Beyond Mvuma

Happy Easter.

Today we (mom and I) went to the Great Zimbabwe ruins with the Cavanaghs.

According to our guide, G.Z. is the second largest ruin site in all of Africa, with the pyramids being the first. It was built around 1250 AD. The word ‘Zimbabwe’ literally means ‘house of stone’ and is of course where the country got its name in 1980 after independence.

We first climbed a rather steep hill with tiny steps of stone embedded into the ground. The king’s quarters or fortress was up at the top of the hill, where he could look down on his kingdom in the valley. It is a series of walls, enclosures and rooms set into the rocky hill top. There is an enclosure in the valley where the queen lived and ruled. Apparently she was really in charge because she was the one who kept the schedule . . . or at least that’s what our guide said.

Mom arrived last night. We spent the morning watching this chameleon outside of Sheila and Tim’s window. Chameleons walk with a strange ataxic 4 legged gait. Apparently, this is because they have 2 brains that are not connected so the usual coordination is delayed.

Later in the day we went to the market in town. Mrs. Blackwatch was there selling tomatoes and working on a basket.

It has been a busy week. I am here in Charundura for just 5 more days so much of my time has been spent finishing up projects and saying goodbye.

On Monday, I met with my English class for the last time. They entertained me with a play and then did a very humorous impersonation of me. Afterwards, I was invited to walk home with one of my students, Agnes who doesn’t live too far from the hospital. We ended up going down the road where I had ridden the bike a few times. Turns out I knew some of her kids already. . . they were the ones that were playing in the shade of the scarecrow and popped out when rode by. At Agnes’ home were her mother, two sisters in law, 9 children (the 3 girls, Linda, Juliet, and Faith are Agnes’), twin baby goats, 3 kittens and a slew of chickens. As I approached the house, I could hear the younger kids whispering ‘marongu’ (word for white person) and laughing, seeming to be very surprised and excited by my presence. They were all smiles as I shook each kids hand and exchanged stares. We chased the goats around for a while and played football (soccer) with a home made ball of sand and netting. And, of course they loved seeing their images on the LCD screen of my camera.

Yesterday, we went to my friend Florence’s home area in Siyahokwe. It is about a 45 minute drive on dirt road or a three hour walk from the hospital. On the way there, we had to cross a bridge where just 100 yards off the road there were some young boys bathing. When we paused over the bridge to take a photo they just laughed and waved.

Once in Siyahokwe, we met her family: her mother and father, two sisters, two brothers, her aunt and uncle (her father’s eldest brother), and several nieces and nephews and cousins plus chickens, goats and pigs. We had a snack of ground nuts (peanuts) roasted over a fire pit inside the ‘imba’ (traditional home) and then some watermelon.

As I explained in an earlier blog entry, the traditional home or ‘imba’ is a one roomed, round structure with a thatched roof. The floor used to be made of pressed cow dung but is now usually concrete. The walls used to be a combination of timber and mud but are now also usually made of concrete. Normally, there are several huts arranged together. One is used for cooking and has a fire pit in the middle. The others might be sleeping quarters . . .one for the parents, another for the boys and another for the girls. Then, there are also smaller structures used for storing grain or to house pigs.

Today was Palm Sunday. There was a big procession from the mission to the hospital and then back to the church. The service was outside and lasted more than three hours. There was incense and palms and drumming and blessing and singing. I half expected the priest to be riding a donkey (as there is a plethora of them around) to the church. Once we got to the church, everyone sat outside to listen to the passion, and then there was more drumming and preaching and singing. I have to admit I was relieved to be tapped on the shoulder and told to go to the hospital to see a young child who had had a seizure during the service. Turned out to be a febrile seizure and all was okay.

Some of my better photos from the last few days. . .

Happy Equinox. Spring for you. Fall for us.

Message for the Stoughton Blog Readers: Your dad / granddad is up to his old tricks again. He has been carrying an egg around in his pocket and pulling it out to show all the staff and locals that you can stand an egg on end today. One of the nurses, Mrs. Madondo said to him, "Oh! Thank you Dr. Stoughton. I don't know how I have gotten along for 49 years without knowing that!" Pretty funny.

Maize Harvest

The Match

Yesterday I found out that if my path eventually leads back to Alaska, I will be taking a 3 year detour in Tacoma Washington: I matched at Tacoma Multicare Family Practice.

Death, Birth and Learning

The 3 month old baby died last night, along with 2 other adult patients with AIDS. We average a death a day, though it seems they come in spurts. I spent the morning on the labor ward. The maternity nurses kept telling me the woman in labor was not ready. Then, finally, they sent for me and said, "Okay, the patient is ready to deliver." They were not kidding. Before I could get an apron on, the babies head was out and before I could put on a pair of gloves the baby was on the table.

This afternoon I had 7 students in class, and another new student. I have to say I was a little annoyed that I keep getting new students and have to catch them up, but I am also pleased at everyone's interest. So I started the lesson and told the new student we would have to do some work after class to catch him up. Then, in the middle of class, another new face came in and sat down. An old ambuya. I thought to myself, there is no way I am going to catch her up. All the students started whispering and then the woman cried out, "Ah!" and threw up her hands, got up from the chair and ran out. The students started howling. She had come to the wrong place for her meeting. Around 6 pm, I was finished teaching. Walking home there was an amazing sunset. The neighborhood children were playing kickball in the last few minutes of daylight, silhouettes of skinny black arms and legs dashing around the dirt yard. I am getting accustomed to their voices and endless chatter outside my window.

There were twins born in the hospital last night. This morning, we started with a Ceasar. The indication was fetal distress and failure to progress. Once we got inside, Dr. Jeketera asked that one of the nurses push the head up from below because it was lodged in the pelvis. Just as the nurse was getting under all the sterile drapes, Dr. J pulled the baby out. Baby and mother are fine. Not a bad way to begin the week.

Update on the 3 month old baby: No change. Still with distended bowels. Now the NG (tube that goes through the nose down into the stomach) is yielding strange thin, dark sheet-like material that Dr. S thinks is the lining of the stomach. Now, the peds staff is saying that the mother gave doses of muti on three consecutive days before coming to the hospital.

I had 11 students come to class today. The most in one class since I started teaching two weeks ago. I gave a practice exam this weekend so I think many came to find out how they did on the exam. They are definitely engaged in the work. . . so much that I have too many papers and work to correct!

Long-Johns and A Baby on my Back

Today it was so cold that I wore my long johns under my pants. Who would have thought it could be wet and cold here? Its as if the Seattle winter has followed me here.

Today we were told that the mother of the sick 3 month old did go to the traditional healer and the baby got 3 doses of muti. No one seems to know what was in the muti. Maybe it is a benign concoction of tree bark and tree leaves. Maybe it really did stop the bowels. The baby's condition has been the same all day. I think the gut is slightly less distended.

I had another meeting of my English class. Today, there were 6 women. One of the new pupils is also a former patient. Today I figured it all out. I had thought that the young woman, Martha, looked familiar, so today I asked her. Turns out we delivered her baby by C section back in January. She brought the baby, named Whitney, with her today to class. So while Martha took her practice exam, I baby-sat. At one point, I took the baby down the hall where some of the nurses were congregating. I had strapped the baby to
my back like a Shona woman would do. They fell out laughing when they saw me with the baby on my back. And made a few jokes about how quickly I had come to Zimbabwe and 'found' a baby.

More Excitement than Usual for A Saturday Night

Spent the last few hours of the night in the 'big theatre.' A three month old baby came in with her mother this afternoon in respiratory distress and a large, distended abdomen. The baby had been ill for several days, was increasingly fussy, and not feeding well. She was evaluated by Dr. Clara and thought to have a bowel obstruction. Abdominal XR showed a belly full of gas. Dr. Brown, the visiting surgeon was called in. After much discussion, they decided to do surgery.

The real difficulty then became the anesthesia and intubation. The child was in severe respiratory distress by the time we got her to the theatre. Dr. S struggled but was finally successful with the intubation. They exploratory surgery was quickly done. . . and no source of obstruction found. In fact the entire bowel was distended, indicating an illeus (abscence of peristalsis/bowel motility). Then the question became, why does this child have an illeus? The surgeon, whose surgery yielded no answers immediately questioned if it was African muti (medicine from the traditional healer).

I have noticed that in several cases when we cant explain what has happened or is happening, someone always brings up the question of muti. I wonder if this is a legitamate concern or just a way for us to 'explain' something that we otherwise can't. Just the other day someone was saying that 'the African' is always looking for an explanation or cause of illness. That a swelling or growth or blindness or stomach pains can be caused by your uncle's brother's sins or can be caused by a curse from your enemies. But are we also guilty of scapegoating? If we can't explain or fix it, then surely it was caused by something out of our realm of knowledge, something like African muti. I wonder, is it as absurd for a doctor to blame muti for an illness as it is for a patient to believe that it was caused by a curse from one's enemies?

At last, A Sunny Day

The sun is back in full force. It was actually hot today. I spent the morning in the theatre. We (Dr. Brown) did a skin graft on the child with the snake bite. I spent the afternoon with my English students.

Finally, our internet connection is up again and able to send small files. I am in the process of updating the blog with pictures and entries from the past month. . . It will take some patience over the next few days. I will note the new updates at the bottom of my new entries so that you can scroll back. . .

New Posts:
Tropical Storm, Tropical Illness, and English Lessons— March 10
It Is Officially the Rainy Season— March 4
The Wound Club— Feb 28
Cellulitis, Bilharizia, and Gerald—Feb 25
Please Excuse This Student from Eating Green Leafy Vegetables— Feb 24
From Zebras to An Axillary Block— Feb 23
Looking for my Passport— Feb 19
Strange Day— Feb 18
My Valentines— Feb 15
Saturday— Feb 14
Names—Feb 12
The Sounds Outside My Window— Feb 11
Margaret— Feb 10
Another Ceasar, LP and Tea Time—Feb 9

Tropical Storm, Tropical Illness, and English Lessons

No, I haven’t fallen of the face of the earth. It’s just that the heavens have dumped the contents of several oceans onto us in the last week. There was a cyclone (tropical storm) of the coast of Mozambique. And so, we have had just about every permutation of rain in the last week and a half: thunderstorms with wind, thunder and lightning, then steady downpours, then drizzle, then mist, then storm again. Currently, we have Seattle weather: misty rain, overcast, and chilly. Its strange to see the locals in heavy sweaters, hats and jackets. Even before this cool weather, I noticed the mothers will bundle up their infants in knitted bonnets and sweaters anytime the sun goes behind the clouds. So now that it is actually cold (62 F), they are layered to the hilt.

I have also had a mystery tropical illness, complete with headache, severe myalgias (muscle aches), GI complaints, back pain, dizziness, a sore on my leg and a strange swelling on my thigh. The differential (of a certain over imaginative medical student) at various stages of my decline included meningitis (stiff neck and back), TB (several patients did cough right into my face), malaria (there were mosquitos in kariba and I did skip one day of anti malarials), tetanus (scratched my arm on a wire on our fence the other day), schistosomiasis (waded over the dam on a walk a few weeks ago, got my feet wet with infested water), deep venous thrombosis (just for kicks, maybe I have a clot from sitting in the car for hours on the way back from kariba), guinea worm (big sore on my leg), cutaneous leishmaniasis (big sore on my leg), and spider bite (big sore on my leg). On Monday, I officially saw ‘the doctor’ who gave me a packet of little pink pills (antibiotics) and now I am feeling fine. Hum. You figure it out.

I have also been busy in the afternoons working with some of the nurse aids from the hospital who are studying English. They are hoping to re-take the ‘O’ level English exam, which they need to pass in order to pursue any kind of higher education. Many of the students have been out of school for several years, are working and have families. I offered to help one staff member in the afternoons, and within a week there have been eleven others who have come. They are extremely enthusiastic.

Besides the rain, the illness, and my English students, things seem to be routine.

Oh, and Margie and her ambuya were back today for a checkup and refill of her medicine. She is doing extremely well. . . she wanted to take a ‘card’ (photo) today. Victor, the nurse aid hasn’t quite figured out how to keep the camera still.