Beyond Mvuma

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.

The Wound Club

Saturday. Up to the hospital for morning problem rounds. A lot of patients on the men’s ward including 6 eleven or twelve year old boys with wounds in various states of healing, or with HIV related disease. Their bodies are still small. Dr. S has said that puberty comes late here. They look at each other giggle when I greet them in Shona. They have and amazing ability to run up and down the halls of the hospital fast and silent, almost as if their feet are not touching the ground and they are just gliding along the newly waxed floor. Though they are on the mens ward, the entire hospital is their playground. During the day, I see them peeking around corners and dashing off in this or that direction. Gerald, the 12 year old who told me English is his favorite subject in school is the leader of the pack.

Cellulitis, Bilharizia, and Gerald

A not so busy morning spent mostly in OPD. I was able to check on my peds admission—the child with pus coming out of his ears, eyes and gums. Dr. C believes it to be Cancrum oris. He was better this morning. Taking food by mouth, general appearance better. His eyes and ears had been cleaned up, and the swelling looked to be less.

The young high schooler with painful unilateral orbital and cheek swelling and bilateral hand and wrist swelling came back with his lab results: slightly elevated WBC’s, everything else, including urine was normal. (though, we cant get a creatinine or electrolytes) I decided to treat him for orbital cellulitis and will have him follow up in a week. Meanwhile, I hope to think about this a little more. . . he was also complaining of photophobia at times and eye pain. I was wondering about uveitis. We don’t have a slit lamp.

Other interesting patients: a young boy with terminal hematuria, empirically treated for bilhariza (schistosomiasis), a young girl with corneal FB, a hydrocele the size of a small watermelon, a child with either a thyroglossal cyst or a strange lymph node (we aren’t exactly sure which). And, then the usual sick patients with ISD in its variable permutations: gastroenteritis, disseminated Herpes Zoster, rheumatic joint pain, headaches, generalized lymphadeopathy, candidiasis, and TB vs. PNA.

I admitted a 20 kilogram boy of 12 with ISD named Gerald because he has septic wounds all over his scalp from disseminated ringworm. He started to cry when I admitted him because he didn’t want to miss any school. He says his favorite subject is English.

Please Excuse This Student from Eating Green Leafy Vegetables

Spent the morning in the small theatre: I & D of a foot abscess, stitched up a head wound, and did an LP. Tea in the staff room. Back to outpatients at 1030: A kid with abscess vs. mastoiditis, a kid with a knee effusion and question of osteomyelitis, a woman with a dog bite, a child with maize up his nose, and an asthmatic adult complaining of cough and chest pain. Also, a 4 year old with pus coming of his ears, eye, and an abscess. Admitted him. And, a high schooler with swollen wrists and hands bilaterally, pain, and swelling on R jaw and around orbit. ??? I didn’t see the afternoon results of labs. No idea about this one? Periorbital cellulitis?

This afternoon, a 16 year old boarder at the local mission high school come in with a request for a written doctor’s note excusing him from eating green vegetables because since 1999 he has had a problem with abdominal pains after eating vegetables, especially green ones.

From Zebras to An Axillary Block

I survived the trip to Kariba. Even got my first glimpse at African wildlife: elephants, zebras, impalas, hippos, water buffalo, baboons and a ton of birds.

Today, it was back to work though we weren’t so busy in the morning. Romeo, the patient that drank battery acid after his girlfriend’s family accused him of rape is being discharged. Margaret is gone already.

Outpatients this afternoon. I did an axillary block and then Dr. S and I set a Colles fracture.

Looking for my Passport

I have heard more about why the local police were looking for my passport. It seems that Mugabe is going to Holy Cross this weekend to celebrate his 80th birthday. So, the police are registering and keeping tabs on foreign visitors. I have to say I was pretty uneasy about it yesterday.

My Valentines

Today I got out the watercolor paints and took them up to the hospital. Margie (Margaret) and I painted watercolors on the porch up at one of the halls next to the hospital. Soon, all the neighborhood 5 and 6 year olds were painting too.

Here’s Margie’s Artwork complete with labels in Shona:
Imba = House
Muti = Tree
Motokari = Car
Mukomana = Boy
Musikana = Girl
Bhuku = Book
Hari = Bowl

Saturday

I had a great day today. Up at 7, breakfast, to the hospital for problem rounds. Took the bike to get the tires filled by Mr. Jeketera. Saw the post op patients on the womens ward. Then found Margaret. Followed her outside. She was going to have sadza with her ambuya. I got out the camera and started taking pictures of her and her ambuya. Then, more of the pregnant mothers in the cooking house. If I only had a camera to take pictures of the women looking at their own images on the camera’s LCD screen. They get sooo excited. . . clapping hands, big smiles, and lots of noise and laughter.

Then, I ran into Mr. Jeketera who fixed the bike. I took it for a trial run around the hospital grounds, stopping to take some pics of people selling fruit and vegetables. Somehow, with the bike, people seem to be more friendly. Or, I was exuding my pleasure at finally being on wheels again.

This afternoon, I had an excellent bike ride. I headed down into the valley, down a smaller dirt road (not the main one that goes from Chaka to Mashingo). It is a road I was curious about but afraid to just walk down by myself since there are a lot of indigenous huts and I wasn’t sure if I was welcome. I figured with the bike, its easier to ride past without intruding. I met a woman there who was picking materials for making baskets.

Then, continued on for a couple of km and 2 gully crossings. The maize plots were in various stages of growth. Some looked really good, some looked brown and dead. In one field there was a scarecrow looking object with feathers on top and another string of feathers across the middle of the field. I wonder if one also goes to the nyanga (traditional healer) to find out how to get your maize to grow?

Later I stopped to take another picture of some scarecrows and heard funny noises coming from the rows of corn. Turns out there were 3 kids sitting under some of the scarecrow clothes, eating maize and playing. They saw me and instantly asked for candy and giggled.

I then went into town and headed to the dam on the bike. Stopped at the market to take pictures of the produce ladies and got the same response I get from the pregnant ladies when I showed them their pics. . . pure excitement and joy.

On the way back from the dam, I got a flat. I hope that it hasn’t put an end to my biking days. . . not sure if I am going to need a new intertube. Couldn’t find the hole after inspecting the tyre (yep, that’s how they spell it).

St. Teresa's still going strong

Here is an article that is rather poignant from the Mail and Guardian. To read this and then walk into St. Teresa's it is easier to understand why there are so many patients on the benches outside waiting to be seen. When I ask patients, they tell me they are coming from Gweru, Mvuma, Mashingo and even Harare to get care here. We are a rural mission hospital, 32 km down an unpaved road. Buses to Charundura are hard to come by. The hospital is overseen and run by Dominican nuns, though salaries and supplies come from the government. We do have some outside medicinal and surgical supply donations through various international agencies. And, we have the HIV testing center (Ruveniko) and Mother to Child Transmission Project which are funded through NGO's. We also recently re-started a nurse training program. We have a very capable staff and now more man power with the nursing students working on the wards. Our fees are minimal. We have some supplies though I have noticed more shortages since arriving. After reading this
article, it seems that though we are struggling, we still have it better than other hospitals. . .

Names

I find myself saying peoples names over and over. Partly because I am trying to pronounce them correctly. To say them right. And partly because they are unique and beautiful.

Perpetua. Petronilla. Talent. Blessing. Rudo (Love). Tsitsi (Mercy). Tinotinda (we are thankful). Gloria. Nobukle. Gandencia. Locardia. Ivy. Rosemary. Nvongai. Rumbudzai. Marita. Rivharisi. Miriam. Emelda. Chipo. Tecla. Alice. Farai. Sasekhani.

Blessed. Hilario. Brighton. Maxwell. Ruben. Hugo. Job. Moses. Tsuarai. Tafera. Godfrey. Norman. Lucas. Patrick. Ian. Phineas. Remigio. Simon. Chidhakwa. Clever. Tomsmanga. Joshua. Lazarus. Augustine. Celestino. Liberty. Joseph. Agreement. Tichouna.

And the last names: Wunganai. Murambiwa. Mawere. Mwisai. Nyuke. Chiwani. Dhona. Takaidza. Mapuvire. Njovo. Tengo. Chipangwa. Sibanda. Hwata. Chitsere. Madondo. Chasuvache. Khosa. Munjanja. Matandere. Dhiba. Rangwa. Denwede. Makupe. Mhosva. Mugarisi. Makupe. Rafemayo. Utawashe. Chagweda. Chagweza. Tavera. Madondo. Shumba. Moyo. Hovi. Gumbo. Mombe.

And places: Siyahokwe. Mhende. Chengwena. Hama. Nyatongue. Chaka.

Here, children are usually given a ‘Christian’ or English name and also a Shona name, and then of course, they also take the Surname of their family. For example, you might name your child, Rachel Rudo Utawashe.

Also each family has a ‘totem’ name. It is a name that has been passed down through the fathers family and is thought to be an indigenous tradition that prevented close family units from intermarrying. Usually the totem is an animal or part of the body. Common ones I have noticed: Mombe (cow), Gumbo (leg), Moyo (Heart), Shumba (Lion). It has been said that in past Shona culture, two people of the same totem were never allowed to marry unless special permission was granted and a special ceremony to appease the ancestral spirits was performed.