20101001 by Tom

This is going to be the last of the notes in the blog made in Mpongwe this year.

We know this has been a fantastic time filled to the brim with interesting things. A few of our inner thoughts. have displayed themselves unwillingly and for that we apologise. You cannot go through life without noticing things and there are a lot of differences between Africa and Söderköping This is extremely clear to everybody from Sweden that have been to Africa. Afew are regarded as good and some are regarded as bad or not so good. We had an interesting discussion with mr Musaka about eating caterpillars. He regarded some as a delicatessen but I can hardly think of eating one. The conclusion is that Zambia and Sweden are as unlike as the fact that the sun in Zambia is in the north but in Sweden in the south.

The morning murmur was as usual and the round frustrating as usual. There was a lot of important tests and other procedures not done and the nurses student that was my aide was not even slightly sorry. She was only carrying the papers. In the afternoon II found out that she had not noted any of my orders and they were not executed. We had some very dehydrated children that needed extra care and she could not be everywhere. I tried to persuade two parents to allow us to set a feeding-tube in their extremely dehydrated daughter. They did not allow us. The child had started giving away some urin which is the first sin that the rehydration is taking effect. Without the feeding-tube her chances of surviving are minimal, we told the parents. The paraplegic boy with the pressure sores have got a little fever and I am dying to do a bacteriologic culture from his wounds.

Maria had blown her head when she found out that our garden boys had equipped themselves with Swedish operating dresses. We additionally found out that a multimillion dentist chair with all possible fittings, was standing under the blue sky and dust without any protection. We contacted the donors and our coordinator and the hospital officials. A lot of people moved the dentists chair and a lot of other things down to the hospital and indoors. When pushed they react.

Late at night the Swedish doctor that is to succeed me, arrived. She had had troubles in customs because her baggage was lost. We, Maria and Tom, served a nice dinner and Anna Karin went to bed early.

We had an interesting and constructive discussion with Dennis from the Workshop. We decided to put our last “give away” money in a project to restore the old OPD into a childrens OPD and ART counselling room. It will be possible to have a room especially done for children and to separate the grown-ups and the children waiting in the OPD. One problem is that not a word of mutual understanding and economics are written down.

At the morning mumbles Friday I told the people there about the Childrens OPD and we all heard Becky talk about heart failure. A very fascinating subject that gave cause for a couple of questions from the audience. I made a short speech and bade goodbye and thenk you for te weeks that have gone. I sincerely hope that the cooperation with Sweden will continue even if it has to be otherwise.

The ward is presumably given to Rick as from Saturday so I tried to write in a reasonably discernable way. The same troubles exists and I guess that Rick will have to fight the same fights as I have done. Nobody is actually dying but there are a few that will if nothing is done.

I want to thank everybody that have used their valuable time to read this blog. Thank you all!

20100929 by tom

This is written on Wednesday after the morning round. It was one of the most frustrating experiences in my medical life. I had a dresser named mrs Mwunda, the oldest and presumably the most experienced of dressers. She was all the time looking through her papers making notes and talking to the other staff, and was not listening to me at all. She had no clue as to why no tests ordered were collected and still lesser taken to the lab for processing. One little patient had been in the ward for two full days completely unnecessary because a simple dipslide urin routine test was not done. I cannot get into my mind that the staff is not at all interested in the patients will or well-being. If they are they hide it well. I have been wondering if there is something in the attitude towards the sick human being tat I have missed completely. If the staff, as it seems, are only interested in the salary they have because they are hired, we have a gigantic problem to overcome , if we aim at getting good care to Zambia. It is a question of the mind not of skill. In this the rotary doctors can play a role. We only stay a short time and if people get annoyed with us it is of no significance. A few Swedish nurses here could work wonders.
On Monday not very much happened as there was an awful lot of patient referred to the ward. Quit a few are dehydrated, partly because of the unusually hot weather. Some of them required a drip and those the staff executed. Someone must have once ordered i.v. therapy and told everyone that if they did not do as ordered the bad eye would be on them for ever. A lot of other things ordered were not done, except giving antibiotics because of fever. Very often up to three different broad-spectrum antibiotics, one quite often given i.v. As the OPD is not open on Sundays except for acute cases the C.O. must have worked very hard as I believe there must have been quite a crowd waiting to get treatment. Then he was wanted on the ward for reassessing patients as the staff did not think the Swedish doctor is totally reliable.
Tuesday was the day of the Scandinavian Party. Maria spent the day making food and arranging flowers for the table. The party was a success. Tuesday Musaka and sister Erna were GOH Guests of Honour, and the two Swedish engineers, and the two English doctors completed the party. Unfortunately mrs Musaka did not come nor any of the Musaka kids. The food was consumed anyhow and the chatting was intense. Sometimes a bit wild I think with the Musaka ears. After the two GOH had left the rest of the party sat down in the “parlour” to drink beer or whisky, and talk about chimpanzees and other interesting subjects.

A last note

This is going to be the last of the notes in the blog made in Mpongwe this year.
We know this has been a fantastic time filled to the brim with interesting things. A few of our inner thoughts. have displayed themselves unwillingly and for that we apologise. You cannot go through life without noticing things and there are a lot of differences between Africa and Söderköping This is extremely clear to everybody from Sweden that have been to Africa. Afew are regarded as good and some are regarded as bad or not so good. We had an interesting discussion with mr Musaka about eating caterpillars. He regarded some as a delicatessen but I can hardly think of eating one. The conclusion is that Zambia and Sweden are as unlike as the fact that the sun in Zambia is in the north but in Sweden in the south.
The morning murmur was as usual and the round frustrating as usual. There was a lot of important tests and other procedures not done and the nurses student that was my aide was not even slightly sorry. She was only carrying the papers. In the afternoon II found out that she had not noted any of my orders and they were not executed. We had some very dehydrated children that needed extra care and she could not be everywhere. I tried to persuade two parents to allow us to set a feeding-tube in their extremely dehydrated daughter. They did not allow us. The child had started giving away some urin which is the first sin that the rehydration is taking effect. Without the feeding-tube her chances of surviving are minimal, we told the parents. The paraplegic boy with the pressure sores have got a little fever and I am dying to do a bacteriologic culture from his wounds.
Maria had blown her head when she found out that our garden boys had equipped themselves with Swedish operating dresses. We additionally found out that a multimillion dentist chair with all possible fittings, was standing under the blue sky and dust without any protection. We contacted the donors and our coordinator and the hospital officials. A lot of people moved the dentists chair and a lot of other things down to the hospital and indoors. When pushed they react.
Late at night the Swedish doctor that is to succeed me, arrived. She had had troubles in customs because her baggage was lost. We, Maria and Tom, served a nice dinner and Anna Karin went to bed early.
We had an interesting and constructive discussion with Dennis from the Workshop. We decided to put our last “give away” money in a project to restore the old OPD into a childrens OPD and ART counselling room. It will be possible to have a room especially done for children and to separate the grown-ups and the children waiting in the OPD. One problem is that not a word of mutual understanding and economics are written down.
At the morning mumbles Friday I told the people there about the Childrens OPD and we all heard Becky talk about heart failure. A very fascinating subject that gave cause for a couple of questions from the audience. I made a short speech and bade goodbye and thenk you for te weeks that have gone. I sincerely hope that the cooperation with Sweden will continue even if it has to be otherwise.
The ward is presumably given to Rick as from Saturday so I tried to write in a reasonably discernable way. The same troubles exists and I guess that Rick will have to fight the same fights as I have done. Nobody is actually dying but there are a few that will if nothing is done.
I want to thank everybody that have used their valuable time to read this blog. Thank you all!

20100929 by Tom

This is written on Wednesday after the morning round. It was one of the most frustrating experiences in my medical life. I had a dresser named mrs Mwunda, the oldest and presumably the most experienced of dressers. She was all the time looking through her papers making notes and talking to the other staff, and was not listening to me at all. She had no clue as to why no tests ordered were collected and still lesser taken to the lab for processing. One little patient had been in the ward for two full days completely unnecessary because a simple dipslide urin routine test was not done. I cannot get into my mind that the staff is not at all interested in the patients will or well-being. If they are they hide it well. I have been wondering if there is something in the attitude towards the sick human being tat I have missed completely. If the staff, as it seems, are only interested in the salary they have because they are hired, we have a gigantic problem to overcome , if we aim at getting good care to Zambia. It is a question of the mind not of skill. In this the rotary doctors can play a role. We only stay a short time and if people get annoyed with us it is of no significance. A few Swedish nurses here could work wonders.
On Monday not very much happened as there was an awful lot of patient referred to the ward. Quit a few are dehydrated, partly because of the unusually hot weather. Some of them required a drip and those the staff executed. Someone must have once ordered i.v. therapy and told everyone that if they did not do as ordered the bad eye would be on them for ever. A lot of other things ordered were not done, except giving antibiotics because of fever. Very often up to three different broad-spectrum antibiotics, one quite often given i.v. As the OPD is not open on Sundays except for acute cases the C.O. must have worked very hard as I believe there must have been quite a crowd waiting to get treatment. Then he was wanted on the ward for reassessing patients as the staff did not think the Swedish doctor is totally reliable.Tuesday was the day of the Scandinavian Party. Maria spent the day making food and arranging flowers for the table. The party was a success. Tuesday Musaka and sister Erna were GOH Guests of Honour, and the two Swedish engineers, and the two English doctors completed the party. Unfortunately mrs Musaka did not come nor any of the Musaka kids. The food was consumed anyhow and the chatting was intense. Sometimes a bit wild I think with the Musaka ears. After the two GOH had left the rest of the party sat down in the “parlour” to drink beer or whisky, and talk about chimpanzees and other interesting subjects

20100927 vilka kvinnor

Oj, vilka kvinnor det finns……..
Ja ibland får man uppleva saker även i kyrkan.
Gudstjänsten på söndagarna är ju alltid full av upplevelser, den här söndagen var inget undantag.
Först var det Ernas tur att vara söndagens huvudperson, jag har ju redan berättat om henne.
Med sin självklara auktoritet tackade hon församlingen för de fem åren som hon fått tjäna dem, hon är missionär och hennes missionärsgärning har alltid varit som barnmorska.
Alla babies som hon fått lyckan att ta emot, tårar av både glädje och sorg som hon delat med deras mödrar, allt berättade hon på engelska tack o lov, jag tror inte hon pratar så bra lamba.
Hon bad för församlingen och deras framtid.
Sen fortsatte gudstjänsten, man förstår ju ingenting utan tolk men emellanåt är det tolkat, t ex alltid predikan. Igår tolkades den av Henry Holmgren och bredvid dagens predikant tolkade han även kroppsspråket, det var sevärt. Predikan handlade om hur Gud skyddar oss om vi bara ber om det. Liknelsen med en örnmamma och hur hon bygger boet, klär det invändigt med det mjukaste dun och sen hur hon matar dem , lär dem flyga med mera, berättat på två språk men med samma kroppsspråk var verkligen roligt och också gripande.
Efter det kom dagens andra huvudperson, en kvinna som berättade om en av körernas missionsresor till Kitwe, en stor gruvstad, där man med hjälp av körsång ”told the gospel”, det var som att sitta på Dramaten och höra och se Margareta Krook.
Hon berättade med en stark röst, stor kropp , stort kroppsspråk, en historia som jag ju inte förstod allt av men tillräckligt, de hade ingenstans att bo, utan fick ligga i lastbilen, som de åkte med, hur män kom på natten med knivar och försökte jaga bort dem därför att de trodde att de var besatta av onda andar. Kvinnorna var ju inte sämre än att de med hjälp av sång och dans och gud vet vad mer, fick de att förstå att de var sända av Gud och inte av djävulen, jag skrattade som jag inte har skrattat sen jag kom hit.
Toms omedelbara kommentar var att hon var en riktig Zonta, jag tror inte vi har så många sådana Zontor.
Hon är änka, hennes man dog i Aids, hon är skild och nu ordförande i Zambiska baptistförbundets kvinnoorganisation. En riktig Grand Old Lady.
Nu har vi haft en morgon utan vatten, det har just kommit tillbaka, jag har varit bank också , lån utan ränta till en som behöver.
Skulle gärna haft tillgång till en sådan bank själv, det här månadsskiftet, är tufft.
Men livet är ju sådant, ibland är vägen knagglig, men den går ju ändå att ta sig fram på.
Hej då för den här gången, från Maria, Ma och Farmor

20100926 söndag betyder kyrka

Ja nu är det söndag igen och idag blir det gudstjänst med nattvard, vilket säkert blir en speciell upplevelse.
Tom har redan givit er en grundlig redogörelse över de sista dagarna.
Jag ska bara tillägga något.
Min surveypresentation gick bra, precis som Tom sa, men vi hade också en allvarlig diskussion efteråt om antibiotikaanvändning, bakteriologi och odling och resistensbestämning, det lät faktiskt som om doktorn, som nu är”in charge” för den medicinska verksamheten lät irriterad över att den ena av de två som kan odla , var borta och att den andra inte tagit tag i det under tiden. Det var verkligen uppmuntrande för oss.
Sedan var den stora sjukhusfesten i vår trädgård en speciell upplevelse, jättelika högtalare som verkligen dånade ut afrikansk pop, människor som dansade långt innan maten var färdig, folk som sprang överallt, två hundar i trädgården, som åt upp allt som föll på gräset.
Alla tal, böner, maten! Önskar ni hade kunnat dela alla dessa upplevelser med oss, det är omöjligt att beskriva i ord.
Så småningom var allt över och vi kunde koppla av med vår lilla whisky i den vid det laget mörka och varma natten. På kvällarna är Afrika fantastiskt, utom myggen förstås. Jag har säkert 20 myggbett på varje ben och de gör ont. Vaknar varje natt vid 4 tiden och måste gå upp, dvs krypa ur mosquitonätet och ta en cetirizin för att så småningom bli av med den värsta klådan., men det är inte malariamyggor, men de finns ju också, men kommer egentligen inte förrän regntiden kommer, och den kommer i slutet av oktober.
Igår lördag, var det återigen avskedsfest för Erna och Dennis Okoko, men familjärt och stillsamt och trevligt. Erna kommer att förbli vår vän, det är jag säker på, fantastisk, 65 år snart och med halva sitt liv i Afrika som barnmorska , hon har varit med om det mesta. Bland annat varit utsatt för och nästan ihjälslagen en natt i sitt hem. Flögs hem till Tyskland för vård och det tog ½ år innan han var återställd och fått hjälp av psykolog i Schweiz för att bearbeta sina upplevelser. Till slut orkade hon åka tillbaka, då hit, där hon nu varit i 5 år, men med vakt i huset dag och natt.
Vi har nattvakter i kvarteret som går runt här i trädgårdarna på nätterna, önskar de kunde få tyst på hundarna ibland också, de för ett jäkla oväsen, en del nätter.
Nu har vi 5 dagar kvar och vi ska försöka få en del saker som diskmedel, salt och en del annat att räcka hela veckan.’
På tisdag har vi vårt avskedsparty, onsdag biblestudies, där jag förväntas stå för klokheterna, det blir inte lätt. Torsdag kommer nästa svenska doktor och lördagmorgon åker vi.
Dessförinnan ska vi också ha kommit överens med sjukhuset om hur det nya väntrummet för barn ska göras, och hur våra pengar bäst ska komma till nytta.

20100923-25 by Tom

The Thursday started without excitement and the mumbling meeting was without doctors exception was little old me. It promised to be a warm day and the late-coming dr Chpaila said that Becky was glad to wait until next Friday for her lesson. Maria got ants in her pants and was in high gear to do her presentation. Not much happened during the round except that a lot of things ordered on Wednesday were not done. I send five patients home among those three relatively well “measles”. Nothing is to report from my afternoon “round”. There was not any nurse or other person around so I looked through some papers and returned home. We had agreed to play Yatzy in the night but Maria abstained in favour of getting well prepared for the big performance. The five of us drank lightly alcoholic drinks and played for three hours. Linda managed to get the best score. Then to bed knowing our plot was to be the stage for a big party Friday at 15 00. We were told on Thursday that the hospital was holding a good-bye party for Erna and dr Okoko. We also learned that it was to be on the backside of our house. Something like 60 persons were anticipated to attend.
Marias presentation on Friday morning was a success. Without a video projector she was forced to use the whiteboard. It worked out all right. She made her point quite clear : there are more infections among children than usually anticipated. Mon the more than 3000 patients handled by the COs every month a considerable amount are children that we in Sweden do not treat with antibiotics as we know that viruses are very common among them. Here they give them antibiotics, very often wide spectrum, Which, she pointed out, in the long run will be disastrous. Maria also pointed out how much hand hygiene will mean. The question about a water-dispensing apparatus in the waiting-room could mean was also discussed.
The rounds Friday were without any special interest.
There is no shadow whatsoever on the backside 15 – 18. We were not invited but we were to attend anyhow, as they were having a lot of the making of the party in our kitchen. They were to put both chicken and beef on the grill, but they did not start the grilling until some of the 20 speeches were held. This gave a late start to the eating but Dennis who was the “confrancier” kept the people on their toes the whole time. There was also some dancing. The locals were very good especially Angela. The music machine was very loud and could not be ignored. Erna was not interested in dancing but dr Okoko did some. The two VIP´s got their presents from the hospital wrapped in nice paper. I te end the food was ready and we all devoured potato salad, cabbage with mayonnaise, Grilled beef and chicken pieces. When it was all over the garbage took all our plastic bags so we had none in our garbage tin the next day. T sure was a stylish party.
We were late out of beds on Saturday morning. The round was uneventful but for one patient. It was a 12 year old buy, who had fallen out of a tree a year ago and broken his back. It made im a paraplegic without any movements or sensations from somewhere around his navel. He had an enormous pressure-sore over his “tail” that had healed at the price of two pressure-sores over his hips. One, the right was 15 x 15 cm wide and deep as to go to the hip-bone. The upper leg-bone was visible under a thin sheet of tissues. There was a foul smell in the room, suggesting a n infection. What on top of redressing is to be done will be discussed on Monday. The only consolation is that the boy does not feel anything.
The Holmgrens had a small party to say good-bye to sister Erna and dr Okoko. It was held in yje garden of dr Okokos former house. Attending were the two VIPs and their family and mrs Musaka and her family(Tuesday was away to some neighbouring country) the Holmgrens and Maria and me. It was a very nice and cosy party, without the high strung speeches. Maria had the computer and showed dr Okoko the results from the survey. As the sun was setting the party ended and Maria and Henry had a serious discussion on God and belief. Maria has got the task of talking some on next Wednesday bible-group, and she did not quite know what to say. I do not quite know if she knows now.
I could not show Henry how to handle the dongle as his coputer has Windows Vista and the dongle had not the right driver on board. I could not easily find the right one on te internet, there was too much to choose from. He is to visit the technicians from which Maria bought the dongle. They will for sure know how to handle this problem. At home we could always ask Måns.