Kawama Clinic Part 1

“The need of the hour, as far as I’m concerned, is to believe that God is God, and that He is a lot more interested in getting this job done than you and I are. Therefore, if He is more interested in getting the job done, has all power to do it, and has commissioned us to do it, our business is to obey Him … reaching the world for Him and trusting Him to help us do it.”  –Dawson Trotman

 

Our team got up hopeful that we might have our medicines back to us by the afternoon.  Festus had been told that the proper officials would release the drugs from customs at around 8 am, so, surely, we would have them in the afternoon.  Bill started us off that morning by reading to us from Dawson Trotman’s “The Need of the Hour.”  He read a section of the essay about the Mar Thoma Church, which is the largest Christian Church in Southern India.  It traces its origin back 1900 years to the work of Thomas, the disciple of Jesus.  When Bill had finished reading, one of our team members, Lovely Philipose, raised her hand.  She said, “I am a product of that church.  My family is from that part of India, and my family is Christian because of the church that Thomas started.”

 

Dr. Bill set us to work sorting last year’s leftover supplies.  Usually, there are one or two bags of supplies left over from the previous year’s team.  This year, we had nine bags left over to sort through.  Dr. Bill told us that at the end of last year’s trip he thought it was odd that there were so many leftovers . . . it was certainly a blessing since we had no other supplies at the time.  We spent the morning counting out analgesics and cough

drops, and by lunchtime, we had counted all the medicines that had been left over.  We headed for clinic that afternoon, a half-day late and short on drugs.  Festus still hadn’t arrived with our supplies.  The crowds at the gate were overwhelming, and the people were obviously frustrated at our delay in getting there.

 

Kawama is much larger than Mulenga was.  We had ample space for pediatrics, a generous though mosquito-infested room with 6 cribs, each with one side lowered for use as an exam table.  This worked well for babies and small kids, but our adolescents were a bit cramped.  The clinic’s usual healthcare workers were strangely absent.  The medical assistant who met us on our arrival informed us that the healthcare workers in Zambia were on strike, negotiating their salaries and benefits with the government.  Every hospital and clinic in Zambia was essentially shut down because all of the nurses, medical assistants, lab techs, and x-ray personnel were on strike.  Only a few doctors stuck

around to attend to duties in the hospitals.  Many people walk for miles just to reach the Kawama Clinic, and Kawama is staffed by nurses, not physicians, so many of them hadn’t had an opportunity for healthcare since the strike began, two weeks before we arrived there.  We arrived at a critical time.  Patients had been discharged early from the hospital, and others had simply been denied care because no one had come to work.  Shipments of the clinic’s regular supplies had also been delayed, so there were no reagents for routine lab work, and medications that we typically buy in-country (anti-malarials, anti-parasitics, etc.) were in short supply.  Our first afternoon, I treated children with pneumonia, malaria, ear infections . . . I enjoyed practicing my few Bemba phrases on my patients and listening to them practice their English.

This is worthwhile work.  I found joy in this work.  In some sense, I felt relieved to be working where I had been called.  I sometimes feel like the past two years have only been anticipation and preparation to return to Africa.

 

By the end of the day, our medications had still not arrived.  They were finally released from customs at 4 pm.  Festus had planned to take a city bus with our things to Kitwe, but since it was going to be getting dark, he was worried he wouldn’t be able to recognize and protect them from theft on the long way there.  He had to hire a private car to take him with the bags back.  All of this took some time, and he finally arrived in Kitwe at about 4 am.

 

June 25, 2009–On our first full day of clinic, we were short on interpreters, so clinic work was slow-going.  I met several families with children with severe developmental delays, children who have never spoken or children who are unable to sit up or walk.  It’s hard to know how to help them.  Zambia has no physical therapy or speech therapy.  I don’t have any medications that can change this.  Sometimes there was an explanation.  One child had survived meningitis as an infant.  Another child had kernicterus from

severe jaundice at birth (this is almost unheard of in the U.S. with available treatments).  Other times I had no reason for a child not to develop properly.  All I had to offer these families were vitamins and prayer.  I also saw my first child with kwashiorkor (a form of malnutrition), and I tended to several severely marasmic babies (a different form of malnutrition).  Each was sick enough to go to the hospital.  I gave each mother some soy flour, vitamins, ORS, and bus fare and prayed that they wouldn’t be turned away from the hospital because of the strike.  As the clinic was winding down for the evening, a woman arrived in active labor with her first child.  Lovely, our family medicine resident, delivered the baby.  During the labor, Mary, a Zambian midwife, asked for a bottle of orange Fanta.  Bill looked around but only found a bottle of water.  Mary set her jaw and repeated, “No, FANTA.”  When Mary asks for Fanta, Mary gets Fanta.  Apparently, Fanta supplies all the energy a laboring mother needs to give her baby life.  Mary

checked the baby’s heart rate periodically with the fetoscope and assured us that everything was fine.  Bill and I helped resuscitate the infant, a baby girl. Everyone else crowded outside the delivery room, peeking in to catch a glimpse of the birth.  Zambians don’t usually name their babies for several days, so I don’t know this child’s name.  She is probably the most photographed newborn in all of Zambia.  After the baby was dried and weighed, we gave the mother a bag of ibuprofen for her pain, and she put her baby on her back and walked home.

 

June 26, 2009–The following day, we worked almost non-stop.  I spent most of the day on my knees examining the kids.  We were overwhelmed with malaria, pneumonias, and malnutrition.  I had a little girl with an elbow injury.  No x-ray was available because of the strike, so Bill helped me make a sling from a torn sheet to protect her until she heals.  Before lunch, a second baby was born.  The mother asked the “nurses” who helped her during the delivery to name the baby.  After listing lots of Biblical women, they settled on Rachel.

 

Matt and I ate lunch with James and Dan, two of the Zambian pastors.  Recently, James traveled to the Congo to help with a mission there.  He told us he saw many miracles there.  Sick people were healed, and many came to know Christ.  While he was there, he was arrested and beaten because the local government felt threatened by his work there.  In one day, the case was taken to the high court in the Congo, and the charges were ultimately dropped.  James was able to stay in the Congo, and he witnessed many more miracles while he was there.  James doesn’t get paid to be a pastor, and he didn’t have the benefit of attending seminary, but he is committed to what he believes is the most important work that he can do.  James believes that there is so much corruption in African government that the only way to help Africans is through the church.

 

In the afternoon, I saw a little girl who was unable to walk after having meningitis as an infant.  Her mother has lost her last 5 babies during the 6th month of her pregnancy.  I prayed for them both.  I also met two month old HIV positive twins.  They need anti-retroviral drugs, but the government won’t dispense the medications until the babies have baseline labs done.  The labs can’t be done because there are no reagents because of the strike.  Ridiculous.  I also met a 15 year old girl who I think has tuberculosis.  I wasn’t able to confirm it because there were no supplies to collect and analyze a sputum sample, and without confirmation, she can’t have treatment.  I drained an enormous toe abscess in a little boy.  He didn’t appreciate it much.

When I made the incision, pus sprayed everywhere, including on my clothes (I was lucky to have gloves; no gowns or anything else available).  I gave him sunglasses to make peace when I was done, but he still wouldn’t smile for me.

 

June 27, 2009–Early in the morning, Chad (our security officer) spotted a baby in the crowd that he brought to me immediately.  Evaristo Kasonde, a one month old baby boy, hadn’t nursed in two days.  I knew immediately that he was sick.  He was in obvious respiratory distress, and his soft-spot bulged outward on the top of his head (which shouldn’t be, considering how dehydrated he was).  His mother told me he’d had fever at home.  He whimpered and whined.  We tried to place an IV but we were completely unsuccessful.  I gave him an IM dose of Rocephin, and someone from the church drove them to the hospital.  I gave mom $2.00 to get back home once they were released and $5.00 to gain emergency admission to the hospital.  In an emergency, you have to pay extra.  Imagine knowing that your child is in desperate need of medical attention, and travel to the hospital costs you two days’ salary, and to be seen in a timely manner, you have to pay a whole week’s income.  That is a desperate situation.  I still don’t know what happened to him.  Later in the day, I saw 11 month old twins who weighed 6 kg (about 13 lbs).  They each had the developmental skills of a 3 month old.  I wanted to test them both for HIV, but of course, the lab was closed due to the strike.  They only ate breastmilk and porridge.  How in the world can I change that?

 

We finished 3 1/2 days of clinic frustrated, exhausted, and looking forward to a few days rest.  We learned that night after dinner that the travel that was supposed to take about 4 hours to get to the national park was actually going to take about 9 hours . . . just one more bump in a rough Zambian road.

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