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