Triumphs and tragedies

We have had a busy fortnight!  Over this time Chitokoloki has hosted a couple of visiting surgical teams who provided specialist input for our patients.  Last week, we hosted Drs Tim and Huyen Bartholomew from the USA. Dr Tim is a maxillofacial surgeon and his wife Huyen is a family doctor who over the course of her career in medical mission has also gained significant experience in obstetrics and gynaecology, anaesthesia and surgery. For the past while, the Bartholomews have been based in West Africa with their two young daughters, but flew out for an intense few days of operating here. For five fortunate patients with disfiguring jaw tumours, we were able to offer free surgery which for some will be life-changing. 

 

We aren’t able to share images of our own patients, but have posted a publicly available picture below which shows the kind of deformity we were dealing with.  For the interested among you, this particular example is caused by an ameloblastoma:

 

 [Image credit: https://www.globalgiving.org/pfil/30312/394A0762_2_Large.jpg]

This week, we hosted Dr Goran Jovic, a very well known face around these parts. Goran was for many years the self-proclaimed ‘best plastic surgeon in Zambia’… in fact, the only plastic surgeon in Zambia, although he now has some colleagues to contest this title! Dr Goran is a key contributor to the FlySpec charity, who operate light aircraft which fly specialists out to some of Zambia’s many remote hospitals for regular surgical outreaches. Goran brought with him Dr Mildred Nakazwe, a plastic surgery trainee, and Dr Amon Ngongola, a paediatric surgeon at University Teaching Hospital (Lusaka). Dr Amon has family roots in North-Western Province and hopes to visit Chitokoloki regularly to provide some specialist input on children’s surgical problems. The FlySpec team were able to help a number of children and adults with cleft lip or palate, burn contractures and other disfiguring conditions. We are grateful to God for this outside help and the opportunity to be involved with these life-changing interventions.

Dr Goran Jovic - also the pilot for this trip!

Dr Amon Ngongola, paediatric surgeon

The FlySpec team with some of the Chitokoloki crew

 

Amidst this surge in specialist activity, all the normal demands on the hospital continued. Last week, the theatre team started a long list of complex jaw tumour patients at 06:00 on Wednesday, given some COVID-related changes in the Bartholomew's schedule.  We were congratulating ourselves at about 18:00 on a hard but successful day’s work, when an ambulance arrived from another hospital, unannounced, carrying a young boy who had been speared through the abdomen 3 days earlier. The team got organised to perform an exploratory laparotomy (open the child’s abdomen), whereupon Stuart found multiple small bowel perforations, and an exit wound in the thigh, with a track through his body that had only just avoided the major blood vessels to the leg. With so many holes in the small bowel, there were some challenging decisions to make, but 3 hours later we had patched things together and fortunately the little boy continues to recover well.  One of our other ‘triumphs’ has been the safe passage of a lovely little premature baby called Albert through the hospital system. In our first couple of days at the hospital, we were involved in his resuscitation immediately following birth, as he failed to breathe properly. His poor mother had suffered four previous miscarriages, and took some time to bond with him. Jess has now established a lovely relationship with her as she has helped cared for Albert through his stormy initial weeks of life. We were able to gift Albert a woollen hat knitted by Stuart’s mum Sandra, who managed to combine all the colours of the Zambian flag – very stylish! 

 

 

 

It is harder to write about tragedies which come alongside the triumphs, but we want to give an honest flavour of life here. Over the past week, we also mourned the loss of three children who came to us horribly sick and despite enormous efforts, did not recover. On Tuesday morning, we had word of an Angolan child who had reached Chavuma Mission Hospital in severe respiratory distress.  The day before, he had been playing with some necklace beads, and somehow ended up aspirating the bead down his right main bronchus (airway). Chavuma mobilised their staff as fast as possible, but did not have the necessary resources to remove this obstruction.  In the end, our light aircraft met their ambulance on a fast journey south. After placing a tracheostomy (surgical airway into the windpipe), we faced the very difficult task of dislodging the bead. Although we benefit from a great deal of donated equipment, there are still significant limitations to what we can do and it required all of Dr David McAdam’s patience and decades of African surgical experience to pull the bead out. It was a blessing to have the skilled help of a visiting anaesthetist from Northern Ireland, Dr Gayle Wallace, who coordinated with us in the dangerous task of keeping the child breathing while removing the object from the airway. Despite the intense involvement of so many, the child succumbed to a post-operative surge of inflammation and infection that would have taxed even the intensive care facilities of the West. A bad day for all of us, including Jess who dealt with all the inpatient needs while the rest of the team were caught up in theatre all day with this child and another man who arrived profoundly unwell amidst all of this with Fournier’s gangrene (severe infection caused by a ‘flesh-eating bug’), requiring an emergency radical debridement (removal of necrotic, dead tissue).

In the face of these hard things, we have to content ourselves with the thought that we have done our best, and that without the intervention of our hospital team, many more would be dying or suffering unnecessarily.  It also reminds us to be humble about both our triumphs and tragedies. One of the fathers of modern surgery, Ambroise Paré simply said of his successes:  “I dressed him.  God healed him.”