds later one of our groups request to meet the president is enthusiastically granted. We file up to meet ‘His Excellency’ Rupiah Banda (himself a Chewa, from this area and extremely popular here).
We get a brief handshake the chance to say where we are from, I utter something ridiculous like ‘I am from Ireland our countries are great friends’. Sadly we don’t get a photo op nor do I get the opportunity to ask him what kind of a country is he running that we often have no blood supply for several days or that the country ‘ran out’ of Insulin a few weeks back or why aid agencies withdrew hundreds of millions in assistance due to fears of irregularities in the department of health or for that matter why is it taking so long to process my work permit. Nonetheless it is of course a great honour to meet him before he leaves in his motor cavalcade.
It was strange to see the president being subordinate to the chief at the event and while he was being whisked away back to Lusaka I was comforted to think that the Undi Paramount chief would be staying locally providing community leadership. Not so unfortunately. John explains that the chief lives in Lusaka and because of this ‘is not nicely connected with the people, I think it would be better if he stayed in the area’. Whilst political leadership in Zambia often serves self interest it is truly heartening to see and experience the richness of the local culture and the pride the people have in that culture.
Sunday, August 29, 2010
Death
Dealing with death and breaking bad news are among the more difficult aspects of work as a Doctor. Unfortunately here in St Francis it is something you have to do a lot. Death seems to come in waves after a couple of weeks of few deaths suddenly a glut of patients are dying. It seems every few minutes you are taking a relative aside saying ‘I am sorry your father/sister/husband has just passed away’ or ‘I am sorry your mother/brother/wife is very sick they have pneumonia/meningitis/renal failure (generally secondary to HIV) we are going to give them the best medicine and care we can but I think they are going to pass away unfortunately’.
Then there is breaking bad news to the patient themselves. Recently I had a man present with massive right leg swelling and what he claims was a short history of poor urinary flow. A rectal examination reveals a rock hard prostate, blood tests show his kidneys are impaired and an ultrasound reveals in addition to his prostate mass he also has a mass in his bladder. The right leg swelling is secondary to obstruction of lymph drainage by these cancerous masses.
He is a happy cherry man in his 60’s, that is until I try to break as gently as possible (how can such news be termed gentle) that he has advanced prostate cancer and unfortunately there is no treatment we can offer save from pain relief (even that we don’t have a lot of) and a suprapubic catheter if he goes into urinary retention. At that point he breaks into tears. I feel utterly helpless to offer him any comfort, at least if I was his GP at home I could ask him to come back in a couple of days to talk some more, to come if there is any problems, get the hospice involved if appropriate, could communicate more effectively with him without the language barrier. Instead a couple of hours later he is packing his bags to go and I probably won’t see him again. The tragedy of this mans case is that he had previously presented to another hospital and was not diagnosed.
The same day I have to tell a young man in his 30’s some bad news. He is a father of young children, a farmer by profession, HIV negative. He has just presented with abdominal pain and swelling. His liver feels like a massive irregular shaped rock has been transplanted into his abdomen. His abdominal swelling is caused by haemorrhagic ascites (bloody fluid). His diagnosis is Hepatocellular carcinoma. This is a common cancer is this part of Africa particularly in men aged 20-40. The prognosis is bleak. Again I have to explain the same spiel, I am very sorry etc, etc.
Sometimes such conversations seem to pass by in your head without thinking too much, become the same as doing a procedure or writing a prescription. It’s easy to forget that these people are somebody’s husband, father, brother or son. It is also easy to forget that their death particularly if in hospital will put huge financial strain on the family, an income earner may be lost and it is much more expensive to transport a dead body back to the village than a live one.
Death is commonplace here and as such is dealt with differently in the hospital. Staff members often seem unperturbed by the occurrence, resuscitation attempts are rarely commenced (if they are appropriate) and there are no single rooms for dying patients so the family can have peace. Screens are pulled around the bed after the incident but there are no candles or no Chaplin. One of the more humbling aspects of the death is that as the body is being moved to the mortuary all of the bed-siders for the other patients accompany the family there. The women cry and wail as the body passes.
As a doctor there are selfish aspects to death also. Recently whilst compiling mortality statistics for the past two months as I was terrified it would look awful but allowed myself be a little pleased when the ‘mortality rate’ was in fact similar to previous months. Some deaths seem to affect us more than others. Two types of patient tend to die here. The first presents extremely ill and passes away in the first 48 hours, these deaths tend not to affect us much. We didn’t get to know the patient ‘they presented too late there was nothing we could do’
The second presents with complex medical problems is in the hospital for a few days, we get to know them and their story recognise their relatives on the ward round. What limited investigations there are available are done in an effort to find out exactly what is wrong, various treatments are tried, books are consulted at night and thoughts turned over in your head. When they die there is more a sense of personal loss as well as failure. Then there is the frustration ‘if only I could have done this test, consulted that specialist, had the other medication’.
Overall the sad fact is that life expectancy at birth in this country is under 40 years. Several things will need to happen for this to change. Antenatal and perinatal care in the community will have to improve to decrease perinatal mortality. Immunisation programmes will have to be expanded to cover disease such as pneumococcus. There will have to be greater awareness of malaria prevention, safe drinking water and the dangers posed by diarrhoeal disease. The HIV infection rate will have to be decreased through mass testing and education. Health care staff numbers will have to be increased and levels of training vastly improved.
All of this will take money and political leadership, neither of which are in abundance in Zambia at the present.
Then there is breaking bad news to the patient themselves. Recently I had a man present with massive right leg swelling and what he claims was a short history of poor urinary flow. A rectal examination reveals a rock hard prostate, blood tests show his kidneys are impaired and an ultrasound reveals in addition to his prostate mass he also has a mass in his bladder. The right leg swelling is secondary to obstruction of lymph drainage by these cancerous masses.
He is a happy cherry man in his 60’s, that is until I try to break as gently as possible (how can such news be termed gentle) that he has advanced prostate cancer and unfortunately there is no treatment we can offer save from pain relief (even that we don’t have a lot of) and a suprapubic catheter if he goes into urinary retention. At that point he breaks into tears. I feel utterly helpless to offer him any comfort, at least if I was his GP at home I could ask him to come back in a couple of days to talk some more, to come if there is any problems, get the hospice involved if appropriate, could communicate more effectively with him without the language barrier. Instead a couple of hours later he is packing his bags to go and I probably won’t see him again. The tragedy of this mans case is that he had previously presented to another hospital and was not diagnosed.
The same day I have to tell a young man in his 30’s some bad news. He is a father of young children, a farmer by profession, HIV negative. He has just presented with abdominal pain and swelling. His liver feels like a massive irregular shaped rock has been transplanted into his abdomen. His abdominal swelling is caused by haemorrhagic ascites (bloody fluid). His diagnosis is Hepatocellular carcinoma. This is a common cancer is this part of Africa particularly in men aged 20-40. The prognosis is bleak. Again I have to explain the same spiel, I am very sorry etc, etc.
Sometimes such conversations seem to pass by in your head without thinking too much, become the same as doing a procedure or writing a prescription. It’s easy to forget that these people are somebody’s husband, father, brother or son. It is also easy to forget that their death particularly if in hospital will put huge financial strain on the family, an income earner may be lost and it is much more expensive to transport a dead body back to the village than a live one.
Death is commonplace here and as such is dealt with differently in the hospital. Staff members often seem unperturbed by the occurrence, resuscitation attempts are rarely commenced (if they are appropriate) and there are no single rooms for dying patients so the family can have peace. Screens are pulled around the bed after the incident but there are no candles or no Chaplin. One of the more humbling aspects of the death is that as the body is being moved to the mortuary all of the bed-siders for the other patients accompany the family there. The women cry and wail as the body passes.
As a doctor there are selfish aspects to death also. Recently whilst compiling mortality statistics for the past two months as I was terrified it would look awful but allowed myself be a little pleased when the ‘mortality rate’ was in fact similar to previous months. Some deaths seem to affect us more than others. Two types of patient tend to die here. The first presents extremely ill and passes away in the first 48 hours, these deaths tend not to affect us much. We didn’t get to know the patient ‘they presented too late there was nothing we could do’
The second presents with complex medical problems is in the hospital for a few days, we get to know them and their story recognise their relatives on the ward round. What limited investigations there are available are done in an effort to find out exactly what is wrong, various treatments are tried, books are consulted at night and thoughts turned over in your head. When they die there is more a sense of personal loss as well as failure. Then there is the frustration ‘if only I could have done this test, consulted that specialist, had the other medication’.
Overall the sad fact is that life expectancy at birth in this country is under 40 years. Several things will need to happen for this to change. Antenatal and perinatal care in the community will have to improve to decrease perinatal mortality. Immunisation programmes will have to be expanded to cover disease such as pneumococcus. There will have to be greater awareness of malaria prevention, safe drinking water and the dangers posed by diarrhoeal disease. The HIV infection rate will have to be decreased through mass testing and education. Health care staff numbers will have to be increased and levels of training vastly improved.
All of this will take money and political leadership, neither of which are in abundance in Zambia at the present.
Monday, August 23, 2010
And on the seventh day
My Bradt guide to Zambia tells me there are an estimated 200 Christian churches in Zambia. Looking around the Katete area I see signs for Burning Bush Church, Jehovah’s Witness, a few different Catholic churches, the Anglican Church at the hospital as well as many others. Overall there is no shortage of places to worship on a Sunday if you are so inclined. Having associated the Jehovah’s witnesses mostly with Americans coming to your door with leaflets trying to convert you, I was surprised to see how big a presence that church has in this area from both the number of patients in the hospital who are members to numerous signs for various ‘Kingdom Halls’.
Frequently in the hospital the issue surrounding blood transfusion arises particularly regarding children who have anaemia secondary to malaria where the parents refuse consent to life saving blood transfusion because the are Jehovah’s witnesses. Thankfully many do seem to change their mind after a reasonable discussion outlining the facts, the absolute necessity for transfusion and the absence of an alternative. Keen as I am to experience as much of Zambian life as I can here I decided to take myself along to a gathering of Jehovah’s witnesses.
A school student tends to my small garden and after visiting his house and family who are all extremely welcoming and generous I discover they are Jehovah’s witnesses. They invite me along to a local convention. On the appointed day I meet my gardener and his dad and we head off. Just a couple of kilometres from the hospital we turn off the tar and drive for another four or five kilometres. We arrive at an immaculate little village with a nice school in the middle. A lot of others are arriving also, mostly on foot and by bicycle, though there are a few other vehicles.
I am introduced to Mr Phiri one of the elders of the congregation. We enter a large enclosure where several thousand others are already assembling. When I ask is this convention for all the eastern province he explains this is for the Katete area only. A couple of weeks earlier I had been to the Catholic service at Katete Stores so I am keen to compare the two. Whilst in the Catholic Church there were a few hundred I later learn there are eight thousand here. Proceedings start pretty much bang on eight thirty another big difference from the Catholic service which like most things in Zambia started considerably later than advertised.
There are several people on a stage with microphones and some speakers around the enclosure, everything is in the local language Chichewa. Mr Phiri gives me an English Bible and some sheets in English out-lining what is going on. There are five or six ten minute talks on different themes such as ‘Jehovah’s generosity’ or his loyalty or his consideration, it all seems pretty reasonable, there is much flicking through the bible from one snippet to another to explain these themes.
There is very little music and singing unlike the Catholic service which had a fantastic array of musicians with lively singing and people dancing in the church. What little singing there is some dull hymns to a tape recording of some drab piano music. It all seems very un-Zambian. Mr Phiri explains that all Jehovah’s teachings are the same the world over. True enough I see looking at my sheets that they are printed in Zambia but produced by the Watch Tower Bible and Trust society of Pennsylvania.
After the talks on the virtues of following Jehovah which all seem very reasonable we move on to the keynote speech. Here things loose the plot a completely. Following my English leaflet I see the address goes from dismissing the theory of evolution ‘how can we be descended from apes and still run away from them when we see them in the bush’.
I then learn that from a passage in Paul’s letter to the Romans the Jehovah’s witnesses foresaw the defeat of Nazi Germany in World War two. Indeed Himmler the head of the SS apparently once bragged that the Jehovah’s witnesses would capitulate but had no answer to the in the last days of the regimen before poisoning himself. I wonder how the average Zambian can identify with any of this. The address moves on to more rational issues that the seven million members worldwide are all apostles spreading the word ‘this is indeed the only organisation that God is using to help draw people to him’.
Leafing through the brochure I have I also see an article explaining that ‘we simply can not socialise with non-believers and hope to suffer no ill consequences.’ Bang on time at 11.20 the interval (and my cue to leave) arrives and Mr Phiri asks me for his thoughts. I first if all thank him for the kindness and generosity shown to me by him and the family that invited me which could not be equalled.
I explain that I found the experience very un-Zambian and struggle to understand the popularity of the Jehovah’s witnesses here. ‘We are an international organisation, anywhere you go will be the same’ he explains as we walk towards his vehicle a fairly new van with ‘Jehovah’s Witnesses Zambia’ printed on the side. He also explains that everyone who attends gets a bible which might cost 65 pen in the shop (about €11). He feels the main reason for their success is that all members must preach everyday so that others can hear their message ‘we are very serious with the preaching work.’
I am not so sure this can explain eight thousand people in an isolated African village. Perhaps there is an attraction to many in the dogmatic nature of the belief system. Perhaps there are other reasons. I ask Mr Phiri the burning question on the blood transfusion issue. He explains that it is written in Acts 15:28-29 and that there is not a total equality of blood. I protest that that surely all Gods children should be valued and not allowed to die when life saving treatment in the form of blood is available.
Mr Phiri calmly explains that ‘why do we bring our children to the hospital if we want them to die, you have other avenues like blood expanders’ I explain that we don’t in Katete and indeed these are no substitute for blood. I ask what will happen to the mother who will consent eventually to a blood transfusion for her child ‘we leave it with Jehovah and herself’.
Frequently in the hospital the issue surrounding blood transfusion arises particularly regarding children who have anaemia secondary to malaria where the parents refuse consent to life saving blood transfusion because the are Jehovah’s witnesses. Thankfully many do seem to change their mind after a reasonable discussion outlining the facts, the absolute necessity for transfusion and the absence of an alternative. Keen as I am to experience as much of Zambian life as I can here I decided to take myself along to a gathering of Jehovah’s witnesses.
A school student tends to my small garden and after visiting his house and family who are all extremely welcoming and generous I discover they are Jehovah’s witnesses. They invite me along to a local convention. On the appointed day I meet my gardener and his dad and we head off. Just a couple of kilometres from the hospital we turn off the tar and drive for another four or five kilometres. We arrive at an immaculate little village with a nice school in the middle. A lot of others are arriving also, mostly on foot and by bicycle, though there are a few other vehicles.
I am introduced to Mr Phiri one of the elders of the congregation. We enter a large enclosure where several thousand others are already assembling. When I ask is this convention for all the eastern province he explains this is for the Katete area only. A couple of weeks earlier I had been to the Catholic service at Katete Stores so I am keen to compare the two. Whilst in the Catholic Church there were a few hundred I later learn there are eight thousand here. Proceedings start pretty much bang on eight thirty another big difference from the Catholic service which like most things in Zambia started considerably later than advertised.
There are several people on a stage with microphones and some speakers around the enclosure, everything is in the local language Chichewa. Mr Phiri gives me an English Bible and some sheets in English out-lining what is going on. There are five or six ten minute talks on different themes such as ‘Jehovah’s generosity’ or his loyalty or his consideration, it all seems pretty reasonable, there is much flicking through the bible from one snippet to another to explain these themes.
There is very little music and singing unlike the Catholic service which had a fantastic array of musicians with lively singing and people dancing in the church. What little singing there is some dull hymns to a tape recording of some drab piano music. It all seems very un-Zambian. Mr Phiri explains that all Jehovah’s teachings are the same the world over. True enough I see looking at my sheets that they are printed in Zambia but produced by the Watch Tower Bible and Trust society of Pennsylvania.
After the talks on the virtues of following Jehovah which all seem very reasonable we move on to the keynote speech. Here things loose the plot a completely. Following my English leaflet I see the address goes from dismissing the theory of evolution ‘how can we be descended from apes and still run away from them when we see them in the bush’.
I then learn that from a passage in Paul’s letter to the Romans the Jehovah’s witnesses foresaw the defeat of Nazi Germany in World War two. Indeed Himmler the head of the SS apparently once bragged that the Jehovah’s witnesses would capitulate but had no answer to the in the last days of the regimen before poisoning himself. I wonder how the average Zambian can identify with any of this. The address moves on to more rational issues that the seven million members worldwide are all apostles spreading the word ‘this is indeed the only organisation that God is using to help draw people to him’.
Leafing through the brochure I have I also see an article explaining that ‘we simply can not socialise with non-believers and hope to suffer no ill consequences.’ Bang on time at 11.20 the interval (and my cue to leave) arrives and Mr Phiri asks me for his thoughts. I first if all thank him for the kindness and generosity shown to me by him and the family that invited me which could not be equalled.
I explain that I found the experience very un-Zambian and struggle to understand the popularity of the Jehovah’s witnesses here. ‘We are an international organisation, anywhere you go will be the same’ he explains as we walk towards his vehicle a fairly new van with ‘Jehovah’s Witnesses Zambia’ printed on the side. He also explains that everyone who attends gets a bible which might cost 65 pen in the shop (about €11). He feels the main reason for their success is that all members must preach everyday so that others can hear their message ‘we are very serious with the preaching work.’
I am not so sure this can explain eight thousand people in an isolated African village. Perhaps there is an attraction to many in the dogmatic nature of the belief system. Perhaps there are other reasons. I ask Mr Phiri the burning question on the blood transfusion issue. He explains that it is written in Acts 15:28-29 and that there is not a total equality of blood. I protest that that surely all Gods children should be valued and not allowed to die when life saving treatment in the form of blood is available.
Mr Phiri calmly explains that ‘why do we bring our children to the hospital if we want them to die, you have other avenues like blood expanders’ I explain that we don’t in Katete and indeed these are no substitute for blood. I ask what will happen to the mother who will consent eventually to a blood transfusion for her child ‘we leave it with Jehovah and herself’.
Saturday, August 7, 2010
Bwelani
I spend my mornings doing a ward round on St Augustine’s the male medical ward. There can be anything from twenty to forty patients to be seen there many with complex medical problems. In the afternoon I go to St Luke’s, our outpatient department. This is where patients have their first contact with the hospital. The HIV clinic is run from here as are the specialist Surgery and Gynaecology clinics. Room 15 is where the doctors from the medical department work.
I feel more at home here, its more like General Practice what I am used to, mixed in with a good bit of A&E and a general medical outpatients. Patients seen in room 15 are a mix of those for review post discharge, reviews of chronic illnesses such as asthma, high blood pressure and diabetes as well as those first presenting be it with chest pain, fractures, miscarriage, anxiety or to have a police report filled.
I sit at a desk like at home and see patient after patient. Bwelani (l is pronounced r) means come ahead (it’s the closest I know to next). One afternoon I see a 50 year old man presenting for admission for chemotherapy for Kaposi’s sarcoma. Bwelani – a 29 year old lady with an ectopic kidney and hypertension for review. Bwelani – a 78 year old man complaining of chest pain who has chronic obstructive airways disease.
Bwelani – a 63 year old man who has TB symptoms, sputums are negative, X-ray looks suggestive, start TB treatment. Bwelani – a 30 year old man with an acute exacerbation of asthma. Bwelani – a 20 year old student who has malaria. Bwelani – a 30 year old man new diagnosis Hepatitis B positive.
Bwelani – a 38 year old man new diagnosis of HIV positive, symptoms suggestive of TB, quite unwell and admit to the ward. Bwelani – a 24 year old lady with congestive cardiac failure secondary to rheumatic heart disease for review. Bwelani – a 7 year old girl with cough fever and constipation, admit to paediatrics (transpires has ileus secondary to pneumonia). Bwelani – a 69 year old lady with anaemia probably secondary to peptic ulcer disease.
Bwelani – a 19 year old girl previous Caesarean section in Mozambique at term, send to ‘waiters’ via maternity (waiters is a house in the grounds where women who should deliver in hospital wait). Bwelani – a 55 year old HIV negative man with sputum positive pulmonary TB, start TB treatment.
Bwelani – a 46 year old man with type 2 diabetes for review. Bwelani – a 36 year old HIV positive lady with pulmonary TB for review. Bwelani – a 3 year old boy with malaria. The afternoon concludes and its back to the still rather unfamiliar territory of the evening round on the medical ward.
I feel more at home here, its more like General Practice what I am used to, mixed in with a good bit of A&E and a general medical outpatients. Patients seen in room 15 are a mix of those for review post discharge, reviews of chronic illnesses such as asthma, high blood pressure and diabetes as well as those first presenting be it with chest pain, fractures, miscarriage, anxiety or to have a police report filled.
I sit at a desk like at home and see patient after patient. Bwelani (l is pronounced r) means come ahead (it’s the closest I know to next). One afternoon I see a 50 year old man presenting for admission for chemotherapy for Kaposi’s sarcoma. Bwelani – a 29 year old lady with an ectopic kidney and hypertension for review. Bwelani – a 78 year old man complaining of chest pain who has chronic obstructive airways disease.
Bwelani – a 63 year old man who has TB symptoms, sputums are negative, X-ray looks suggestive, start TB treatment. Bwelani – a 30 year old man with an acute exacerbation of asthma. Bwelani – a 20 year old student who has malaria. Bwelani – a 30 year old man new diagnosis Hepatitis B positive.
Bwelani – a 38 year old man new diagnosis of HIV positive, symptoms suggestive of TB, quite unwell and admit to the ward. Bwelani – a 24 year old lady with congestive cardiac failure secondary to rheumatic heart disease for review. Bwelani – a 7 year old girl with cough fever and constipation, admit to paediatrics (transpires has ileus secondary to pneumonia). Bwelani – a 69 year old lady with anaemia probably secondary to peptic ulcer disease.
Bwelani – a 19 year old girl previous Caesarean section in Mozambique at term, send to ‘waiters’ via maternity (waiters is a house in the grounds where women who should deliver in hospital wait). Bwelani – a 55 year old HIV negative man with sputum positive pulmonary TB, start TB treatment.
Bwelani – a 46 year old man with type 2 diabetes for review. Bwelani – a 36 year old HIV positive lady with pulmonary TB for review. Bwelani – a 3 year old boy with malaria. The afternoon concludes and its back to the still rather unfamiliar territory of the evening round on the medical ward.
Monday, August 2, 2010
Mutu uwawa?
After seven weeks I feel I finally have some notion of medically (and linguistically) what is going on. I am beginning to recognise patterns of disease figure out a little easier who might have TB, meningitis or toxoplasmosis. In the past number of days I have seen a surge in cases of meningitis some meningococcal, one pneumococcal and some Cryptococcal. The later seems to have a particular pattern of symptoms.
Cryptococcal meningitis is caused by a yeast infection. It is almost unique to HIV positive patients with severely suppressed immune systems (although some HIV patients present for the first time with Cryptococcal meningitis). The patient will have a long history of headache and confusion. On arrival to the hospital they will be confused agitated and not compliant with examination. Diazepam, with relatives consent, is frequently needed so that lumbar puncture can be performed for diagnosis. During lumbar puncture the CSF (cerebro spinal fluid) comes out at high pressure but is clear not like the turbid CSF I have seen with the bacterial meningitides.
One of the satisfactory things about medicine here is the pureness of it. There are no CT scans, simply do the LP bring the CSF to the lab who will often examine it straight away preparing the slides just like we were thought in medical school. There is nothing high tech about it. The latest case of Cryptococcal meningitis on my ward is Felix. He presented much like the others with a chronic headache, confused and agitated. He has been on treatment for five days now. My ability of pattern recognition doesn’t yet extend to knowing if he will survive the illness or not. Some patients like the one I mentioned a few weeks ago with the really high pressure CSF do well, others don’t.
Every day Felix’s wife sits by his bedside and cares for him. Staffing levels here are much lower than what we are used to in the developed world. ‘Bedsiders’ like Margaret are relied upon to carry out much of the patient care. Since Felix was diagnosed HIV positive in March this year he has been sick and has been admitted four times. This has had a huge impact on the lives of Margaret and the rest of the family.
Felix previously had a business repairing dishes and pots. Since he has been sick the family have had no income and are surviving on some savings and the good will of relatives. In the six days since Felix has been admitted Margaret has been here caring for him and sleeping on the floor beside the bed. Their three children aged 8, 5 and 3 are currently staying with Margaret’s parents. The family’s home is about 60km from the hospital.
During our conversation Margaret gets up to bring the bed pan to her 36 year old husband and after he has finished carries it to the toilet. Margaret tells me she also wipes him after bowel movements, washes him and changes the bed clothes. She will also be given any oral medication he is on to administer.
The care people give to their loved ones who are ill always astonishes me everywhere I have worked. Be it the lady who cares for her husband who has MS or the man in his 60’s who goes to the nursing home every day to bring his wife, who has had a stroke is immobile and PEG fed, out for a few hours. That is not to mention the countless others I have met caring for parents, siblings and children who are ill. Here in Zambia it is just the same.
Margaret has also tested positive for HIV but has not been ill like her husband. She is taking Anti Retroviral Drugs (ARVs). I ask her have the children been tested ‘not yet but it is important specially the little one’. Margaret tells me about how her and Felix first met. She was working in a shop at that time and knew his sister who informed her that her brother was looking for a wife to marry. They knew each other for three years before they married nut didn’t see much of each other at that time as he was living and working in the copper belt.
She says she doesn’t know why she and Felix have got HIV but she does know how it is spread. ‘It has been difficult for us to accept but emotionally we are there for each other.’ I take the opportunity to again explain to Margaret that Felix is seriously ill and may not survive this illness ‘I think Felix is going to get better, without him it would be difficult for me and my people to take care of the children’.
Through the ARV programme Margaret has learned a lot about HIV and its transmission. She feels that availability of ARVs is really important and that people should adhere to condom usage and not exchange instruments like razor blades or needles. She is a member of the Jehovah’s Witness Church but doesn’t feel this influences her views on healthcare beyond her objection to blood transfusions. She explains that in the future she would like to be able to educate all the children and build for the family a better house with a corrugated iron roof.
I am struck by her care and devotion to her husband. Margaret has one question ‘now that I am taking ARVs am I going to have enough life up until the time my children grow older?’
Cryptococcal meningitis is caused by a yeast infection. It is almost unique to HIV positive patients with severely suppressed immune systems (although some HIV patients present for the first time with Cryptococcal meningitis). The patient will have a long history of headache and confusion. On arrival to the hospital they will be confused agitated and not compliant with examination. Diazepam, with relatives consent, is frequently needed so that lumbar puncture can be performed for diagnosis. During lumbar puncture the CSF (cerebro spinal fluid) comes out at high pressure but is clear not like the turbid CSF I have seen with the bacterial meningitides.
One of the satisfactory things about medicine here is the pureness of it. There are no CT scans, simply do the LP bring the CSF to the lab who will often examine it straight away preparing the slides just like we were thought in medical school. There is nothing high tech about it. The latest case of Cryptococcal meningitis on my ward is Felix. He presented much like the others with a chronic headache, confused and agitated. He has been on treatment for five days now. My ability of pattern recognition doesn’t yet extend to knowing if he will survive the illness or not. Some patients like the one I mentioned a few weeks ago with the really high pressure CSF do well, others don’t.
Every day Felix’s wife sits by his bedside and cares for him. Staffing levels here are much lower than what we are used to in the developed world. ‘Bedsiders’ like Margaret are relied upon to carry out much of the patient care. Since Felix was diagnosed HIV positive in March this year he has been sick and has been admitted four times. This has had a huge impact on the lives of Margaret and the rest of the family.
Felix previously had a business repairing dishes and pots. Since he has been sick the family have had no income and are surviving on some savings and the good will of relatives. In the six days since Felix has been admitted Margaret has been here caring for him and sleeping on the floor beside the bed. Their three children aged 8, 5 and 3 are currently staying with Margaret’s parents. The family’s home is about 60km from the hospital.
During our conversation Margaret gets up to bring the bed pan to her 36 year old husband and after he has finished carries it to the toilet. Margaret tells me she also wipes him after bowel movements, washes him and changes the bed clothes. She will also be given any oral medication he is on to administer.
The care people give to their loved ones who are ill always astonishes me everywhere I have worked. Be it the lady who cares for her husband who has MS or the man in his 60’s who goes to the nursing home every day to bring his wife, who has had a stroke is immobile and PEG fed, out for a few hours. That is not to mention the countless others I have met caring for parents, siblings and children who are ill. Here in Zambia it is just the same.
Margaret has also tested positive for HIV but has not been ill like her husband. She is taking Anti Retroviral Drugs (ARVs). I ask her have the children been tested ‘not yet but it is important specially the little one’. Margaret tells me about how her and Felix first met. She was working in a shop at that time and knew his sister who informed her that her brother was looking for a wife to marry. They knew each other for three years before they married nut didn’t see much of each other at that time as he was living and working in the copper belt.
She says she doesn’t know why she and Felix have got HIV but she does know how it is spread. ‘It has been difficult for us to accept but emotionally we are there for each other.’ I take the opportunity to again explain to Margaret that Felix is seriously ill and may not survive this illness ‘I think Felix is going to get better, without him it would be difficult for me and my people to take care of the children’.
Through the ARV programme Margaret has learned a lot about HIV and its transmission. She feels that availability of ARVs is really important and that people should adhere to condom usage and not exchange instruments like razor blades or needles. She is a member of the Jehovah’s Witness Church but doesn’t feel this influences her views on healthcare beyond her objection to blood transfusions. She explains that in the future she would like to be able to educate all the children and build for the family a better house with a corrugated iron roof.
I am struck by her care and devotion to her husband. Margaret has one question ‘now that I am taking ARVs am I going to have enough life up until the time my children grow older?’
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