I have given D the blog baton for a few weeks now but he is getting such a positive response from his writing and even known by some of the other new doctors here “as the one of us who writes” that out of slight panic at having my role overturned I have decided to write an update. So much seems to have happened since I last wrote that it is difficult to know where to start. Time is flying by and our days have fallen into a gradual blurred routine of starting work at 8am on Mbusa and SCBU (the Paediatric and Neonatal wards) or D on the adult female ward Monica, eating rolls with basil and avocados from our garden in our sunlit house before going back onto the wards in the afternoon. One of my favourite moments of introducing D to Africa was when on the flight D kept worrying that he would feel claustrophobic under a mosiquito net despite my many reassurances When we then arrived he watched in amazement as I hung up our mosquito net on hooks over our bed and he told me that for all his life he had thought you just covered yourself with the mosquito net like a blanket. A misunderstanding which is one of the perils of marrying a boy from central Glasgow with a girl who was home-schooled and sent to China alone by her parents aged 13.

I am loving the hospital and working on Paediatrics and so feel increasingly happy with my decision to accept the Paediatric job I was offered in Bristol from this summer. I work with another doctor from the UK L and a Zambian medical intern H and I feel that we have built up a great team. L and I are probably overly supportive of each other’s decisions and will occasionally continue to write down the other ones unlikely impression out of “loyalty” but it’s such a treat to work with someone else who you can discuss ideas and thoughts with about tricky patients and decisions. H tends to look on in bemusement as he sees patients at a much quicker rate mainly because L and I get sidetracked by picking up cute babies at regular intervals under the pretence of “weighing them to help out the nurses”.

We are lucky that the Zambian nurses on our ward are wonderful. The head nurse is a young and increasingly (as he knows us better) sarcastic male nurse called Mr Sakala who seems to very much enjoy his role as “in charge” and I hear “Dr Rachel” from him multiple times throughout the day. As the senior paediatric doctor is away for a few months L and I are also part of some general running of the ward and join all the nurses at 7am on a Wednesday for a ward meeting where we discuss issues

which range from the next cockroach spraying timetable to discussing the latest HIV testing guidelines. We also have a joint hospital meeting twice a week where we present mortality for each of the wards and where the pharmacy and lab update us on what we have in stock. The list of out of stock medication is read out as a monotonic list by a quiet timid man who rattles off essential items such as “Insulin, IV fluids, Gentamicin” with a completely deadpan expression. The irony of having no insulin and only 10% Dextrose as a fluid was not lost on us.

The nurses are excellent although very overstretched – overnight there is just one nurse for a ward of often about 40-50 children some of whom are desperately unwell. This is possible mainly because of the role “bedsiders” or the parents play in the care of their children. It is something I have come to love about medicine here that the responsibility for the recovery of the child seems to be shared between us, the nurses, the parents and also just general fate or spirits or God. Parents do all the washing, cleaning and feeding and are responsible often for complicated feeding and fluid plans. Nurses do all the bloods tests, get dragged by us in all directions to act as translators when our list of one word questions in Nyanja (similar to Chichewa) is exhausted, give all medicines and the checking of “obs” (which is just that the children get their temperature meticulously checked every 6 hours). Sadly this lack of other observations means that often when a child dies overnight you have no idea what happened in the intervening 8 hour period between you seeing them on the ward round and the doctor certifying the death except for a religiously recorded set of temperatures. When children die the shared care means that parents are often very understanding and accepting – and often heartbreakingly take time to thank us for “doing everything that can be done”. This is particularly poignant for me when I am so fully aware that there is so much more that exists that can be done, just not in this setting.

Life here seems to be one of extremes. We are in many way living a completely idyllic dream where we travel on safari to see ladybird picture book animals, we have ‘film nights’ in the square where we use the hospital projector and the blank whitewashed wall of one of our houses to make an outdoor cinema under the stars. We spend a lot of evenings eating lots of chocolate by candlelight and creating inventive meals and cooking pancakes on gas stoves while the power is off. On the other hand we are faced every day with extreme sadness and at times feelings of futility as children on our malnutrition ward die of literally nothing to eat while we struggle to manage the complex balance of their conditions with only a handful of medicines or investigations. Or frustration as we try to explain to the parents of children with severe malaria and anaemia (often with Hbs of 2 or 3) that we don’t have any blood in stock not because there is none available but because the country has run out of the reagent used to test if the blood is safe to give or not. However there are moments where we are filled with happiness on the hospital ward too: when a 5 year old boy I admitted overnight with seizures lasting several hours and who remained unconscious for a week comes back to see us in clinic now able to walk and talk, when a tiny baby who L and I looked after as a tiny skeletal 1.5kg creature wrapped in layers of cloth pulls through, puts on weight and starts looking around, when all the mothers laugh at you when a tropical rainstorm catches you unaware on your on call or when at night you walk to the hospital under a wide dark sky with luminous stars. When I tried to explain this difference in life here compared to life in the UK to another doctor visiting he questioned whether in fact the beauty and colour we experienced in life here was more obvious because of the other extremes of hardship we are witnessing too and after thinking it over I feel that he is probably right. Things feel much more colourful, all shades of dark and light and the darkness seems to make moments of light all the more vibrant.

We are loving reading the stories from all of you wherever you are in the world. Thank you for messaging us and for your post and thoughts. We miss you and are inspired to hear of your adventures.


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