“The most we can do is to write — intelligently, creatively, critically, evocatively — about what it is like living in the world at this time.” Oliver Sacks. “To take a photograph is to align the head, the eye and the heart,” Henri Cartier-Bresson
Jester – I am not sure if this is meant to be Chester, or Jester. Maybe the parents are fans of Top Gun.
Hunky – The baby was not particularly big, just over 3kg at birth. And is growing normally. I wonder if the parents are fans of Marvel Superheroes and the Incredible Hunk. Or perhaps they see him growing up to be a bodybuilder.
Donoraold – This is how it was spelled. But Zambians have trouble with “R” and “L” consonants, often mixing them up. It is clear that this is Donald, as in Trump.
Arthur Chizzy – Arthur is a fine name, but partnered with Chizzy makes it sound like a spiv.
Ebeneziah – I called out for the next patient, “Ebenezer Zulu?” and a young lady came forward. “No, I called for a man, Ebenezer,” I said. “This is my book,” she said, “My name is Ebeneziah.” Okay, I am all for inventing new names, updating the Biblical classics, such as Jehosophat and Isiaiah. But who wants to be called Ebeneziah?
Gudlak – At first it sounded Norwegian, but then it became obvious as I said it.
Proud and Praise – Twins, P and P. Alliteration.
Prince and Princess – Twins, but premature and not doing very well at present.
Prince and Prosper – Twins, P and P again. I reckon that they have found inspiration from Jane Austen.
Destiny – Ambitious
Sagacious – and I have met a Wisdom, too.
Golden – I have heard of an American football player called Golden Tate
Marvellous – But of course.
Bottle – This man told me that his previous two siblings had died in infancy, so he was given the name Bottle as his life was going to be poured out soon. He was in his 40s now. I recall another lady from Swaziland who had a similar tragic family, with nine children not surviving to adolescence. She was called (in siSwati) “Sorry going to die soon”. She was over 50.
Fatness – Delicious, no issues of body image here in Zambia
Loveness – I asked the health inspector what he would do if he had been called Loveness as a child. He said he would change his name to Derrick. Which is what it is now.
To qualify for the blog, I have to insert a door or two. This is the door (blocked with branches) of a local barbershop. The message on the tree reads “Welcome”, with a bench for people waiting to be clipped. Marky C, the owner of Get Smart Barbershop, appears to have disappeared. This is in Cropping Village, Mfuwe, Zambia.
It was on the cards, really. All the danger signs were there. The baby had failed to thrive and a few weeks before I started work at the clinic, she had been referred to the local hospital as an emergency. The hospital diagnosis was pneumonia, and the doctors had asked the mother to come to Kakumbi for follow up a week after she had been discharged.
The infant looked thin and gaunt. She was breathing quickly
and using additional muscles of respiration to suck in as much oxygen as she
could. Her mother was clearly very anxious and concerned. I asked her to remove
her daughter’s outer clothes so I could examine her. The child’s chest looked
deformed, as though there was a lump under the lower breastbone on the left.
The spaces between her ribs were indrawn at each breath.
I laid my hand on her chest and counted the pulse – 200
beats per minute. The chest wall seemed to push up against my fingers and I
could feel a thrill, a palpable murmur caused by turbulent blood flow within
the heart. It was like a thrumming sensation moving from left to right.
Listening with my stethoscope didn’t help me much because of the rapidity of
the pulse and the noisy breathing. There were some crackling breath sounds at
the base of the right lung but they didn’t sound like they were caused by
infection. There were no peripheral signs of bacterial endocarditis.
I hesitate to write “my heart sank” but that is
what I felt. This child almost certainly had a ventricular septal defect – a
hole in the heart between the left and right main pumping chambers. Part of the
blood which was meant to be pumped into the aorta and around the body was being
diverted into the right ventricle. This had become grossly enlarged and had
deformed the chest wall. As the swollen right ventricle contracted, it
“heaved” against the inside of the ribs. The abnormal flow of blood
from left to right ventricle was causing the vibration I could feel with my
Was I sure? I had no access to the hospital notes regarding
the admission for pneumonia (if indeed, this is what it was). I could not see a
chest radiograph or get the results of a cardiac ultrasound (ECHO). I was
relying solely on my clinical examination.
Sometimes, small holes create loud murmurs as there is a more
distorted flow of blood, whereas bigger, more significant holes can cause less
turbulence, resulting in a quieter murmur. This is known as “Maladie de
Roger”. I hoped that the thrill I felt meant a smaller defect, as these
can sometimes spontaneously close as the child grows. But the rapidity of the
heartbeat was very worrying. The heart was working flat out.
Having made the diagnosis, what could I do about it? There
is no access to surgery to repair complex congenital heart problems in Zambia.
I told the mother that the baby was very ill with a heart problem, there was
little we could do, but I would review her in the village at next month’s
community clinic. I did not think that returning to hospital would help. I
tried to convey the seriousness of the baby’s condition without pronouncing a
Sadly, she returned that night to the clinic with the baby
in extremis. An ambulance took the baby to hospital but she died on admission.
One might think that having a doctor working at the clinic must be beneficial. Doctors have more training, more skills and knowledge than the clinical officers and nurses. But just being able to diagnose the problem doesn’t mean you can solve it, especially when you have the meagre resources of a developing country.
“The good news is the doctor knows what’s wrong with you; the bad news is that the doctor can’t cure you.”