Breen showed me his home and I met his housekeeper, Phyllis. She
offered me lunch: chicken, pumpkin mash, rice, and a cold Coke. It
was very delicious and fresh. Breen arranged for me to have a room
next door. There are two rentable homes next to his that are owned by
the Hospital. The nuns who manage the hospital grounds didn’t really
know I would be there, but Breen thought it would be fine. He said if
they gave me trouble to refer them to him. Thus far, no
confrontations with nuns…
My house is dusty but comfortable. The front door opens into the main
room, which currently serves as a storage area for some building
supplies. Several large bags of mixable concrete fill a portion of
the room. An old broken couch and chair are all that’s left in this
room. A longer hallway runs off the main room with several doors off
on the right. The first door is my kitchen. It has a non-functioning
sink, non-functioning small refrigerator, a few pots and pans, and a
working electric stove top. Further down the hallway is a bathroom
and further yet is my room, the last door on the right.
My room is simple. Single bed, sheets, pillow, and blanket. I
requested a mosquito net that Phyllis kindly provided. Breen
remarked, “Oh yes, the Americans don’t like mosquitoes.” I have a
functional sink (most of the time), a lamp, and a small table. It is
comfortable and adequate for me. Not sure how James and Samuel would
have done…
After I unpacked, Breen took me on a tour of the hospital. We visited
L&D, postnatal ward, antenatal ward, GYN ward. These are all adjacent
rooms and are connected with outdoor sidewalks. It was obvious that
everyone knows him and that he is running the show. Breen is an Irish
OBGYN who has been the primary women’s provider in Monze for ~15
years. He lives in Monze but travels around Africa providing OBGYN
care and educating new African doctors. Currently, there are 6 “med
students” and 1 “intern” resident. The 6 students have spent nearly 6
weeks with Dr. Breen and have only one week left before moving on to
another rotation. These men and women will move out into Zambia and
be GPs for their community. They are trained in basic management of
OBGYN issues, but also are learning how to perform c-sections as well.
Being able to perform an emergent, safe CS is important for their
training. The intern, Dorica, has been with Breen for 4 months and is
great. She is well trained and knows well how the system works and
what the standard methods of management are. She walks the students
through cesareans (even though she’s done only ~20!) and is assisting
in hysterectomies. See one, do one, teach one is for real here.
Sometimes at UNC it feels more like see one, see one, see one...
I met Mike and Huange (pronounced Hun-jay), the married couple living
in the other rentable house. Mike is a PGY3 family practice resident
at UT Southwestern; Huange is a biomedical engineer. They have been
with Dr. Breen for 2 weeks and will be with him until the end of May.
They are both extroverts, talkative and friendly. It’s been really
nice to have them here. They’ve taken me around Monze and shown me
good places to eat. They have paid for their house and have a maid
who cooks for them. They’ve taken me in and fed me a few meals.
Dr. Breen is a man of habit. He eats the same thing for breakfast
every morning, has a routine for rounding on patients everyday, and
every night he goes for a swim. He doesn’t have a pool but knows a
local man who does. Apparently, Breen has delivered this gentleman’s
grandchildren and offered his private pool to Dr. Breen. So, each
nigh at 5pm Dr. Breen treks off down the dirt roads for a quick dip in
the pool.
So at 5pm on my first day in Monze, Breen, Mike, and Huange, and I
went for a swim. The pool is outdoor and is very cool. The weather
in Monze is comfortable: 70-80s in the day, 50s at night. The air is
cool at 5pm and the pool is cold. So none of us swim for very long.
An outdoor shower is there. Mike says that this is where he and Breen
shower because the water is more reliably working. The shower water
is cold but at least it is flowing. After the pool, Dr. Breen took us
further into Monze to see the railway tracks and to see other parts of
the city, all walking distance. It gets dark early and it was pitch
black by the time we arrived back at the hospital at 6pm.
I didn’t sleep too well my first night, waking up at 2am. I could hear the music of
the local Saturday night parties. Finally back to sleep at 3am.
The next morning was Sunday, and Breen always golfs at 0630. Though
there is a golf club in Monze, only 6 people are members. That
morning the three of us went at sunrise to the Monze Golf Club. Breen
hires a couple of local men to caddie. They carried our bags and
found where our balls landed. It was nice to play a bit of golf.
It’s a 9 hole course with rough fairways and very rough rough.
Interestingly, they don’t have greens.
They have “browns.” Browns are essentially a green made of sand/dirt
(much easier to maintain). There are holes but no flag pins. Once on
the brown, Martin (one of our caddies), would take a pipe and level
out the sand/dirt between your ball and the hole. Martin would
announce whether the brown was fast or slow – essentially based on the
amount of sand/dirt that was there. Though I hit the ball well and
got to the browns pretty easily, putting was very different and I was
terrible. But we had a fun time.
Later that morning, I went to Heshima Shopping Center “For All You
Groceries and Household Goodies” across the street from the hospital.
I picked up two bottled Cokes and two bottles of water for 12K
($1.60). Mike and Huange invited me to early lunch: seared onions and
potatoes, oranges, and avocado. Good stuff.
Mass started at 11am. As mentioned, the hospital is a Catholic mission hospital run
by nuns. The small chapel on campus seats about 150-200 and has a
rotation of traveling priests who rotate every week. We got there a
bit late, and the singing had already started. It was beautiful.
Thick harmony. Amazing African rhythm and style. They had a guitarist
who played through a small amp and provided background texture.
Percussion was 3 on djembe and 2 on shaker. A group of 40 men and
women made up the “choir.” Just amazing… I could listen to it all
day. It was Ascension Sunday and the priest preached from Acts. He
didn’t talk about the Gospel too much. Rather, he mostly chided
Zambians for not working hard enough and blaming others for their own
problems. It was a kind of “pick yourself up and work” message.
That afternoon we had a BBQ with friends of Dr. Breen. It’s not a
frequent occurrence but was well timed with my arrival. It was a very
familiar menu: grilled steak, chicken, pork. Lots of salad and sides.
And plenty of beer. There was an African brew available called Castle
Lager. It was good; not as flavorful as some of the craft beers in
the US but better than Bud Light. We had interesting conversation
about regional politics/economics/attractions with locals and
international visitors from Norway at the BBQ. We went back home
afterwards and I went right to sleep with the help of my friend Benadryl.
The next morning was my first work morning. Breen has a predictable
schedule during the week:
Monday: Rounds + OR
Tuesday: Rounds + GYN clinic
Wednesday: Rounds + OR
Thursday: Grand Rounds (long rounds)
Friday: Rounds + OR
There’s lots of OR time which is nice. The ORs generally only run
from 8am-2pm. The scrub techs are ready to close up shop by the
afternoon. So there’s only enough time for 3-4 cases per day. He
does a lot of different cases: TAH, TVH, radical hysterectomy,
vesico-vaginal fistula (VVF) repairs, perineal repairs. There are
two OR rooms. Both are lighted mostly by natural sunlight through
open windows. Sterility is desired but hardly achieved. They have an
autoclave which gives them sterile instruments, gowns. We wear
waterproof aprons underneath the sterile gown b/c the gowns aren’t
waterproof.
Just like in my room, the water supply is not guaranteed. To scrub,
someone pours filtered water over your hands while you use a soap bar
to wash your hands. The OR instruments are worn out. Many of the
clamps don’t grasp well. The cautery device is frequently
non-functional. During our OR cases, the power would go out
frequently. All the patients get spinal anesthesia (except
emergencies) so they are awake, though sedated, during the cases.
My first OR day, we did a radical hysterectomy and VVF repair. He
gave me a lot of autonomy and let me do a lot without immediate
instruction. It was one of the first times I was given that kind of
freedom in a hyst. We don’t often get to do radical hysterectomies
open in the US (mostly robotic). It was nice to dissect out the ureter
and follow the entire course into the bladder. The radical hyst is
done for cervical cancer – and there’s a lot of cervical cancer in
Zambia. Poor screening, high risk sexual practices, HIV all put
patients at higher risk. Our patient was obese with a BMI ~40 which, for
Zambia, is very very very obese. Dr. Breen says he hasn’t seen anyone
that large in a long time. So, it was a difficult case but went well.
I think I had more patience for it b/c I’m used to that kind of BMI.
Breen mostly did the VVF repair. He’s working on getting a camera
mounted to his head so he can record his cases and use them for
teaching.
After the cases, there wasn’t much happening in L&D. There is a
general clinic that runs everyday. Mike has occasionally helped in
that clinic – so we decided to help out. It was full – patients
lining the walls and out the door. I explained to the triage nurse
that I was an OBGYN. So I sat in a small room with an exam table and
saw a bunch of OBGYN patients. It was very similar to my continuity
clinic. I saw a patient with PID vs. gastritis, round ligament pain,
retained products of conception. We had to take the RPOC patient to
L&D for a curette evacuation of her uterus. She stayed overnight for
antibiotics and to monitor bleeding.
... More to come!
The antepartum ward at Monze Mission Hospital (check out those hospital linens!)
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