“This is our life…”

Another blue-sky day. Another day in the shamba…

At this time of year, as the Little Rains begin and the Long Rains loom, with the wheat harvest over, time in the shamba planting maize is a priority for everyone, including the staff.

It had been a quiet weekend in the hospital. An undisturbed Sunday morning service. From our perspective, a time to recharge the batteries and celebrate the Day of Rest. The phones, laptops and other devices were being recharged too, from solar as we had another mains power-cut. We also shifted the fridge over to solar, grateful for the back-up system.

Monday morning also started quietly. A brief report on the lack of weekend action, sympathy for the nurse who had fallen out of a tree while collecting fruit, thankfully not breaking her ribs. She was sent to Ludewa for X-ray which showed no fracture, though I’m not sure X-ray is all that useful since there is no treatment aside from pain relief. It brought back memories of a crash when downhill skiing followed by a year of pain, especially when trying to turn over in bed. I didn’t need an X-ray to tell me what I had done.

I took advantage of the lull to continue an on-line course in fetal cardiac scanning since I have a patient who has lost two babies, the second a definite cardiac anomaly, and I’m not confident that the ultrasound of the heart in the current pregnancy is normal.

And then I was called to assist with the car. Our hospital driver is away. Would I go to the forest in my car and investigate an accident? The night-watchman from the Bible School had been injured and maybe killed. Bring him back if he’s alive but leave him there if not.

Taking our experienced male nurse anaesthetist and our laboratory manager (for their availability rather than expertise) we drove down the hill behind the hospital through the sub-village of Msikitani into the forest of pine trees, planted by various villagers, one of the few cash crops in this region. Some way down we reached the scene, where a number of people had congregated. The track is very steep here and we put a rock under the wheel for safety before leaving the car. The village tractor was embedded in the trees, the trailer 45 degrees on its side, the load shed and the body of Andrea beneath the trees covered in a kitenge.

The brakes had failed, the young men in the trailer had leapt clear. Andrea had been beside the driver who also jumped off but poor Andrea didn’t manage to get out of the way. And he had simply been on his way to the shamba and had hitched a lift.

It didn’t take long to certify the death. The impact of the trailer against his chest wall left a deep hollow where the ribs were broken and the heart crushed. For some months earlier this year he had been our night watchman when I had hardly any ability to speak his language and our exchanges were limited to ‘Welcome very much’, ‘Good evening’ and ‘I wish you well in your work tonight’. From time to time he managed to communicate that the light had been left on in the store and I would get the key to switch it off.

The light has gone out now. Good night Andrea. We will miss you.

We are standing for some time among the pine trees belonging to our friend Erasto. He breaks the silence with a short comment. “Our life is…”

I wait for him to continue, not wishing to presume what he is trying to say, though he is clearly searching for the right word in English. Perhaps the word is ‘hard’. Perhaps he is being more philosophical and wants to say ‘short and insignificant’. After a significant pause he rephrases his sentence.

“This is our life…”

The body had to remain where it was until the police and the village chairman and the Ward Chairman had visited the accident scene. I returned home for a cup of tea and was surprised to burst into tears. Where did that come from? I wasn’t aware of feeling upset.

Before long I returned to the hospital office and resumed my online course in fetal cardiac ultrasound. It seemed somehow meaningless. What if we can detect an abnormality before birth? Can anyone treat it here? No, they can’t. This is still the Middle Ages in many ways, except that the tractor and trailer work alongside the donkey and the ox-plough, and I can watch the threshing of the wheat by hand from the window of my car, and there never was a Middle Ages here.

Today our cleaner would have burned our rubbish but she is a close relative of the watchman and went to the forest to sit with him until the body could be brought home. Instead I lit the bonfire after nightfall as a tribute to a friend. It burned brightly for a time and then went out. As we all do, when the time comes.

The day I walked into the church…

Many of our patients are of short stature and that accounts for many of the Caesareans we do. If they are short the pelvis tends to be small. In some cases the babies are proportionately small so those should deliver normally and thankfully often do. It also follows that many of our nurses are short and one of them called for me during the morning service on Sunday.

I have been without a mobile phone for 3 weeks because of issues with ID but that will soon be resolved, I hope. Meanwhile, at night someone shouts ‘Hodi!’ outside my house and I respond ‘Karibu!’ and set off for the hospital. During the day they have to find me; in church, if need be.

Dutifully and speedily I followed her down the aisle, out the door and round the corner watching carefully where I tread since the ground is irregular in places. Smack! A sudden blinding pain in my head and I found myself on the floor. She picked up my books, I picked up myself and hurried on towards the hospital rubbing my scalp and seeing blood on my hands. The church roof overhangs and is very low on that corner and I am much taller than the nurse.

The patient is a schoolgirl, 16 years old and 18 weeks pregnant, also in pain and bleeding. Ultrasound shows the baby’s head in the cervix and miscarriage is inevitable. She is transferred to the labour ward (rather a grand title for a small room with two ancient delivery beds propped up on bricks because some of the castors have collapsed) and a sublingual tablet brings the process to a rapid conclusion. She aborts, stops bleeding and the pain subsides. It was a little girl.

Teenage pregnancy is not always unwanted but access to contraception and to appropriate education is a challenge for those who need it. Almost one quarter (23.4%) of our pregnant patients in the first 9 months of this year are teenagers. Each one will get contraceptive and sexual health advice before leaving for home, but reaching them before the first pregnancy is not so easy.

Back at home I washed the blood from my hair and decided to wear a cap for the rest of the day; it saves unnecessary sympathy and explanation. I was soon joined by Hilary who left church (avoiding the overhanging roof) after the first hour of the sermon, leaving the preacher in full flow. He was wearing fluffy bootees and a gangster tie, and energetically repeated the words ‘watoto’, ‘shamba’ and ‘kanisani’ suggesting his theme was children helping in the harvest when they could be in church. However, we often loose the thread and the relevance of the fluffy bootees was certainly lost. We are grateful for the YouTube and Zoom services from home, a spin off from Covid, that keep us in touch and in fellowship with our church family in North Wales. Together we joined a moving Remembrance Service involving many of our friends and featuring the war memorials in our area.

While all this was going on, an expectant patient in Mlangali town, 70km away, experienced her membranes rupture. She got on the next bus for Milo and arrived at 4pm, walking the last 10 minutes from the village to the hospital with a cord prolapse. When the umbilical cord emerges first, the baby will die unless delivered very quickly and true to expectations, this one had. But, surprise, surprise! The ultrasound scan revealed twins! Hitherto undiagnosed, the second baby was still very much alive. Yet another Caesar; another baby rescued, and a mother who got what she came for – the safe delivery of a healthy baby. It is very sad that the first twin died on the way, but the woman was completely unaware of the problem and she now has 6 children and that’s plenty.

From walking into the church to pulling out a bonus baby, it was an eventful day to be sure, and to be fair we do benefit greatly from our church friendships. Tough luck this Sunday I came away with a headache. Next time I’m about to walk into the church I shall keep my head down!