Kalene Mission Hospital

God's Perfect Timing

Peter Gill (Echoes of Service, May 2005)

Kalene Hospital
Kalene Hospital Scene (Click for larger image)

In November 2004, I (orthopaedic surgeon, England) and my longtime friend, Raymond Allen (anaesthetist, Northern Ireland), visited Kalene Mission Hospital, in Zambia, with individuals from Brass Tacks, Echoes of Service and MSC (Canada). The purpose of the visit was to consider the future of the hospital, as well as much needed improvements to its infrastructure. This was influenced by the construction of the Zengamina hydroelectric scheme through the North West Zambia Development Trust. The visit was very profitable, as well as interesting, and we all left Kalene with a sense of excitement and anticipation for the future of the hospital. I wish, however, to recount an incident that occurred on our departure, which illustrates how the Lord provides and also highlights the needs of this work at Kalene.

The day before our departure from Kalene, our pilot, Bruce Poidevin (Canada), developed severe back pain. Indeed, he was so sore that when he stood and tried to walk, his back was twisted and in so much spasm that he was stooped over by an angle of nearly 45 degrees. We were all concerned for him, for his well-being and his ability to fly us, safely and comfortably, to Lusaka to connect with our BA flight to the UK. Raymond handed Bruce some of his own supply of emergency pills (strong anti-inflammatories) which gave reasonable relief. Early the following morning (the morning of our expected departure), Raymond and I went to the hangar to see if Bruce was in a fit medical condition to fly. He seemed to be in fair shape but, nevertheless, we considered it prudent to provide him with some additional medication which he could take over the next two or three days when in Lusaka. This medication was in the hospital pharmacy. We duly left the hangar to get it, arranging to be back in time for our departure flight from Kalene at 9 am sharp. We had also been reminded that a storm was threatening later that day; November is the start of the wet season and the weather is rather unpredictable.

Viv and Raymond at Kalene
Viv Davies and Raymond Allen (Click for larger image)

Dr Vivian Davies had informed us the previous evening that he had a routine Caesarian section to perform at 8 am, so we decided it was only right to call in to the theatre en route to the pharmacy and bid him farewell. Looking through the theatre door window, we could see Viv scrubbed up, with his back turned to us. On knocking on the window, Viv turned to see us, pointed at us (like the Lord Kitchener poster) and very deliberately beckoned us in. It was obvious from his demeanour that he was in some difficulty. I opened the door to see what was happening. Viv wanted an anaesthetist urgently, as the patient was having serious breathing problems as a result of the spinal anaesthetic compounding the effects of an unexpected complication of her obstetric condition. Raymond (the most conveniently placed...well, actually, the only anaesthetist at the time!) went off to change into theatre clothes, but as the patient's breathing suddenly deteriorated, I shouted to him to "Hurry and get in there quick!" Realising that the situation was critical, I, too, went to change.

When I got into the theatre, Raymond was manually ventilating the patient with an old, dusty Ambu bag (found in one of the cupboards in theatre) as she was, by this stage, totally unable to breathe by herself. Viv was well into the surgery (which now had become very much an emergency procedure) and was about to deliver the baby. On opening the patient's abdomen, he found that the uterus had just ruptured, with blood spilling out alarmingly. No wonder the lady was in trouble - and her baby too!

Without any further delay, Viv delivered the baby, handed it to the midwife and then promptly started to repair the rupture, which immediately helped to stabilise the patient's condition. And, thankfully, the manual ventilation was proving very effective as well. However, the little one was making no attempt to breathe, nor, indeed, any attempt to move or cry;just a poor, 'flat', non-responsive newborn whose time was running out fast. I was handed the Ambu bag to continue to ventilate the semi-conscious mother, while Raymond transferred his resuscitation and anaesthetic expertise to the newborn, using, again, an old baby Ambu bag and poorly-fitting face mask.

At this stage, you need to know that Raymond had brought from home a suitcase full of specialist infant, child and adult anaesthetic equipment, including new Ambu bags (equipment used for the manual ventilation of unconscious patients).

Realising that the ventilatory support provided solely by the baby Ambu bag wasn't sufficient, Raymond asked for a special infant airway - one from the selection he had brought. These were still in a corner of theatre in a large plastic bag which was quickly upended on the floor and ransacked until the relevant piece of equipment was found. Our anaesthetist battled on, using what he had at hand, but soon concluded he wasn't winning; he needed to pass a tube into the baby's lungs to deliver oxygen more effectively and to suck out all the mucus, debris and blood that was accumulating. He asked for the relevant tools: ET tubes and a laryngoscope - again, equipment he had brought. Unfortunately, these weren't in theatre, but had been stored up at the guest house. An urgent phone call was made and, very soon, a breathless member of hospital staff arrived at the theatre door with the appropriate equipment.

Whilst waiting, Raymond had asked for extra oxygen and oxygen tubing. As always, there was an oxygen cylinder in theatre for resuscitation. However, within a minute of turning it on, the cylinder ran empty. And while all this was happening, both of us were calling out orders for vital resuscitation drugs and transfusion fluids (including blood) to be administered to the mother while Viv coped manfully with the demands of surgery.

It was about this time (9.30 am) that Alice Turner (Canada), the hospital matron, appeared at the door and informed us that everyone was waiting at the hangar, wondering where on earth we had disappeared to. It was a curious sight indeed that met her: Viv was splashed in blood as he put the last few stitches into a very badly torn uterus, I was ventilating a semi-conscious mother, and Raymond was resuscitating a tiny, 'flat' baby and barking out orders regarding drug injections. I shall never forget Alice's question: "Are you spectating or participating?" "Most definitely participating!", Viv replied.

About half an hour later, when Viv had successfully finished the surgery and had descrubbed, the mother was at last beginning to surface and breathe unaided. We could confirm this by the improved readings on the Oxygen Saturation Monitor, a vital piece of monitoring equipment which had been attached to the mother right at the start to keep us informed of her condition. The monitor had been shipped out earlier in the year from the UK. The little one was also beginning to breathe spontaneously for the first time and started to thrash around. What a wonderful sight after 30 minutes or more of frantic resuscitation and even more gratifying that this dramatic improvement was sustained after the breathing (ET) tube was (nervously) removed. We stayed a little longer to ensure all was well, then changed out of theatre clothes and went off to collect the medication we had originally come for. We rushed back to the room where we were staying, grabbed our luggage and scuttled over to the hangar. Only an hour or so late, but, thankfully, this was a CMML Flight Service and not BA, otherwise the plane would have already flown!

Needless to say, an explanation was required and there was a lot of interest, empathy and gratitude as we recounted our 'adventure' in theatre. It was a very poignant moment too, when Viv arrived up at the hangar, all changed, cleaned up and relaxed, just in time to 'inflict' on us a great big goodbye bearhug before Bruce 'ordered' us on board.

As an aside, within an hour of leaving Kalene, we lost radio contact with our base there because of the storm which had just broken over that corner of the country. Had we delayed much longer, we most likely would have been grounded the rest of the day and, consequently, missed our BA flight home from Lusaka next morning.

Ward Round at Kalene
Ward Round (Click for larger image)

What does this story tell us? That God's providence is amazing. If Bruce had not been half-crippled from a bad back, we would have had no reason to visit the hospital pharmacy that morning. Had we not passed that way, Viv would have been in serious trouble in theatre, not being able to do his Caesarian section, ventilate the mother and resuscitate the baby successfully all at the same time. There may well have been at least one death - perhaps two! We shudder to think of the consequences of such an outcome: a devastated surgeon, heartbroken relatives, and a trusted, established mission hospital with a shaken and tarnished reputation. Even in suffering, all things work for good, and not necessarily for oneself or even for those we know. A week or so after arriving home, an e-mail from Viv confirmed that both mother and baby continued to do well.

This incident also confirmed to us that the improvements planned for the hospital were indeed necessary. We believe that this was a 'stamp of approval' from the Lord for the hydro scheme and the upgrading of the hospital and all its facilities.