Beyond Mvuma

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.

It Is Officially the Rainy Season

We have had thunderstorms at least every afternoon for the last 4 days. There are puddles everywhere. The paths have become small tributaries. The grass is wet and tall. The clothes on the lines are not getting dry. The kids have mud on their pants and wet seats from playing outside. The rain gauge stays full. The leaves on the trees are shiny green.

My patient, Mr. Sando with the suprapubic catheter came back to see me. . . he did go to Drefontien (another mission hospital with a surgeon on staff) and did have a prostatectomy. He was back to profusely thank me and to show me his slightly infected surgical scar which he has not been covering with a bandage. Yikes! I put him on Abx and give him strict instructions for daily dressing changes and monitoring and a return visit in one week. It might be considered overkill, but I like happy endings and want to ensure that all goes well.

This afternoon I got started with the English class. There were 5 women who came today and rumors of 4 or 5 others who may be interested. I had them answer some questions about their intentions to take exam, strengths, weaknesses, etc. One of my questions was, “What do you want to get out of this class?” and the students reply was, “I do not want to get out of this class!” Then, had them write a composition about a traditional Shona custom. We meet again on Saturday. It will be interesting to see who shows up, who follows through. I spent the evening reading through their essays and picking out sentences to have the class revise. We definitely have our work cut out for us.