Report to World Medical Mission on Mukinge

Report on
World Medical Missions
Trip to Mukinge Hospital
Kasempa, NW Province, Zambia
March 26 to April 26, 2001


The Locale and the People:
The Mukinge Hill area is a wide valley running down to a small river which eventually drains into the Zambezi. The hill area undergoes intensive rains during the wet season which was just ending in April. This leads to rutting and washout of the red dirt roads which then bake hard by the end of April. Many of the roads I was driven over, dwindled to foot paths in the further reaches of the district. Mukinge is located a few kilometers from Kasempa the local “Boma”. These were organized around tribal units and have become the government centers with independence. The Boma was about a 40 minute walk from Mukinge. During these trips we would pass about a dozen small villages immediately beside the major footpath. Each village consisted of a half dozen or so thatched mud huts which typically house several nuclear families and perhaps a “mother-in-law or two.” Large villages of several thousands which were the rule a hundred years ago have vanished as the threat of warfare and arab slavers have subsided. Each village appears to be furnished with at least one barking dog and a complementary gaggle of small boys. The later will begin to ask in unison and in severality “How are you?” on the approach of a any westerner. We rapidly learned to turn the tables and say “Moogia biepi?” Kikoande for “How are you?”
Kasempa includes a radio station, district government offices, several private schools of various stripes, a bus station and market. This later consists of a sloping rutted and weed-grown square with a public pump and rows of small shops on streets surrounding the square as well as leading away for a 100 yards or so at seemingly random directions. The shops all seem to offer an almost identical supply of notions, eggs, kesapis, biscuits and toiletries. An open-air market selling bread, dried fish and fresh vegetables adjoins the square. In addition, a clothing market is situated near the market. This consisted of stick-built booths to shield the sun and waist high tables, to display the wares. These consisted of newly made kesapis (1 by 2 meter cotton print material) and old clothes. Of the latter variety I saw near-new T-shirts for a midwest grocery chain among others.
The area around Kasempa and Mukinge Hill is intensely cultivated. Each village is situated among its fields. These are mostly field corn and raised rows of eggplant, okra, tomatoes and onions. During the rainy season vegetables become scarce and small. Very few domestic animals other than a rare goat are in evidence.

Nature of the Facility:
Mukinge Hospital is a 200+ bed hospital in rural Zambia serving the mostly subsistence farmers of the Kuanda tribe. The hospital is a collection of one-story buildings including seven wards, an operating theater, pharmacy, administration building and outbuildings. The wards include 2 pediatric, one male, one female/OB, one male TB, one female TB, one eye/ortho. The pediatrics wards were divided into two, each with approximately 35 patients. The acute ward, “Paeds I,” included mostly malaria which was unresponsive to the usual therapy (chloroquine), complicated or associated with other diseases. Other diagnoses included infections (mastitis, shoulder bursitis), burns, fractures, Burkitt’s Lymphoma and bacterial gastroenteritis. At times I had six patients on the floor waiting for beds.
Patients who were thought to have more chronic conditions were admitted to “Paeds II.” This was therefore the “kwashiorkor” ward. Kwashiorkor produces in the young child, swollen legs, pot-belly, paler skin and reddish hair which is due to a diet deficient in protein, vitamin and micronutirents. Any child with tuberculosis was treated here also. This disease is a cognate for HIV/AIDS. The incidence of HIV+ patients is about 20-24%. Due to this, serological studies for HIV are seldom done as no treatments is available.
Mukinge Hospital was started in 1953 by Dr. Robert Foster, the son of the original missionary couple who started the station through the (then) Sudanese Interior Mission (SIM). Zambia represents an example of a mission giving over authority to the indigenous church, the Evangelical Church of Zambia which it started. Both SIM and ECZ are administratively responsible for the facility. Since independence in 1963, the government has sought to have closer ties with Mukinge as it supplies needed health resources for a large area of rural countryside. For this reason, Mukinge has contracted to supply in-patient and out-patient care to the population under government support. However, the government hospitals are less well supplied than Mukinge, despite better access to transportation. While I was at Mukinge, a number of patients who had been seen in the provincial capital, Solwezi, came to Mukinge by foot or bus in order to see the doctors there.
One boy with Burkitt’s Lymphoma had been waiting for medication in Solwezi for several months. His huge tumor had eroded through his face in two places, closing his right eye. Five days of medication (Vincristine, Cytoxan, and prednisone) reduced his tumor size by twenty-five percent and allowed him to start eating again. Five more courses would most likely result in a cure (90% 5 year survival) if the medications could be obtained and given properly.
The nature of medical care changes dramatically in the third world. One young mother brought her 4 month old son to the hospital at night after a two day walk from her village. The infant evidenced severe respiratory distress, cyanosis and lethargy. He had been treated for pneumonia several times without benefit. He however, had a huge liver and large heart associated with a single loud S2, dramatic evidence of congestive heart failure. He also had the typical appearance of trisomy 21, Down Syndrome. By the next morning, diuretics and oxygen had helped his condition and a chest x-ray was consistent with my suspicions of a severe form of cyanotic congenital heart disease, Transposition of the Great Vessels. In the best of circumstances, this child had some chance of normal cardiac function in a good tertiary hospital immediately after birth. Even then, a substantial palliative procedure would have allowed continued growth for many years. But no intracardiac procedure was available either here or in Lusaka, the capital. Moreover, none would have been done for a child with so little potential for compete recovery. On reexamination of the baby, he now appeared to have gotten over the little honeymoon provided by the previous night’s treatment and was rapidly worsening, typical of this kind of heart defect; he was within hours of dying. I tried to explain this through a translator. It would have been unnecessarily cruel to try to bring this mother to a true understanding of her baby’s disease only to say we could do nothing. Instead, I said that the baby’s heart was not fully developed and that he would get sicker and die from this and that we had no treatments for it. We prayed at the bedside and the mother wanted to know if she and the baby could go home now. I told her that the baby would die during the two day walk and her response was that she wanted to be home to bury him. With all the other patients, I didn’t see her leave.

Insights
Inserting yourself into a foreign culture produces a huge number of insights from the trivial to the occasionally profound. I undoubtedly received more blessings from those I met than what little I provided. Nevertheless, I think the most profound insight was voiced by a medical student with whom I was traveling. He stated that he had discovered that “People live here.” This is no longer “Central Africa” to me but a few square miles of Kuanda homes and fields populated by people who are wise and foolish, strong and weak, saved and lost. They have no more essential spirituality nor veniality than suburban America. They still have to answer the same questions we all do. Their problems loom on their emotional horizon just as emphatically as ours. Their problems seen from afar seem overwhelming and inexorably triumphant. Seen from up close, the people will deal with them in some fashion. There are mature Christian brothers and sisters who are dealing with their own problems, making their lives, responding to the urgings of the Holy Spirit. If there is one regret that I had, it was the baseline presumption that as a Western doctor, I had peculiar and important expertise out of proportion to anything the Kuanda could produce. This served to separate me from those with whom I wished to fellowship.