Bedsiders

Every single patient admitted to St Francis has a “bedsider", usually a relative, who looks after them during their stay. If we are lucky the bedside will speak English and act as an interpreter, but this is rare in a poor rural area where very few residents have attended secondary school.

The bedsider performs basic tasks of caring for their patient, such as feeding and washing, leaving the nurses to take care of drugs and procedures. Almost all of the bedsiders are female – I didn’t really pay much attention to this in the female ward, but I really noticed it when I entered the male medical ward and discovered that most of its inhabitants were female bedsiders – about 3 for every male patient.

 There is a single male bedsider in the female medical ward at the moment. His wife is in with gross ascites due to liver cirrhosis, and has a hugely distended abdomen with about 25L of fluid. He helps her dress, helps her sit up, and washes her dishes. When one of the doctors drained some fluid from her abdomen, the hole from the drain kept leaking fluid, soaking through the gauze and running onto the floor. Her faithful bedsider took a mop and quietly mopped up the fluid which was running along the floor.

Thank God for bedsiders.

Taxis

As far as I can tell, taxis are local people who own a car and wish to make money from it. Perhaps they have special licences but it’s hard to tell. As you step out into a public place (like exiting an airport, crossing the border or getting off a mini-bus), you are immediately swamped with taxi drivers. The first one to grab your bag wins the fair, apparently, and so they all battle over the luggage.

Like the mini-buses, taxis usually only leave when they are full (hence all the guide books refer to “shared taxis” – there’s really no choice).

 Our mini-bus from Chipata to Katete, a 16-seat van, waited 2 hours before it left the bus station. For the last hour all the seats were full, but people kept coming along needing a ride, so the driver kept cramming passengers in. By the time we left there were 27 passengers on board, including 2 screaming babies. A colourful ride indeed.

EDIT: We hired a driver to take us to Chipata, a 90km trip to from Katete. On the way we were stopped by police and he was told of for “pirating”, or acting as a taxi illegally – they wanted him to paint his car blue to mark it as a real taxi. I’ve never seen a marked taxi, this is the first I’d heard of it. He had to pay a K54,000 fine (about $15) which I think was more of a bribe, before we were able to move on.

Medicine

I don’t know what I’d expected from rural Zambia, but the medicine here is really not too different from home. There is a lot of malaria and tuberculosis of course, and about 80% of the patients are HIV positive, but apart from that the common conditions are the same as home.

My friend and I are currently on the female medical ward “St Monica”. We have patients in with pneumonia, stroke patients, a woman with ascites from liver cirrhosis, a young woman with pericardial effusion, and a few with diarrhoea. I think the threshold for admission might be a little lower than home, because most patients live remotely and don’t have transport.

 

The ward setup is a lot different – you don’t get a private room unless you happen to be the only measles patient in the isolation ward. For most patients, the beds are lined up next to each other along the walls of the ward. There are screens for privacy during procedures such as lumbar puncture, catheterisation and pericardiocentesis (there have been two since we’ve arrived). Normal examinations are just done in front of everyone.

 

Apparently it is quite acceptable to discuss medical conditions in front of a large group, because traditional healers would have everybody in the same room in a circle, and they would go around discussing their ailments.

Similarly, the outpatients clinic is conducted in a small room with three or four doctors all working at once with different patients. There is a single examination bed behind a curtain, and two doctors will usually share a desk – one on each end. Privacy is not even optional, but nobody seems to mind.

Spare Tyres

Our taxi driver from Lilongwe airport manoeuvred between two cars which had been stopped by police on either side of the road. Curious, I asked him what was being checked.

“Licences. And these (tapping on his car’s registration sticker). And spare tyres.”

“Spare tyres?” I questioned

“Yes, if you do not have one, you get arrested. They say if you don’t like someone, you should steal his spare tyre”

Interesting, that people can ride on the back of trucks, our taxi didn’t have functional seatbelts, and many cars have massive cracks across their windscreens, and a spare tyre is the thing that could get you arrested.

That said, our driver from our accommodation in Lilongwe to the bus station carefully arranged my friend and I to keep all the weight off his completely flat tyre. Perhaps he was saving his spare for a police check.

Money

I always find foreign money something of a novelty. I took out some US dollars before the trip, which do not seem like “real money” at all. By the time I’d landed in Africa the notes had all crumpled and looked like they were about to fall apart.

I bought a coffee in Johannesburg airport – they happily accept US currency, but can only give change back in local money. I’m not sure how it worked out, but I paid $5US for my coffee and received 50c South African in change. I also discovered that the 50c was magnetic when I found it later stuck to my MP3 player.

Withdrawing some cash from an ATM in Lilongwe, Malawi, I was fascinated by the K500 notes (500 Malawi Kwacha), the largest denomination I’d ever seen ... until we crossed the border into Zambia and I withdrew K200,000 from my account (about $40AUD) and was rewarded with K50,000 notes. Amazing!

AFRICA!

I'm in Africa!!

My friend and I (well mostly my friend) have been organising a medical elective term in Zambia since early last year. She's been emailing, we've been researching and shopping, and on Saturday I even started packing - with the help of my boyfriend and his amazing tetris skills.

There wasn't much time to really prepare - we finished our Term 3 rotations on Friday and left the country on Monday, so it was a little bit hard to get excited as we frantically packed our bags.

Even on the plane, it was hard for reality to sink in. 6,000km trip to Kuala Lumpur followed by a 6-hour stopover (our plane was delayed by an extra hour). We slept on our backpacks in the airport and waited for our flight to Johannesburg, which was delayed by an hour, and then I slept for the 10-hour flight, only waking for meals and falling asleep by the time the tray was taken again. On the plus side, we arrived in the morning and I wasn't too jetlagged.

But now we're here in Katete, Zambia, staying at the St Francis Hospital and helping out as much as we can there. My friend and I are both on the female medical ward, "St Monica" for the time being because that's where the fewest medical students are. There are about 15 students at the hospital at the moment, mostly from England and the Netherlands, although most are leaving in a few weeks so we will probably move around the hospital to wherever we are needed most.

I'll try and share some of the stories here.

Infectious

Some might say that I'm taking my Infectious Diseases rotation a little too seriously. I turn up early for the morning ward rounds, I take many pages of notes, I gave a lunchtime presentation, and I know enough about the third cranial nerve anatomy to ask questions that stump the consultant (his fault, he made me look it up). I write in the progress notes, I examine patients, I participate in the team meetings, and I go and see consults.

Oh, and I have pneumonia.

I've been coming in every day with a hacking cough, making my presence felt throughout the hospital. I really should have stayed home, but nobody said that was okay, so I kept on coming in. Pretty dedicated, you might say.

But then I made a fatal error last week and went to a compulsory workshop without informing my supervisor.

The very next day, I was called in for a meeting with absolutely no warning and berated for my "disappointing lack of attendance". Had my supervisor told me off for spreading germs throughout the hospital, I would have understood. Had he focused on my appalling lack of knowledge of antibiotic use, that would have made sense. 

But he was disappointed in my attendance. 

So disappointed that he might just fail me.

Maybe I should cough louder so he knows I'm here.

Signs of Pain

How will you know when your older patients are in pain?

Will it be the classic head-in-hands posture?

The downcast expression?

The phrase, "I'm in pain?"

Will you recognise the signs?