Upon finally landing our feet in Macha, my thoughts turned to work.  I immediately recalled the first day of work here three years ago, when I arrived at the “operating theater” and an hour into assisting a surgery, I experienced what can be described as “a near fainting.”  The rest of the day was quite eventful, but I did manage to keep it upright.  This time, I prepared myself and the medical director by warning that I was likely to make my first work day only a half-day.   The medical director looked surprised that I was planning to work right away, he must have remembered my first near-syncopal day.  Despite the jetlag, we managed to go to bed at the reasonable hour of 11pm, so I was prepared to hit the ground running.


Finishing my commute

As planned, I got up and out the door to join rounds 8ish.  Unfortunately we had not been organized to make breakfast, and since I’m not a fan of the taste of the filtered water, I hadn’t had anything to drink yet.  I did manage to take my Doxycycline prophylaxis for malaria.  On my 5 minute walk to the hospital, I felt a little woozy and my head felt stuffed with cotton balls.   Hoping for a quick recovery from these strange “illusions,” I pressed on to rounds and joined the doctor currently in charge of the women’s ward which I will be covering during his vacation next week.  There was also a nice medical student from the states, Adrienne.  After our introductions (“Doctor, Doctor. Doctor, Doctor…), I went straight to seeing the patients and feeling enthusiastic about the task at hand… for about 5 minutes.  A wave of severe dizziness followed a more severe urge coming from my stomach. I was able to contain myself control long enough to make it to the front garden of the hospital, where I promptly expunged the contents of yesterday’s dinner.   My witness was a concerned-appearing small man wearing galoshes to whom I explained in English that I had been travelling on airplanes and buses for over 2 days.  I doubt he neither cared nor understood my language, and based on my previous experience, he probably was not aware of airplanes or where they took people.

Needless to say, the rest of the day that was supposed to be clinical was spent napping, pampered by Mark, who has never known me to be weak of stomach, but knew that this was perhaps my most dreaded bodily revolt.  I decided to avoid water and food to avoid any more incidents, which immediately led to forced feedings and plea bargains regarding my likely inability to return to work at any point if I continued my general food strike.  I grudgingly accepted milky, orange-flavored water and the last of our Czech chocolate cookies.

I awoke to my second day less enthusiastic than the first.  After a hearty breakfast I headed in to the hospital without knowing the schedule or plan, but luckily encountered the Female Ward doctor who was kind enough to round with me on the veranda patients.  The “Veranda” is reserved for patients with pulmonary diseases, mainly tuberculosis.  The 10 or so beds were occupied by two women with cryptococcal meningitis, four women with pulmonary tuberculosis, one woman with advanced metastatic cervical cancer, one with severe candidal esophagitis, and one woman with psychosis from amitryptaline used to treat HIV neuropathy.  All of these are complications related to AIDS, but here, there is almost no point in mentioning something so obvious and common.  Equally as interesting is the way medicine is practiced.  The veranda is as it sounds, an open air balcony holding roughly 15 beds which now has glass windows.  Here, as in the rest of the hospital, there are no dividers of any kind between the beds, only tied mosquito nets hanging from the corrugated metal roof.  


Using the solar-powered x-ray viewer

Rounds consist of walking bed to bed, picking up a piece of paper which acts as a medication record sheet and daily temperature recording.  The nurses distribute paper charts that consist of two pieces of heavy-weight construction paper covers revealing off-white pages inside.  These are reusable by crossing out the current patients name at the end of a hospitalization and writing a new patient’s name until the all of the pages are filled.  On the inside sheets the doctor makes an artificial divider, writing the assessment on the left side of the sheet, and plan and orders on the right side.  The nurses are supposed to be close at hand to immediately record the orders and hear the plan, but usually are huddled about four patients back socializing while waiting to be called.  The other patients calmly look on at the doctors, nurses, other patients and visitors without much emotion.  Many patients are just spoken with and not physically examined, although when we approach to examine them, they quickly sit up (if they are physically able to do so) quickly remove their shirts and make themselves available for auscultation.

After rounds finished at 10am, I went home to hang out with Mark for an hour at home.  He was visibly tickled by me popping in during the morning, since back home I usually try to call him on my lunch break at about 4pm and otherwise maintain radio-silence as I try to dash through my hectic days.  We both walked back towards the hospital at 11 for the start of “OPD” (the Outpatient Department) which, like most things except church, starts leisurely when convenient for all involved. 

OPD is conducted from one room with three tables and a multitude of chairs and benches.  The Tonga people do not typically do anything of importance in solitude.  If I am seeing a patient, there is likely at least one family or community neighbor lurking in the waiting room and perhaps five more waiting by “the fires” (to be explained in more detail later).  The language and social translators dart between conversations in the room, as there can be up to four healthcare providers administrating care to four sets of families at any one time. For brevity sake, I will summarize the major complaints of the 20 or so people I saw during the morning session: rheumatic heart disease, diabetes, hypertension, asthma, HIV, tuberculosis, pneumonia, pediatric developmental delay, and several admissions for new or serious diagnosis of those above.  In the U.S., this would be an unusually exciting week of diagnoses.  The afternoon session was roughly the same, though at a much slower pace than usual due to the torrential rains that are a hallmark of the rainy season here.

The rest of the afternoon was spent reading “Getting Stoned With Savages” by J. Maarten Troost, his sequel to “The Sex Lives of Cannibals.” Both books describe life on remote South Pacific islands, which is a strangely similar life to that which we are currently enjoying in the landlocked country of Zambia.  However, I was unable to stay awake much past 6pm due to the 10 hour jetlag.