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.

20100922 by Tom

It looked like being a hot day as there was little wind and the sun was bright as ever. The mumble-meeting was short with some true words spoken by Erna who had her next to last night as a midwife, ever. Nobody had heard anything from Becky and Rick, but we all hoped all had gone well. During the round I was accompanied by a nurse student named Clara. She speaks bad English and is vaguely interested in the patients. I sent six of the 20 odd patients home. Among them four of the so called measles in isolation ward. The poor child with hydrocephalus had an ultrasound scan, which showed traces of brain tissue. The rule is apparently that the ones with brain tissue on the scan are referred to have a shunt. But this mother refused, she could not leave Mpongwe and had no money to go to Ndola, so she will go home on parents wish, with no action taken. Our three burns had their wet dressings that were not wet. The mothers had not the amount of necessary information that made them good nurses for their children. To have them on fluid lists and daily weighing was too much to be asked of them. The staff did not bother. The little boy with burns in his face did not eat nor did he drink enough. He is one year and breastfed, and has some reserves to take from so we do not lean too much on him.
At “home” the garden boys under the leadership of Angela and Maria have worked
wonders around the house. In a few months time it will be lots of flowers around the house but for the moment it is just nice beds and that will be all on Friday at the party.
At 1930 it is bible-group at Rosies next to Erna and after that Maria and Tom are going to the maternity ward to take photos of Erna on her last night on charge as a midwife ever. There were not very many women in the ward. Erna had to unlock the door to the maternity ward for us. She said that the drunkards from the market tended to use the maternity ward before the lock. The place looked very worn down to our eyes. There was two women in labour in the ward and they would deliver during the night. Tom took some pictures in the ward and delivery room. And then we thanked Erna and went home to our whiskey. It is very warm still 2200, 28 degree C. Maria ends her writing and so do I.

20100921 by Tom

Today was the day Maria and Tom was to be talking to sister Jane about spending money on the MMH. The mumbling session was rather brief but none had died and that was that. Sister Erna had had her second last night and was rather outspoken about the general lack of vital medicin, in this particular case oxytocin (a drug given to women who have just delivered a baby to contract the uterus and avoid unnecessary bleeding). There was only three capsules in the hospital said Erna and that was not enough for the coming week. After the mumbling session we had to wait for a quarter of an hour to meet Sister Jane. She was all in favour for a general sum of money going into the coffin of MMH, or a sum of money to buy foodstuff for the patients. Maria and Tom wanted something more tangible so we settled for a refurbishment of a waiting-room for children. It was to be made in the former OPD next to the lab. We will have a draft this week we hope. There is some money left after the autoclave sins Mike has got money from the state, within a program for promoting bacteriological work. Maria and Jane has obviously made a quick one sins Maria has gone to Luanshya to collect some cash.
The morning round started rather late as we had a longish talk with sister Jane. There was quite a lot of patients but a lot of things ordered yesterday were not done so I had to be stern again. I also learned from the nurses student that was my aide, that they never do shunts on hydrocephalus’s ere in Zambia. They do a scan and then tuck them away to die from various reasons. It grew hotter and hotter as the day went on and you could feel it in the ward. The smaller children were not at their best. The air stood still even if the windows were all open. In the burns ward there is always a bit warmer than elsewhere the temperature was formidable. We have four burns there now, all burnt by cooking water and they are < than 10 % all of them. They start crying when you get near to them, just in case, and are generally speaking having pain all the time. By the time I got home Maria had gone to Luanshya to get some money for the hospital. We donated the money to the hospital kitchen to get it over a sudden failure to get stuff to make decent food for the patients. As we were sitting in the back lawn of the doctors house in the quickly darkening evening a midwife arrived. She happened to walk by and used the opportunity to inform us that a farewell-party in the honours of dr Okoko and sister Erna was to take place in our garden on Friday. We were invited to participate in this party the hospital was throwing in the afternoon. As it grew quite dark we had to retire to the interior. Maria was trying to get some fashion to her project by sorting her patients in different ways. It was comparatively easy as she had put them all into an Excel-spreadsheet for calculating and statistics. She might present her data on the Friday mumbles.

20100922 pengar, pengar pengar

Världen är sig lik, vad handlar det mesta om i denna onda värld, jo just pengar.
Vi har ju med oss, men på ett konto, de ihopsamlade pengarna sånär som på de 28000:- som redan gick åt innan vi åkte hemifrån, till autoklaven.
Men vi bestämde, innan vi for, att vi skulle titta på behoven när vi kom hit och se vad vi ansåg vara mest behjärtansvärt och naturligtvis viktigast för vården.
Veckorna har gått och vi har diskuterat det här varenda kväll. Desillussionen har kommit krypande och vi har tänkt om minst 10 ggr.
Igår morse hade vi ett möte med chefssjuksköterskan, för att höra hennes förslag, hon tyckte att vi skulle sätta in alla pengarna på sjukhusets konto för alla akuta behovs täckande.
Det finns sådana dagligen som får lösas på olika sätt.
Vi var inte särskilt tända på den idén utan ville att vi skulle få uppleva en förbättring av något slag på sjukhuset, något som annars bara skulle skjutas på framtiden och kanske aldrig kunna förverkligas.
Kom ihåg att vården, byggnaderna, hälften av alla anställdas löner, betalas av sponsorer.
Medicin står staten för samt 3 läkare, 2 clinical officers, samt 12 sjuksköterskors löner står också staten för.
Allt annat skall hostas fram på ett eller annat sätt.
Vården ställer man sig ofta mycket frågande till, framförallt personalens attityd mot patienterna även att läkarnas ordinationer inte blir utförda, är i våra ögon sånt som bara måste ändras på.
M en, det finns de som är fantastiska och jobbar som djur och är duktiga.
Vi fick i alla fall ett par konkreta förslag på sånt som står högt på önskelistan och som vi själva kan inse vidden av, så vi bestämde oss för att satsa resten av slantarna på en akutmottagning för barn.
Alla akut sjuka barn får vänta bland alla andra, i timmar, skrikande, jag vet, eftersom jag varit på akutmottagningen i 2 veckor och upplevt alltihop.
Dessutom har det varit tillfällen med både mässlingar och påssjuka bland övriga pat också.
Det finns redan ett rum där den gamla akutmottagningen låg, som ska användas till det.
Vi bekostar , viktigt, vatten(handfat, toilette) i anslutning till själva väntrummet, ommålning, möbler och (vill vi, leksaker). Från det här väntrummet som även innehåller bås, där man kan undersöka barnen, sen är det bara några steg till lab och apotek , barnavdelningen ligger också rel nära.
Ja det var det roliga som hände igår. Jag var tvungen att göra en akutinsats med pengar till mat till ALLA pat, vilket tog 3 timmar med bil till närmaste stad, fick även betala bensinen!
Men det var en privat insats.
På eftermiddagen satt vi i trädgården och pustade, det är varmt nu, riktigt varmt, när en snygg sjuksköterska klev in i trädgården och berättade att partyt för Syster Erna blir här hos oss på fredageftermiddag. Vi såg väl ut som två fågelholkar, men det var ju bara att gilla läget.
Vi gillar ju framförallt Erna, så det blir roligt.
Vi blir visst c:a 50 pers!!!
Sen är det avskedsparty hos Holmgrens för Erna på lördag och på tisdag har vi vårt avskedsparty. Men kom ihåg att alla tillställningar är helnyktra, så man vaknar utan huvudvärk!
I kväll har vi haft biblestudies, det är underbara stunder, när man upplever, djup och äkta religositet, som man aldrig upplever i Sverige.
Nu har vi tagit vår lilla magförstärkare, och ska gå och lägga oss.
God natt alla, älskade barn, barnbarn, vänner, arbetskompisar, från Maria, Ma och Farmor

20100917-20 by Tom

The mumblingmeeting on Friday was short. Nobody was hooding a educative talk. Okoko was no longer there and Becki was supposed to be on her way to Lusaka. As it turned out their papers were not ready so the English had to wait until Sunday to go to Lusaka to get their visa and other papers. Tuesday was going to help them. The round was also relatively short as we only had 9 children in the ward, of which three were malnutritioned and another three were suspected measles that were all coughing but relatively well. I could hear no sounds on their lungs suspect of being pneumonia. The hot day was spent with a book, in my case by Jeffery Deaver, very good. About a magician who could vanish from a closed room. The evening was spent in a local “restaurant” drinking beer and eating local specialities. That means nshima and fried chicken. We spent the entire evening together with the English and the two architecture students from Malmö. It was very cosy and we had discussions on all subject imaginable. I do not know how long they stayed, but Maria and I went home around 11.
Saturday begun with a morning round, that was full of stress. There were 7 patients waiting to be admitted ad I was in a hurry because Maria and I were supposed to go to Ndola with a transport. It turned out that it was Tuesday Musaka that drove the two Swedes to their flight. We bought a lot of things in Shopright and went straight home. Nice but very hot, AC is something you do not use without cause.
Sunday is he day of rest so we stayed In bed long. Marias stomach was not ok, so she did not go to church. It was a special service with a lot of singing and choir-dancing. I gave up after two hours when they had a show in bemba that I could not understand one word of. Maria was at home “gardening” which means planting different flower around the house. More exact you can read in this blog by Maria.
Monday found the ward with 20 patients of which I had not seen the best part before. Nearly everything the CO had ordered in the way of tests and medicines were not done. Of course nobody knew why the given orders were not followed, although I know it is of no use being angry I ordered them again and was nearly rude. We had a ugly underarm fracture with some angulations and small fragments of bone around. Dr Chipaila was going to try to correct it in Ketalar analgesia. We will see tomorrow what was the result on x-ray. A small boy with a water-head (hydrocephalus) we will send for a shunt after ultrasound to establish the amount of brain tissue. A malnutrition child with HIV we were sending to another hospital to be nearer to its sick mother.
During the day Maria and the garden boys have continued gardening and soon there will be flowers all round the house. Most of the evening was spent in front of the computer to write this and to look for the results of the Swedish election.

20100920 mer från Mpongwe

20100920 måndag i Mpongwe
Det är dagen efter valet, som vi faktiskt kunde följa korta snuttar av, på nätet. Det blir inte lätt för Fredrik Reinfeldt att kryssa mellan alla minor, som uppenbarligen, de avundsjuka andra politikerna kommer att lägga ut. Men jag är ändå glad att Alliansen gick segrande ur det här valet, det är ju nu man kan genomföra , det man lagt grunden till, första perioden, t ex skolreformerna.
Faktum är att BBC world haft tre inslag idag om det svenska valet där svenskar kommenterat resultatet. Det är roligt att vi får litet uppmärksamhet någon gång.
En annan positiv sak som hänt, medan vi varit borta. Är att kronan stärkts så mycket, härligt för oss.
Vi har börjat nedräkningen för att åka härifrån, nu.
Imorgon bitti ska vi träffa , chefssjuksköterskan på sjukhuset, som verkar både trevlig och pålitlig. Hon skulle höra runt på avdelningarna om de hade något de riktigt hade trängande behov av.
Vi har ju fortfarande labbet, där vi vill , om det behövs, satsa mer, för att baktlabbet ska komma igång. Jag hoppas att vi kan träffa labchefen innan vi åker. Han fick barn häromdagen, ett par veckor före beräknad tid och är för närvarande i Lusaka, hans familj kanske kommer därifrån, vad vet vi.
Han var i alla fall så omtänksam så han skickade oss ett mail igår och berättade varför han plötsligt var försvunnen.
Den helg som just gått, har vi varit en resa fram och åter till Ndola för att få handla litet mat, drycker och så vidare, inget vin, nej, nej. Men en liten whisky för magen , på kvällen blir det.
MBA som är paraplyorganisationen som sjukhus, kyrka, skolar, bostäder, sorterar under, har just haft utvärdering av ett stort projekt, med div personer från Sverige, Tanzania och Kenya, inblandade. Vi har träffat allihop, mycket imponerande människor som gjort väldigt mycket i jämförelse med oss vanliga. En av de två svenskarna, från evangeliska frikyrkan, Interact, utomlands, talade t ex Arabiska, Swahili, Temchack(talas av tuaregerna i Niger), franska, engelska och svenska förstås, imponerande, dessutom var han väldigt trevlig. Han hade bott 6 år i Niger bland Tuaregerna och haft ett brunnsgrävningsprojekt där.
Nu åker han runt, just nu i Afrika och gör sånt som de just gjort.
Vi var på ”krogen” i fredags, med de engelska doktorerna och de svenska studenterna som går igenom sjukhuset, för att skriva sitt x-jobb på Malmö tekn högskola.
För övrigt har jag ägnat mig åt trädgården, några dagar, till och med lyckats få med mig våra trädgårdsboys, som inte gör många knop per dag.
Min survey är färdig och jag ska bearbeta den i exsell imorgon, hoppas det blir bra. Jag ska presentera den antingen nu på fredag eller nästa fredag.
Mår bra, hade en omgång med orolig mage igår, så jag vågade inte gå i kyrkan. Hade förmodligen inte tvättat händerna innan jag åt chips på kvällen.
Man måste tänka på hygienen hela tiden, sköljer även grönsaker i flaskvatten.
Vattnet blir rent, genom att man lägger ut flaskor med kranvatten i ,i solen i 9 timmar.
Till barbarnen:
Hej alla söta barnbarn! Ni kan inte ana hur mycket jag längtar efter er. Samtidigt hade det varit så roligt om någon av er kunnat vara med här och få uppleva, den här främmande världen, som verkligen är så långt från allting hemma, som man kan komma.
Här bor de flesta i en hydda, utan vare sig el eller vatten inne. Ändå ser de jättesnygga ut, vår hjälp, Angela, bor så, och jag har träffat hennes två flickor och de är så söta och fina i sina skoluniformer. Den äldsta är 12 och hon ska nästa år försöka komma in i 8 klass. Dit kommer man om man har riktigt bra betyg. Hennes föräldrar har betalat för hennes syster och henne ända sedan första klass, man måste ha med sig, skollunch och vatten att dricka.
Angela har flaskor med vatten liggande i vår frys, som hon springer ut och ger dem, när de går förbi här, på väg till skolan. De har ju ingen el, och således ingen frys, inget kylskåp, eller annat som vi tycker är självklart.
Vi har sponsrat, plåttaket till deras nya hus, som ska vara färdigt, nu innan regntiden kommer.
Där får flickorna ett eget rum, men fortfarande ingen el, det hoppas de ha råd med nästa år.
Jag kan nästan inte föreställa mig, hur de har det, men vi ska få komma hem till dem innan vi åker hem. Som ni säkert vet så ska vi göra en resa till södra Zambia innan vi åker hem, för att få se Victoriafallen, världens största vattenfall, det heter på Nyanja, språket man pratar där,mosi-o-tunya. Det betyder röken som dundrar, man trodde förr att det bodde onda andar i dundret och vågade inte ens gå i närheten av fallen.
Det ska bli spännande!
Petter, jag hoppas Du är frisk från din halsfluss nu!
Kom ihåg att be er aftonbön! Stora och varma kramar från farmor.

Till er andra, ha det bra, vi ses snart!!! Kram från Maria, Ma och Farmor

100917 Nyheter från Afrika

100917 nyheter från Afrika

Nyheter av det mindre slaget kan man väl säga.
Onsdag, var jag hemma , gjorde litet i trädgården, fick bl a ett stort skott av en pelargon av ansenliga mått som Holmgrens har i sin trädgård.
Samt en del tagetesfrön, som Stella tar vara på, när blomningen är över.
Stick bara ner pelargonkvisten i jorden så tar den sig direkt, sa den ädla givarinnan och minsann den lever än, nu är det fredag morgon. Jag sådde tagetesen också efter att på egen hand ha bearbetat jorden med en hacka, på äkta afrikanskt vis. Spadar finns inte.
Jag bakade matbröd, det har jag gjort sedan jag förstått att det Zambiska brödet inte är den sortens bröd vi gillar. Det är lätt gjort, jag har hittat ”brown” mjöl, jag tror att det är grahamsmjöl, råg verkar inte som det finns här.
På kvällen hade vi biblestudies, med Henry Holmgren som uttolkare av ett bibelord som han valt. Det var den bästa förkunnelse av bibeln, jag någonsin hört.
Om det funnes fler sådana präster eller snarare förkunnare, så skulle människor strömma till kyrkan. Nu är han baptist , liksom hans far före honom, missionär, som arbetat i Zambia och Mozambique, större delen av sitt liv, det är en fascinerande person.
Biblestudies är en sorts studiecirkel, där man tränger djupt in i ett bibelord och tolkar det.
Så sjunger man ett par psalmer, ber förbön för några som man föreslår där och då.
I onsdags hade vi förbön bl a för Pelle Hervius, vi tänkte och kände mycket den stunden.
Ja det var onsdagen.
Igår torsdag, var jag sista dagen på OPD, och har nu c:a 100 pat i min survey och har tänkt att sammanställa siffrorna nu och presentera dem på nästa fredags morgonmöte.
Det var en intressant förmiddag, med mycket spännande och otäcka fall.
En våldsam , psykotisk patient, som drogades ner, när man övermannat honom, vad som hände sedan vet inte jag.
En liten flicka som varit utsatt för ett sexuellt övergrepp i måndags, mycket konstigt betéende från mamman är allt jag kan tillägga.
En Aidspatient med Kaposis sarkom, ena foten tre ggr så stor som den andra och hur den för övrigt såg ut, ska jag hålla för mig själv, det orkar ni inte ens läsa.
En del andra för mig tidigare okända sjukdomar såg jag också, intressant och lärorikt.

På eftermiddagen, fick jag trädgårdskillarna att hjälpa till, med mer blomplantering.
Vi hämtade fler pelargonskott i gästhusets trädgård och planterade och hittade Tagetesplantor som Sylvia Norén planterade när de var här i april-maj.
De är nu utplanterade i trädgården och det kommer nog att bli fint runt huset så småningom.

Man kan uppenbarligen plantera vad som helst och det gror.
Jag har nu planterat litet rosen kvistar som kom från Dr Bandas trädgård, vi får se,
Det är väldigt roligt, alla vill ge något avtryck, vi kan i bästa fall lämna rabatter med blommor , som gör hus och trädgård, ännu mer attraktiva.
Huset är ju sååå trevligt. Vi är nu av med en mus, som irriterade mycket första veckan, hål på brödpåsar, mjölpåsar, ätna tomater osv.
Angela köpte råttgift på marknaden och det har nu gjort nytta.
Även kackerlackorna, även om inte helt borta, i alla fall under kontroll.
Igårkväll hade vi en mycket intressant och givande diskussion med en svensk, Bernt-Åke……., chef för Interact i Afrika, som tillsammans med tre andra , är här för att utvärdera ett projekt, delvis SIDA finansierat, som på gått sedan 2007. de två från Mozambique, resp Kenya, träffade vi i tisdags.
När han gått vid niotiden, satte vi oss för att äta litet ”lätt” kvällsmat, trodde vi.
Angela hade köpt fantastiskt stora och mogna avokados på marknaden. Tillsammans med litet räkor med majonäs, skulle det bli fest. Vi hade verkligen överskattat vår aptit, efter en halva per person var vi proppmätta och efter ytterligare en halva per/person, kunde vi nästan inte resa oss.
Vi stapplade i säng, men sov gott.
Kram till alla , nära, kära familj och vänner från Maria, Ma och Farmor

100917 Nyheter från Afrika

Now we have reached halftime here in Mpongwe. The same routine carries on as all days with breakfast and a mumbling morning meeting. Most of it was about a rather complicated patient in maternity ward. The dentist read aloud the report from general wards and he did not know all the difficult abbreviations and lingo used in the report.
The round was rather quick as we have only 9 patients of which 3 are in malnutrition ward. It seems to be impossible to get a decent fluid-list that tells you not only at what time they get their feed but also how much seen for the 24 hours and the specific meal. In malnourished children this is very important. But as the staff leaves everything to the mothers it is hard to have them fill in lists they do not understand the meaning of. Naturally there were a few tests that had not been taken and one tat had to go to Ndola were not sent until yesterday although it was collected the 10th of Sept. (This is five days ago) The explanation was that transportation happened only Wednesdays. The patient is in malnutrition ward so there is no hurry. We know she has HIV but we would like to have this verified so that we can give her treatment and hunt for the contaminating party.
Maria had a hardworking day on OPD where she collected the last twenty patients for her survey. She saw a lot of awful patients among these one Kaposis syndrome with an ugly foot.
We met the two Swedes that are here in Mpongwe, send by Interact=Evaneliska frikyrkan, the same as sent the Wijks. They will try to evaluate a project sponsored by SIDA concerning the management of MBA and the hospital. We had an extremely interesting evening with a swede that was the head of EFK=Interact for Africa. We discussed MMH and MBA and their interaction and leadership at some length. We concluded that something had to be done, but the speed of action and the actions taken, was to be considered closely. A forthcoming meeting for all parties, including Scandinavian Doctors, was to be planned for next spring. The meeting should focus on information between all groups with an interest in MMH. There are too many people and too much of resources at stake to make anything without careful planning.

201000912-14 by Tom

The Sunday was very quiet and without shocking events. The sermon in church was full of songs and quire dansing. The preacher was comparatively short and the simultaneous translation very good. We made a short bicycle tour to get more airtime for our sim-cards, but otherwise there is nothing much to talk about.
Monday morning we found two of Taiga´s puppies in our lawn. One of them can be seen on a picture. After feeding them (they were very hungry) Maria went to the Mousaka house to tell them were the puppies could be found. Mrs Musaka sent two of her grandchildren to fetch them.
The morning mumble gave as usual very little. The round was rather uneventful as not much had happened in the ward during the Sunday. A few tests had not been taken and the new ones had most ordinations OK. The little boy with the broken upper arm still waited for transport to Ndola. He was referred on Thursday and waiting this long with great pain as soon as he moved, is child abuse. Getting a fluid list that stated how much the child was given and how much it had actually got (or swallowed) was still a subtle whish from the doctor. I soon will give up this whish in the general ward but in the malnutrition ward that they will reopen after restoration tomorrow I will be firm. Giving children in pain something to ease the pains is something else worth fighting for. As it is now they give something the first day or two but some will need painkillers for a longer time. Burns and broken bones are good examples. I am too soft they think but I think only of the child in pain. The little boy with extensive burns has “only” one not healed burn left, on his left thigh. The mother, who has cared for him for more than a month, is very tired of the ward and tells me every time I see her, that she is capable of caring for the boy at home. We will send the home in a few days time. The wound has healed very well the last couple of days and we think that it is best for the patient to heal in the relative clean surrounding of the ward.
At night we were invited to the Holmgren family together with Becky and Rick the English doctors. We had a most agreeable evening talking a lot about the conditions of earlier times and the hard time the earlier missionaries had to endure. We returned the three books Stella had given us earlier, all about missionaries and their work. Mostly the Doke family, Olive and C.M. Doke. They had on top of “ordinary” mission work, translated the entire bible in lamba. Henrys father had a hand in this too. Clemens Martyn Doke was a professor in amongst other things, Bantu languages (for example lamba). A booklet on the Baptist mission of lambaland was most informative. We tumbled home and into our beds that night.
The Tuesday started out quietly with the morning murmur. The round was uneventful but two patients were to be operated on. One little boy had extra toes on both feet and was to be operated on by dr Okoko. X-ray showed extra bony toes but no fixed connection with his ordinary toes. One was a boy, eight months old that should be circumcised, because of phimosis. I said that all boys of his age have a relative “trunk” penis (trunk as the elephants have) and in Sweden we do not operate without mortal need on patients before one year of age. But the C.O. Edvin did operate with the help of Maria and all went well. The boy with te extra toes was I great pain as we saw him in the night.
In the period after the round I went to the “before five”. They were going for the normal Tuesday outing. This means that a team goes by car to remote places to have a regular once a month child and mother meeting. T was the same thing as Maria was going with the Tuesday before. It is fascinating to see how you with barely any resource at all can do a lot. They weigh the children to follow their progress. They give hem immunisation shots and speak about family planning. All the mothers and the pregnant mothers are tested for HIV. They examine all gravidae and record their progress. They find out the possible date of birth and plan for it. Two male community worker, or informants, talked about HIV protection and of general cleanliness and common ailments like malaria. Most mothers and children tried to stay in the shade but the temperature was unbearable in the sun. As we had visited the two “stations” we took to the very bad road home. As I got home I found the house deserted, no Maria. After five minutes there was a knock on the door. It was two Swedes, Linda and Björn. They study architecture in Malmö and are going to do their exam-thesis on te hospital buildings, their state (of decay) and what you might do about it and how much that would cost. Björn is the grandson of the man that built the hospital back in the 70is, Stig Nilsson. We had some beer before we parted.
We were invited to a farewell-party for dr Okoko and family at the Mousaka house in te evening. Classical Zambian food inclusive of ishima was on the menu. Very good but is hard working for your stomach. The dinner started out with the traditional washing of hands. Then you are expected to use your fingers when you eat. A lot of interesting people were present among tese the two Swedes, the two Enlish doctors, Erna, two men from Tanzania and the old pastor Mukuele. A lot of speeches to hail dr Okoko and his family, that were leaving. There was no troules to fall asleep this evening.

20100914 mer från Mpongwe

100914 lite mer från Mpongwe

As People encourage us to write on the blogg, I will even today, although i feel that there is not much to tell you today.
Sunday is a day of rest and was so for us as well.
Toms stomach had finally cured, with a good help from Resorb, a fluidrestore tablet, which helps restore the salt balance in the body, Primodium also helps, as does lots of tea and not very much food.
So he felt secure with two hours in church.
The music and choirs is always the big experience, the spoken word hard to follow, although Henry Holmgren helped out a lot, sitting between us and translating, what he thought was worth translating.
The rest of the Sunday was mostly reading and writing.
There is a severe wind blowing all the time, which according to Angela is not common in this time of the year.
The red sand comes inside the house and everything is covered by red dust. The heat is tolereable, and the mornings quite chilly.
Now Swedish as the grandchildren will like this.
Igår morse när jag tittade ut klockan halvsju på morgonen var det två små valpar på gräsmattan tillsammans med sin mamma Taiga, tiken som jag både ger mat och kärlek.
Valparna försvann ju från vår häck för två veckor sedan, efter att ha skrikit , säkert av hunger, de sista två dygnen.
Valparna är så söta och jag har tagit några bilder på dem som jag kan lägga in på bloggen, så ni får se dem.
Jag hade ett stort ben till Taiga, sparat i kylskåpet, som hon fick och så gav jag valparna mjölk, medan hon åt på sitt ben. dom drack mjölken så fort dom kunde , Taiga hjälpte också till, hon behövde tydligen också dricka.
Så fort de kom i närheten av sin mamma bet hon dem så länge hon hade benet, så dom skrek, hon är verkligen ingen bra mamma.
Ja , jag tycker det är roligt med hundarna här som ni vet så jag gick inte tillbaka med dem , även om jag visste var de hörde hemma, jag tyckte dessutom att ägarna kunde leta efter dem själva. Fram på eftermiddagen gick jag dit och berättade att jag hade valparna hos mig och varför, ingen verkade bry sig särskilt mycket och jag erbjöd mig också att fortsätta ta hand om dom tills vi åker hem, men då ville dom ta hand om dem, antagligen har de tänkt sälja dem snart.
Det var måndag förmiddag, på eftermiddagen var jag ett par timmar på OPD, akutmottagningen, där jag håller på med en survey, för att ge dem litet uppfattning om hur mycket infektioner, de har. Målet är ju att göra de, som skriver ut medicin ,mer medvetna om vad det är de skriver ut, antibiotika alltså. Behandling i någon mening är det sällan tal om, det är mest att skriva ut medicin och lägga om sår, mycket brännskador.
På kvällen var vi på middag hos Dr Holmgren och hans fru Stella, han är teologie doktor och tituleras doktor, liksom alla andra doktorer här.
På middagen var även de trevliga engelska doktorerna.
Igår, tisdag, var Tom ute med barnavårdsteamet, samma gäng som jag var ute med förra tisdagen. Själv var jag på OPD, ganska många timmar tillsammans med den bästa av the clinical officers. De har längre utbildning än svenska sjuksköterskor, arbetar på OPD som en sorts sorteringsdoktorer, skriver ut medicin, läser av röntgenplåtar skickar folk till lab för provtagningar av olika slag, de är väldigt duktiga.

’På eftermiddagen skulle han dessutom operera en liten pojke med phimosis, vilket gjorde mig förvånad, Jag visste inte att de hade sådana kunskaper och befogenheter, men det har de, i varje fall här. Så jag fick vara med och titta och även ge pat litet mer ketalar och även nitrazepam. Allt gick tack o lov väl, men jag tyckte det var litet otäckt, han fick mycket att sova på och var bara 7 mån, usch. Jag övervakade honom, en timme på avdelningen också, han sov ju väldigt djupt, när jag bar honom tillbaka till avdelningen, insvept i operatörens gröna rock, det var det enda som jag tyckte var tillräckligt rent.
På kvällen var vi bjudna till Mr Musaka och hans fru och där var massor av folk, jag tror vi var 17-18pers, ytterligare två svenskar som kom i förrgår kväll. De är studenter från Högskolan i Malmö, de ska bli byggnadsingeniörer och ska titta på byggnaderna och underhållet, det ska bli intressant att titta på den rapporten. Hans morfar byggde för 30-40 år sedan, det här sjukhuset och tre av villorna som ligger här i ”vår” del av området.
Vidare var det en synnerligen intressant man från Tanzania, management consultant, som tillsammans med en Kenyan, ska utvärdera ett utvecklingsprojekt som SIDA bekostat.
Han hade bl a bott tre år i Genève, som någon sorts kyrklig consultant för Kyrkornas världsråd, annars var London, där han bott större delen av sina 30 år utomlands, hans andra hemstad. Nu bor han hemma i Tanzania, vid foten av Kilimanjaro.
Det här har ytterligare spätt på min längtan att få uppleva mer av Afrika.
Han pratade också om en karta över Australien, med alla öar, där de 7000 Fijiöarna är med, kanske något för Göran och Lisa.
De här fyra nyanlända bor i gästhuset, bredvid vårt, där Tom bodde förra gången han var här.
Annars var kalaset ett avskedskalas för Dr Okoko och hans familj, som nu flyttat till Luanshya.
När det var slut vid 9-tiden gick Tom och jag tillsammans till barnavdelningen och tittade till den lilla nyopererade pojken, som sov gott, men hade varit vaken och druckit litet.
Sen gcik vi lugnade hem och sov gott.
Stor kram till alla nära och kära från Maria, Ma och Farmor

20100911 utflykt

20100911 utflykt i det gröna

Här är nu lördag kväll och jag kan inte med bästa vilja i världen påstå att vi har något spännande nattliv, men andra har det.
Vi bor, som ni alla vet på en missionsstation i det svartaste Afrika, verkligen in the middle of nowhere. Runt sjukhuset som har 120 anställda ligger bostäder för sjukhuspersonal och en del administrativ personal på MBA, vilket betyder Mpongwe Baptist Association, det är även ett par skolor,samt den religiösa verksamheten som är omfattande, kyrkan är navet i verksamheten. Vi bor naturligtvis i den ”fashionabla” delen av området, där det ligger fina hus, med trädgårdar som sköts av gardenboys osv, medan de andra husen ser rätt ruffiga ut, det mesta ser rätt ruffigt ut, om jag ska vara ärlig.
Men och nu kommer jag till nattlivet, utanför missionsstationen finns ett marknadsområde av ansenliga mått och där är ett sjudande nattliv, där det serveras starka drycker, förbjudet inom missionsområdet, (whisky är som ni alla vet, medicin), man kan få allehanda STD, om ni inte vet vad för sjukdomar det är, så kan ni kanske räkna ut det. Jag stod som ett levande frågetecken, när någon berättade för mig att patienten sökte för STD.
Musiken därnere är uppskruvad på absolut högsta nivå och vi hör den väldigt väl i vårt hus, men som sagt det är en del av Afrika, det också.
Sitter vi på vår veranda, på kvällen så ligger huset mellan oss och musiken och vi kan istället njuta av cikadorna.
Idag har vi varit ute på en lång tur med två unga engelska läkare som verkligen blivit våra vänner här, vi fick hyra en Toyota landcruiser av MBA och gav oss iväg på förmiddagen, först för att bada i en mycket känd förkastningssjö som ligger ett par mil härifrån, sedan till vår närmaste större stad som heter Luyansha och faktiskt är en bit större än Norrköping.
Där skulle vi äta lunch och bunkra för ett par veckor, vi för tre veckor noga räknat.
Vägen till sjön är en obeskrivlig po t hole road, där man inte ens kan köra 40 km i timmen utan att skaka sönder njurarna, man kör helst halvvägs ute i bushen på endera kanten av vägen, det är ju vänstertrafik här, men vi körde helst på höger sida för vägen var något bättre där, det är bara när man möter någon och det är inte så ofta, som man måste köra över på rätt sida av vägen.
Så småningom kom vi fram till sjön, som var otroligt vacker, vattnet kristallklart , grönt och minst 25 grader varmt, där fick jag årets skönaste simtur. Vi stannade någon timme och vi lyckades naturligtvis träffa på ett par andra engelsmän, han läkare hon lärare som också var här, men ändå långt från där vi är, väldigt trevliga.
Så for vi tillbaka , på samma pot hole road, och fortsatte sedan 40 km åt andra hållet, allt medan vi ängslades för att dieseln skulle ta slut och vi skulle bli stående ute i the middle of nowhere, men vi kom fram till Luyansha, fick en okay lunch och kunde bunkra mat för tre veckor, dock utan kött, för köttdisken var redan stängd, när vi kom.
Jag får förlita mig på Angelas granne, hon med kycklingarna.
, annars får vi väl börja äta Ishima, folkets mat nummer ett, majsgröt, som absolut inte smakar någonting. Kl 19 var vi hemma igen, stjärnhimlen gnistrar , det är ett otroligt äventyr.
God Natt till er alla nära och kära , jag längtar ofta efter er, kram Maria, Ma och Farmor.

20100909 by Maria

Not much to tell today, except that our gardenboys almost set fire to the whole garden, when they were getting rid of old branches , which they had got left, when trimming a tree full of dead branches. It was really quite scary.
I have been in the OPD this afternoon, but did not see a lot of infectious patients, one was really nasty, but the others just had minor problems.
Sister Erna, the midwife, has got heelinfection and can not walk, too bad for her and too bad for me as I should have been following her tomorrow in the maternityward.
H
Tom has trouble with his stomach and has been lying down most of the day, feeling better though, this evening.
It is hot!!
Till barnbarnen, ni skulle sett elden vi hade I trädgården idag, 5-6 meter höga lågor I buskar och träd runt huset. Det är väldigt torrt ute och vår trädgårdsmästare skulle elda upp torra grenar som han huggit ner från ett träd. Oj, jag trodde hela huset skulle brinna upp, vi har ju vasstak på husetoch de kan ta eld väldigt lätt. Farfar har varit sjuk idag, lite tråkig i magen, som Petter säger, men han är bättre i kväll. Puss och kram, från Farmor.
Kom ihåg att läsa aftonbön

Love from maria

20100908-09

The dogs were comparatively quite during the night but sleep was not coming as it should anyhow. We went up as usual and Maria decided to stay home for the day. The morning meeting was little attended and I could not hear what they were reporting. The round was uneventful and I emptied the ward of some well patients. In a Swedish hospital they would have been kept in the ward for malnutrition, but here they are considered well and can be fed at home. I have hard to adopt that meaning, but the parents are very clear on the subject. The little boy with the wound in the thumb-grip did not want us to see the wound but we took away the wet dressing and looked. It was a deep wound but no signs of infection. I think a surgical physician will want to revise the wound in a fortnights time so we will send him home with dressings and things an make him come back in a fortnight time. The afternoon round was no round only a moment of control.
On the ninth of September we were discussing the English doctors and what they should be used for. The discussion was a bit inflamed as Richard pointed out very clearly that he was no surgeon. What will come out of this is unclear. In the ward there was a child 2 months old that should have a operation. The referring doctor had said in an almost unreadable scribble that the patient should have a cosmetic circumcision. Te risks wit an anesthesia in a so young patient is obvious and Rich did not want to have a pert in it. I supported this and the child was sent home without any operation. A complicated humeral fracture near the elbow with a lot of deviation was referred to Ndola. We sent some home and some stayed. I had a rather lively night as my stomach turned outside in. After 10 visits to the toilet and 7 tablets spposed to sto the gut I feel better now at night. I have spent most part of the day on the bed, while the garden boy was burning the garden down. It was quite a bonfire. Now at eight o clock we can still see some glowing tinder in the bushes.

20100907 by Tom

It is Tuesday and the night has been very noisy with the dogs howling all night. We got up as usual and ate out frugal breakfast. Maria was going out with the before five team so she washed her hair and made herself ready for the big adventure. She will write about it in her own part of the blog. I went to the morning meeting as usual first to come to the room 800 sharp. Dr Okoko was not present but dr Chipaila led the proceedings. I could not hear what the reporting nurses said, but I know from experience that it will take a few weeks before I do. After the meeting I asked if anybody knew of a map of the region. Nobody did but told me that if anybody did it would the MBA. Then I went for the morning round. The child with central malaria was earlier sent home so there was nobody in the acute ward room. A few small patients with GE (gastroenteritis=bad stomach) were all better with less diarrhoea and no more womitting. Maybee they can go home tomorrow. Two small girls have swollenness in the face: one a proposed submandibular abscess and one a suspected abscess in the salvary gland to the right. I do not think the submandibular abscess is suitable for IAD (incision and draining) even if she has no more fever, and the salivary gland is more like a stone or something in the duct, could even be parotitis. Dr Chipaila Was going to look at the to decide what to do. The swollen finger is also going to be reviewed. Our two tractions was given a plaster instead as it was not possible to have them in traction any more. They were howling steadily. So dr Chipaila gave them a plaster each and sent them home. It suddenly was very quiet in the ward. The boy with the wound in the thumb grip did not like us when we redressed him. His wound is deep and wide enough to make it impossible to stitch even if we should want to. There is until now no infection. A small girl had drunken some diesel, but she was well after 24 hours. She had thrown up four times when she had drunken the stuff ut had no cough, that could mean aspiration. She was somewhat sore in the mouth but had no visible damage to her mucus membranes. She was sent home. The parents were told to keep poisonous things away from the girl. I took a short turn to look after the ward in the afternoon but there was very little to do so I had an interesting discussion with Thimoty the nurse.
I was a short turn to the MBA office by bike to get some money from mr Musaka for the digital camera we had brought. The knew of no map over the vicinity. I took the bike to the Workshop to have my saddle a little higher. They fixed that and the bike was a bit easier to ride.