Iguana Crossing

I’m sure you knew Pat was an animal lover…but did you know she’d risk life and limb to save poor defenseless creatures in a foreign land? Now, let me preface this story first with this, pedestrians do not have the right of way in Zambia. Sometimes, I think no one has the right of way, but people on foot definitely come last. No, wait, iguanas are last, unless Pat is around. So walking down a busy throughfare on the hospital grounds where speed has no limit, we notice a cute little iguana crossing the road. Pat in her animal loving heart decided that this little guy will surely be road kill if he is not helped across, so she steps out into the street, in front of a car, putting her hand out (the universal sign for stop, which in Zambia is the universal sign for crush my pelvis) and scoops the iguana into Kristin’s umbrella. Because the man driving is probably bewildered by this crazy white woman, somehow he stops, does not hit Pat, and the iguana safely makes it to the grass (for at least a few minutes).

Social Committee

A large number of the pediatric admissions to the University Teaching Hospital are for orthopedic trauma. We were told by the surgical teams that this time of year is mango season, and the children will climb into the mango trees to pick the mangos. Hornets also like to nest in mango trees, so if the child disturbs the hornets, they get frightened and fall out of the tree, and break something. Like a femur. Or a humerus. And, because this 900 bed hospital with 1200 patients and 4 functional operating rooms has very few orthopedic surgeons they fix this fractures with weeks and weeks and weeks of traction. The good news is the kiddos really aren’t in pain. The bad news is they are bored. So, Miss Julie, the head of our Social Committee decided to intervene because they were really cute. All we really had to give them were ‘Copa highlighters and paper, which they loved, we took some goofy pics, and visited them everyday.

Lost in Cyberspace

I wrote this sitting in the airport, over a week ago, where I was paying $10/hr for wi-fi access, waiting 2 or 3 minutes for pictures to load, and just as I was about the push the "POST" button, the last hour of internet access I had paid for timed out and I gave up updating this blog until I was done traveling. So, after a nearly 3 day adventure trying to get back home (don't ask, I might tell, but it's more of a story than I'd like to reveal at this time), and then a second domestic trip to the North American Burn Society meeting, I am now nearly 3 weeks since being home.

IN JOHANNESBURG:

As I sit in the airport during my 10 hour layover in Johannesburg (which is a story all by itself that maybe I will tell later since I was supposed to be in London), I am feverishly trying to update the blog I so wanted to keep during this trip. We did have internet access at the hospital nearly everday, but as one of the registars (the eqivalent of a resident) had put it, the reliability of the signal depended on what side of the bed you had gotten up on that morning. Most days you could check your email, but not much else.



I maybe could have updated the blog with text only. But I think that sometimes the pictures say more than words could ever say. So, I am getting done what I can with this pay by the hour wi-fi, that still takes WAY TOO long and sometimes several tries for pictures to load.

University Teaching Hospital, Lusaka

Oringinally written January 5th, 2010...

We arrived to round with the Yellow Firm Surgical Team at 0900 on January 5th. The hospital is an enormous, old, and hard to navigate building with lots of open breezeways to help with the stale, humid heat. The University Teaching Hospital was built 40 years ago, just after the Zambians won their independence from the British. The hospital is a 900 bed facility, currently housing about 1200 patients. Family members litter the grassy areas outside in a makeshift waiting-room.

Code Cart

We met 5 young burn victims during rounds today, aged 2 years old to 5 years old. All were burned in the kitchen by scalding hot liquids, 2 by hot porridge, one by hot tea, one by hot water, and one was pushed into a pot of hot rice. Generally these patients wait several days to come into the hospital to seek care for their injuries, until they start to develop infections. The burns we encountered ranged from 10% total body surface area to 45% total body surface area. Burns are treated topically by saline soaked “nappies” (washcloths) and twice daily hydrotherapy. The patient’s families are responsible for buying the nappies and the soap for the hydrotherapy. Pain medications ranged from three times daily oral paracetamol (acetaminophen) to an oral elixir called Brustan that was a mixture of ibuprofen and paracetamol, to IV or IM pethidine (meperidine) for wound care.

Lweendo

Lweendo is a 3 year old girl who sustained a 45% total body surface area burn from hot porridge. She presented to the University Teaching Hospital 3 days after her burn occurred after being referred from an outside hospital with signs of burn wound sepsis. She was first encountered by our team on 1/5/09 and had a fever and was breathing very fast. She has full thickness burns to both of her legs, her arms, her abdomen and chest, her back the back of her head, and her perineum. The unit uses metal frameworks above the child to keep the bedding off their wounds and dressings. She was admitted to University Teaching Hospital on 1/4/10, and after 3 days of IV antibiotics, IV fluids, and twice daily wound care with saline soaked nappies, she suddenly collapsed, and Lweendo died on 1/7/10.

Wound Care
Patients with burns undergo wound care twice per day. They are taken to the tub room first at 0700, then again at 1400. Wounds are vigorously scrubbed with soap, water, and cloths (wouldn’t want to see what a Zambian nurse could do with a norsen!), then the wounds are redressed in the saline soaked nappies. The family is taught wound care within the first few days of admission because there may only be 1 or 2 nurses for an entire floor (24ish pts?). They are taught to change out the nappies any time there is any blood soaking or other soiling. Once the slough (or eschar) has all come off the family is taught how to apply silvadene, and so long as a graft isn’t needed and the patient is sent home.

Our New Home

After meeting with our contacts in the Department of Surgery at the University Teaching Hospital in Lusaka, we left our comfortable surroundings of the Taj Hotel to inhabit the quaint guest cottage on the hospital property (good-bye swimming pool, good bye wi-fi, good-bye air conditioning). We fought ants, mosquitos, and had to bathe in a bathtub that was hardly wider than my butt that had a handheld showerhead with all the power of a water pick. We decided this was a little more "Africa" than where we had started.




The cottage is equipped with a small kitchen, and to help save money, Pat and Kristin set out in a taxi to find a grocery store so we could make something for dinner. A 60,000 kwacha (about $13 USD) round trip taxi ride later, they returned with bread, peanutbutter, honey, beef bouillon, eggs, a bag of chips, a bag of cookies, some bottled water, and soda (Coke Light--it's delicious). We had feast of peanut butter and honey sandwiches.

Exploring Lusaka

Walking along the tree canopied streets of Lusaka is a far cry from sterotypical images of arid, remote savanna often thought of when speaking of Africa. Lusaka is a city, with shopping, and restaurants, and people talking about watching CSI NY. And Subway...6 inch or foootlong?

Our First African Meal

We asked our taxi driver, Max, on the way to the hotel from the airport, what kind of food we should eat. At first, he told us Chinese food was a good choice, but we told him we wanted to sample some of the authentic local cuisine, so he told us to so to the Fairview Hotel for some nshima. Nshima is cooked porridge made from ground maize, and we were a little worried when the first thing brought out to the table were bowls of water for our hands...which meant we were eating with our fingers.