Evie...

When we first arrived at Mount Meru hospital we were introduced to a beautiful little girl called Evie who was being treated on the paediatric burns unit for substantial burns she had received from hot fat to her head arms and torso. Evie always had a smile and a wave for the Mzungu students when you meet her around the hospital grounds, and so it was lovely to be welcomed onto the surgical unit by her and her friends. Evie always wears a headscarf draped over her head and shoulders and the extent of her burns was covered until we were assisting with wound dressing changes one morning.



Mzungu Kerry and Evie

This was taken just after dressing change

 The resources here are very limited and so gauze is used to dress the burns in attempt to keep the wounds free from infection. Unfortunately it sticks tightly to the wounds and on dressing change day, bottles of sterile saline are gently warmed in buckets of warm water and applied liberally to the wound areas to aid removal of old dressings. The children on the ward are so familiar with this routine now that their tears pre-empt the arrival of the saline bucket onto the ward. The mothers assist competently with the procedure, and as we moved quickly around the ward we come to Evie who is sitting quietly waiting.
She slid the head scarf off as we approached and I was shocked to see that her ears were almost completely burned off, with just two small stumps either side remaining. Her sweet smiling face beamed through the healing scar tissue, and I was genuinely moved by the bravery of this young girl as she sat stoically still as her wounds were redressed.

As part of rehabilitation, we encouraged the willing children to join in singing heads, shoulders, knees and toes which promoted stretching and circulation to their healing wounds. Just before I left to come out here, mummy Robbo bestowed many chapsticks upon me to “keep a happy smile” and one Thursday I remembered to give one to Evie for her poor sore lips and showed her what to do. Delighted, Evie hid the chapstick in her pocket and hugged me and whispered a sweet “Asante sana!”. I had moved to Obs and Gynae on the following Monday but popped back onto the burns unit at the end of my shift to find Evie waving and as welcoming as ever. The doctor appeared and said she thought Evie’s lips were looking much better and when she asked, Evie showed her an empty chapstick tube and beamed her biggest smile yet!

Evie had been in hospital for just over 5 months when she was discharged that afternoon. I was really delighted that Evie’s bravery had seen her through her horrific injuries and I believe that her sunny disposition will give her the strength to shine through the physical disfigurement of the burns. It was a sobering thought to compare the level of care and rehabilitation that Evie may have had back in the UK to all that is available here.

RAFIKIS Evie (on my kneee) and Versace (2nd from right)

Evie is just one of the many children who have been the source of such delight and joy during our time at the hospital especially as despair can feel a little overwhelming at times. 2 year old Versace, a brave wee boy who obtained severe burns to his torso after falling into an open fire, would cling onto my leg as soon as I set foot on the ward. One day Versace discovered the drawstring for my scrubs during ward round and decided to pull them down, which proved so entertaining for the inpatients, and a little embarrassing for me!

Some of the children were not so sure of these Mzungu vistors with their reactions ranging from open-mouthed awe, to sheer hysterical laughter. However, a lovely paediatric physio from Australia bridged the cultural differences on production of a bottle of bubbles which could lighten the mood, even during dressing change day and some of the children wept at the end of the shift as it was time to say “Kwa Heri” to them.

Rotation 2 - Surgical (photos to follow!)

After my rotation on general medical I moved to the surgical wards, and arriving to find the cleaners hard at it made me think it may be a slight step up from general medical. While the wards were still pretty basic on surgical, they were somehow cleaner and a little more orderly than those on general medicine. The surgical wards are over two floors in two buildings with a grassy area between, where the patients were relaxing in the early morning warmth. I soon discovered that this was not by patient choice and in fact the cleaners had turfed them out for this daily ritual as the floors were cleaned, with only the very, very sick or immobile permitted to remain. One morning I walked on to find one small boy from the paediatrics’ ward pushing the bed of a young girl in traction off the ward – cleaners ruled here!

On the adult block, the four wards were split male and female – (which is impressive as mixed wards continue to exist in Manchester, in Nightingale arrangements) with a further split between general surgical and orthopaedics. The smell of festering wounds is pretty pungent around the surgical wards, and it is very common to find poor stitching and wound care post-surgery has left the patient with gaping, oozing wounds that MRSA wouldn’t stand a chance in.

During ward round one Tuesday morning, we were accompanied by Tegan a radiographer in the house from Brisbane who was expertly showing us the x-ray films of the patients on the orthopaedic ward. Most of the patients had two sets of x-rays, a before and after. I cannot really begin to describe my shock at noticing the dates on several patients’ x-rays which clearly showed a marked difference in the bone setting process, where after 4 weeks in cast, the bones were further displaced than the original injury had caused. No explanation was offered for this almost horrific phenomenon, but our assumption was that little explanation and education had been offered to the patients once in their casts and perhaps financial pressure had led them to continue with manual labour after their initial discharge in their plaster cast.

On the orthopaedic wards, many of the lower limb injuries warranted traction which was a simplified version of home, where a screw would be protruding at the appropriate point attached to a length of string which was weighted at the end of the patients’ bed with a carrier bag containing rocks. During one ward round on the paediatric ward the Dr realised the small child with the fractured femur was able to wriggle free from her traction, and so he instructed the mother to gather more rocks for the carrier bag, and she was wedged into position with this.

While the fascinating insight into wound care and orthopaedic care was good, the greatest draw for me came from the two paediatric wards on the ground floor. One ward with 10 beds saw children with a variety of surgical and some medical complaints, ranging from hernias, injury sustained when thrown from a moving vehicle in road traffic accidents, to fractures sustained “playing”, and rather grimly, injury caused by sexual abuse and other forms of neglect. Each bed contained at least one child and their parent, but at busy times it was common to see two children with their respective parents sharing a single bed. On the other side of the nurses’ office was the burns unit, with its 12 beds containing mainly very young children with mainly severe burns to large areas of their bodies, caused by falls into open fires, hot porridge or hot water being toppled onto them. A glance in the report book told me that some of the burns sustained caused wounds susceptible to infection that their small bodies just couldn’t fight, and infant death rate from injuries caused by burns is high here.

I have studied to be an adult nurse, and so many of the illnesses and ailments facing these children surprised me, as I couldn’t believe that children could be struck with such a cruel blow so young. But as nit was explained to me, however big or small, the human body can make the impossible possible and I should never discount the unimaginable.

Elephant Day... PART 1...

Sunrise on the Serengeti

 

The Rising Serengeti Sunshine

Tembo

The early morning rise in the dark was warmed with a hot sweet coffee, but the sight of the rising sun on the Serengeti made it more than worthwhile. The first animals appeared quickly this morning – a gracious elephant herd grazing, on a day which will forever be known as elephant day. 

Again, the plethora of animals was spectacular, as they all appeared keen to avoid the heat of the midday sun, by making an early appearance, much to our delight.

PHOTOS

Rod Stewart on Safari...

Pool Commentator - Two Hits To Who??

 

The first proper sighting!

Excitement rose as Simba’s had been spotted across the plains making an early morning kill. With great excitement we approached the scene, but the long Serengeti grass obscured the full picture, but we could see Simba’s mane shining brightly in the early morning sun.

Simba after breakfast

A Jackal keen to get in on the breakfast

 

With a little movement, the true tally of the pride was seen, 5 females, 2 cubs and 2 males. The lions were so close to our jeep that I was terrified my beating heart would betray my excitement: I realised I was holding my breath!

 

Here Kitty Kitty...

A hairdo Derek the cat would be jealous of...

Smiler

 

Machars Lion??

As Simba walked away we truly couldn’t believe the day could get any better...

 TO BE CONTINUED.....

Happy Birth Day...

It started like any other as we plodded up to Mount Meru hospital, but today I was going to the Obstetrics  and gynaecology department and my first day on the labour ward. As Lizzie and I arrived we were made blatantly aware that the cleaners were on the ward – and they were a whole lot tougher than the ones in surgical, as we were met by a glare and a threatening shove of their mops as we attempted to step onto the ward. So instead we turned on our heals and headed for the western toilets to get changed down at the admin block.

Returning in our fresh clean scrubs, some of the fear-faced doctors were braving the ward, so we took this as our invitation and plonked our bags in the cupboard. Venturing onto the labour ward, we were met by a very curtain-less, sheet-less, generally dignity-less sight.  Apparently we were just in time for two births happening side by side. Literally. There is no curtain between the mothers, but their modesty was nearly spared by a curtain at the foot of each bed which could also double as a baby catching device. (NB. I discovered today (tues 21^st) that these are in fact shower curtains and are indeed for protecting against the impromptu splashes, not sure how often they get cleaned yet...)

Within 7 minutes of our shift beginning, two little heads were crowning. Choosing to focus on just one, the young girl in front of me, who was putting in a brave and solo effort. It is pretty apparent here that no dads-to-be present are present at the births, in fact there are no males here at all, and with only the female nurses offering assistance, the song # sisters are doing it for themselves # inappropriately cropped into my head. Aaargh!

I was beginning to question how on earth a small anything was going to pop out when my thoughts turned to the many happy times spent down in the lambing tunnels at Culbae and suddenly it was all so natural. I must admit however, I don’t quite have the same vivid recollection of the episiotomy, which is carried out here without local anaesthetic. To be honest, the whole birthing process so far had progressed on sheer determination, without so much as a glance from simple analgesia. A few modest wimpers and a look of sheer exhaustion and the final push was really rather magical. A beautiful baby boy, who took one look at the world and exclaimed with all his might that he had arrived. As mother and baby met in person for the first time and the final stage of labour passed, my attention spun to the lady beside, as I realised that another wee fellow was about to make his entrance.

 I never thought silence could be a more terrifying sound. There was just no sound at all. The little bundle was scooped up in a Kanga and rushed to the little table outside the ward labelled “resuscitation table” where a small plastic tube carrying low flow oxygen was poked up his tiny perfect nostril and there he was left, dazed and confused as the nurse returned to see to mummy. It was all instinct as we approached the table to the lifeless bundle and gently shook the tiny shoulders. A junior medic stepped in then and rubbed the tiny sternum and two blue eyes appeared. Still no audible breath. A heartbeat was pronounced, and the willing rub continued, urging the baby to take a breath. Taking a step back, I realised there is no urgency in further intervention from the staff here. No one appeared alarmed, or perturbed, and deep down I began to wonder if this was survival of the fittest – something which I have seen so many times here. If he was supposed to make it, he would? A wee wimper signalled that we shouldn’t wait any longer, so we suggested that we could take the baby to the neo natal unit, for fear of hypothermia and the nurses agreed, pleased to have a task off their hands. We rushed him over the court yard and into the building which serves as neo natal care, where simple wall heaters ensure temperatures sore to over 30 degrees and tiny babies fight for their lives every day. Our wee friend was received by a young, unassuming nurse and she gave him a swing by his bag legs and plopped him onto a cot under a hot lamp, the similarities to the lambing were almost amusing. With that, his eyes were wide open and an almighty wail came out of his toes, as he realised his trance had been broken. Back on the ward we were able to tell mummy that baby had taken a great cry and the relief in her eyes said it all.

Often here we have been writing the names of patients in notes and wondered how anyone could come to be called such things, but today made me realise, that sometimes there is nothing more apt than calling your baby Lucky.

Zebra Crossing...

The Safari Posse (Georgio Armani on the roof and Davies in Mustard Shirt at  the back)

First spotting on Safari - just before we reached the Ngorongoro conservation area

A Baboon Proon...

One of the Masaai camps in the Ngorongoro conservation area

PHOTO OF ZEBRA’s CROSSING

The eagerly awaited second weekend finally arrived and was set to be a corker – we were going on Safari! The usual Thursday night BBQ was tremendous but our  6.30 collection from the house was the real topic of conversation, and not much sleep was had that night.

PHOTO OF DAVIES COLLECTION

Davies rocked up in the Safari jeep the next morning and the adventure began. The drive out to the Serengeti took us through the Ngorongoro conservation area, which is peppered with masai tribal villages throughout.

PHOTO of MASAI VILLAGE

The anticipation of spotting the first animals almost pipped the excitement of the real sighting. With donkeys leading the way, and the cheeky baboons at the gate to the Ngorongoro conservation area, the animal count soon began to count up.

I feel  that the pictures from safari  tell a thousands stories that my words just can’t do justice, so here’s a few sights form the first day...

PICTURES

If you look carefully you will see the lion resting on this rock.

The vultures resting in the nearby tree gave these lions away, resting after a recent kill.

The most amazing sight on this first day, was the zebra crossing.  A wee bit different to the one in Newton Stewart, this sight was amazing, we timed it beautifully for the beginning of the mass migration, the zebra and wildebeest in their thousands crossing the Serengeti plains. It was truly awesome, and I don’t feel that these photographs truly do justice for the sheer volume of animals which stretched as far as the horizon.

This first day was wrapped up with a sighting of a sleeping leopard, lazing in a sausage tree. He was a little further away than we would have wished, but no less awesome. Apparently aware of his audience, he struck a pose which delighted everyone.

On the way to the campsite, we crossed a swamp and right in the middle was a bathing hippo. It was a great sight, but trumped only by her friend who appeared from behind a tree in the distance. The approaching hippo caused great hilarity with her apparent embarrassment as she skipped from the cover of one bush to the next until she finally belly flopped into the swamp with her friends!

Our Serengeti Campsite

The race was then on to reach the campsite and pitch the tents before the sun dipped too low in the sky. I was genuinely a little alarmed to see there was no fence, or wall or anything really between the pitched tents and the wild plains of the Serengeti.

Sunset on the Serengeti

The lesson in tent pitching was quick and adequate, and the tents were up and bedding rolls laid in time to watch the sun go down on a fantastic day. That night a delicious meal was served by Georgio Armani, our personal chef, and our dreams were full of the adventures we hoped to have the next day.