Blog 8

Christmas in Tonga land. 26/12/08

There appear to be no words for wishing someone a “Happy Christmas” in Citonga, the common local language in Monze! This could be because their language has not changed since the arrival of the Christian missionaries with David Livingstone or because they are so poor that they can’t celebrate as we do. It is a one-day holiday with no Boxing Day, it is difficult to find any sign of Christmas decorations or any Christmas goods in the shops and although families get together there is neither special food for Christmas dinner nor many presents exchanged.

The hospital did give away 20+ live chickens as staff presents but I don’t know how they decided who should get them. There was quite a melee to get the fattest with more than the chickens having ruffled feathers.

We eventually found, on Christmas Eve some shop assistants in Santa Claus hats, the only visible evidence together with one poster advertising Christmas entertainment at Tooters that Christmas was almost here in Monze!!

As we had had no invitations we were planning to have our Xmas dinner with Natasha and Dhun our VSO colleagues. At the last minute however we were invited to a Christmas Eve barbeque, a Christmas dinner, a walk by Monze’s reservoir before dinner and finally a party organized by Sister Bertha in Mazabuka on the 27th. The Christmas Eve BBQ was at Kitty’s workshop

Kitty on Christmas Eve

The lorries loaded with charcoal for the Congo

in the 'workshop'.

Laura (our neighbour, Crispin's wife) and friends

on the outskirts of Monze, with a spit roast lamb (was more like a sheep!) and goat cooked over charcoal.

Much booze, mainly spirits and beer was available and the party was attended by many of Kitty’s Asian and African friends including Perry, Crispin and the local bank manager.

Some younger native Zambians tried to gate crash, and unfortunately friends Natasha had invited were sent packing also (a case of mistaken identity).

The meat was more spicy than the conversation, we met some more of the locals who were very friendly but the evening was otherwise uneventful and we got home at midnight.

Perry, Judy and Dhun chatting over beers Xmas 2009

On Christmas morning we attended mass at the hospital chapel at 9.30 with typical Tongan worship, drums and all but no carols.

The one and a half hour walk by the reservoir later that morning was luckily in the sun, immediately preceded and followed by torrential rain. As we approached the river and dam by car the light went, the surrounding trees began to disappear in a Scottish mist and it rained as can only happen in the tropics, with huge drops capable of drowning anyone daring to emerge from shelter with or without an umbrella. However after a short wait the sun re-emerged and in a lovely rain cooled breeze we started our walk. Michael Breen told us they had seen crocodiles there before and we had wonderful views of the very green and wet countryside surrounding the reservoir. Some locals lived close by in what appeared to be idyllic rondavels with easy availability of water for their crops. The walk gave us a good appetite for our Christmas dinner at 15 hours.

Our dinner was at Sisters Mary and Barbara’s home with Sister Bertha from Mazabuka and their close friend Michael Breen who had engineered our invitation, “the best Christmas dinner in town”!

We had a lovely meal with chicken, stuffing, ham, jacket potatoes, rice, cranberry sauce, onion relish, maize, peas, and carrots and a tasty South African red wine shared between four of us. The wine, after three months without it tasted wonderful and was enough to make MRT merry. We sang grace, Rejoice, rejoice and again I say rejoice and then helped ourselves without further prayer to food, Mike T had seconds and thirds and Michael Breen was well into his meal by the time Mary arrived at the table with hers. The conversation was easy and we learnt that Sister Mary at the age of 70+ was doing a new job as an archivist reviewing documents recording the early RC church in Monze with some help from a Jesuit priest. She had been so successful at the Diocesan Centre she was being transferred, after forty years in Monze, to do the same in Lusaka. She didn’t seem to be the least bit phased by this and seemed to feel this was quite a normal thing for a nun to do. Sister Bertha at the youthful age of seventy-eight ran a catering school for young people in Mazabuka and was on some executive caring for orphans, which seemed to be more than a full time job for a 78 year old.

Pudding was not neglected either. There was trifle and Christmas pudding with brandy cream. The Christmas pudding was to be brought in flaming, and we had bets as to how many times Sister Mary would attempt to do this before she succeeded. In fact she did it on the second attempt with a not inconsiderable amount of brandy. Fresh coffee to follow, made in a cafetiere, is a rare luxury and we were also offered Obama whisky to go with it. This had been bought at our local ‘supermarket’ and on close inspection was noted to be 75% proof. So one dinner had given us fresh cream, fresh coffee and whisky – courtesy of Roman Catholic nuns!
They told us that some previous guests to their Xmas dinner had died soon after. It caused great hilarity when Mike suggested they probably shouldn’t have told us this. Over all it was great fun to be with them, and have an insight into their lives. I am sure they don’t normally live as luxuriously but it was fascinating to be with three seventy-plus year olds who have no retirement plans!
The entertainment was to be repeated at the party in Mazabuka on Saturday 27th, also said to be the best Xmas party to be invited to in the area.

Nuns dancing

Brothers singing

Michael drove us the forty-five minutes to the party at Mazabuka. On the way we did a shop at Shoprite for some of the nice things in life which you can’t get in Monze (wine, butter, and yoghourt) as well as the basics before arriving at a house about 3 miles out town in the middle of a sugar plantation. This is the home for mostly Irish nuns. There were about thirty people at the party, half of whom were nuns, mostly Irish, dressed very simply in civvies with about 5 Zambian nuns dressed traditionally and four to five Irish “brothers” dressed in a very relaxed style! There were about eight Zambian brothers dressed in smart trousers, shirts and ties, one Asian Christian family in saris (at least the women!), a Ukrainian surgeon and his 8yr old son who was to play a key role later on in the party and ourselves with Michael Breen. The sun was mostly out and not too warm, about 75 degrees centigrade, the meat was barbequed which together with lots of good salads was very enjoyable, particularly as it was followed by a very tasty traditional Christmas pudding with either brandy butter, fresh cream (only the second time since we arrived in Zambia) or custard. MRT had two large helpings at the nun’s insistence and omitted the cream the second time round. The drinks flowed freely although it seemed to me mostly water was imbibed, Only the very bold had one or two glasses of wine although Judy seemed to have no embarrassment in knocking back Mosi beer straight from the bottle. We were just wondering how we could fill the rest of time until we were taken to our lodgings for the night at the Christian Brothers home/school in Mazabuka, when the entertainments began. It was like Xmas at home in the 1950’s with songs and simple games each one present being gently encouraged to do their party piece. Fortunately for us, although it was very much a minority we weren’t the only ones gently refusing. Our excuse was that we would do something next year if invited!
The entertainment started with the Ukrainian surgeon’s son who re-appeared very smartly dressed in a light beige suit, the jacket fully buttoned, matching shoes and dark hair combed and flattened with a parting, He was ushered in by a nun who apologized on his behalf for his recent lack of practice. He seemed very confident in spite of this, gave a short bow with a completely serious face and continued without a word for the whole performance. He played a medley of songs including a carol or two and Jingle Bells without a seconds break on an electric keyboard. He retreated from the room to great applause after one or two hesitant bows never to be seen again for the rest of the evening. I have to say he reminded me of the son from the Adams Family (apologies to Hannah and Scott). This certainly got us in the mood. We had an Irish Brother and a Sister from New Foundland on guitars, playing and singing mostly Irish songs some plaintive and sad and some jolly.

We all joined in with the chorus. There was one nun who had a very good voice who sang very long religious songs with very high notes, which made it difficult to join in. We finished with some interactive games such as hokey pokey and songs such as “pia, pia, piano I am a music man, I come from down your way and I can playay”, with the response, “what can you playay?” and other party songs to catch you out. I once again tested Maji’s toes in a waltz to music produced by the brother and nun’s guitars.

The nuns obviously had a great time and enjoyed every minute. It made us wonder whether they look forward to this all year, as it obviously has become a great tradition, or whether they have sing songs, dancing and get togethers with the Brothers at other times of the year. After Sister Bertha’s last song the party was called to a close and we all left at the same time.

Sister Bertha on the left leading us in the last song

We spent a very comfortable night in the bridal suite (Brother Michael’s terminology) at the school the Brothers run. We had a breakfast of porridge, and by 8.15 after helping with the washing up were in the car back to the Nuns’ house for a short service. This was a very simple communion, followed by another breakfast if we wanted it (we did have the fresh fruit and coffee). It transpired that most of the Nuns were too late to have breakfast before the service as they had been watching the DVD of “Mama Mia” until after one am. and had overslept. They thought it was a brilliant movie, though MRT thought they didn’t appreciate how anti-men it was. He is very sensitive about such matters. The service was very domestic in their lounge and intimate, quietly conducted with surprising confidence in view of the expert congregation by a young Zambian father home on holiday! The wine and bread was passed around of which Maji and Paji did not partake. Michael Breen said it was the most enjoyable and meaningful service he had been to during his 8 years in Monze.
On the way home we stopped at Shoprite for the perishables not bought the previous day. A short walk followed this on the Mazabuka golf course

where we closely inspected a huge Palm tree with enormous fruits;

then home to Monze after a very full and alternative Xmas, interspersed with the clinical work on Friday, Boxing day - a normal working day.

Clinical Work over Christmas.

At 22 hrs on Christmas day I regretted offering to be on call for all the bowel blockages over the holiday period particularly as there was no junior medical cover from 16 hrs. The nurse from the male ward rang to say there was such a patient and should she send hospital transport? Fortunately the 2 glasses of wine I had had at Sisters Mary and Barbara’s Christmas dinner had pretty much worn off. Although I was in no mood to go out I put on some more formal clothes and went to see Cliff Haninmyi, a very miserable, and probably frightened twenty year old who had blocked bowels for two days. The x rays weren’t typical

and as he wasn’t too unwell I felt that as it was now 23.30 he could wait until Boxing Day. After an x ray of his bottom and a failed attempt to unblock him by inserting a tube into his backside we managed to get him to theatre at 15hrs.
He had a very severe twisting of his bowel, which I had to remove and then leave him with a stoma or bag.

His parents were appalled at this idea and were only partially reassured by the fact it would be possible to close it in 6 weeks. The patient remained very miserable but rapidly got better and went home eating normally 6 days after the operation. In the UK this sort of procedure is not unusual but occurs almost exclusively in older patients. The reason it happens in young folk here is not known but it is worthy of some speculation. This patient’s bowel was abnormally large and not just due to the blockage. Although he may have been born like this I would speculate that it is acquired perhaps because of previous damage to the nerves or muscle in the bowel by an infection some years ago. This would predispose to the development of a mega-colon and the twist or sigmoid volvulus is merely a reflection of the vulnerability of long baggy and dilated bowel to twisting. The lumen of the bowel also contained much undigested fibre from the mango fruit. Is this another downside of Mangos!?

Unfortunately he “fainted” the day after his discharge home and was brought back into hospital dead. He was buried without a post mortem 2 days later. It is difficult to be sure why this should happen in an otherwise very fit young man but it is most likely that he had a massive pulmonary embolism or the breaking off of blood clot which can develop in the leg veins and then travels centrally in the veins to completely block the blood vessels to the heart depriving it and the brain of any blood supply. His very devoted parents will be devastated and I wonder whether they will blame the hospital or me for some omission. They were a well-educated couple but this doesn’t mean they will not invoke some local customs to explain these tragic events! Subsequently I learnt they said it had happened to a previous relative which, if it did, makes it more likely that it was a clot breaking off as this can run in families.

On the Sunday after Xmas the baby girl I had operated on a month ago for pyloric stenosis

As she was when she left hospital before Xmas

was readmitted with large bowel obstruction or blockage, at least this was strongly suggested by an Xray.

She had been very well up to 2 days before this admission, was eating well, putting on weight and was apparently opening her bowels normally. I tried to operate on her before we caught the bus to Mosi-oa-Tunya but couldn’t as she had just eaten porridge. This was a little surprising as her little tummy was very distended but it meant that we couldn’t operate for at least 4 hrs by which time the bus to the Victoria Falls would have left. She was subsequently operated on the next day by Dr. Engulula who found she simply had bad constipation with faeces impacted in her lower bowel. These were simply squeezed through and removed without opening the bowel so I hope she now gets better. I also hope she doesn’t have some congenital abnormality in the functioning of the large bowel to go with her congenital pyloric stenosis.

These two cases show surgery is never easy or straightforward even when you apparently do all the right things. It can be stressful for the surgeon as well as being very rewarding.

Over Christmas we have also agreed our final programme so our introductory period is officially over and although our work won’t greatly change we do have support for both Judy and myself to do out-reach HIV/AIDS clinics in the more rural areas.

So on to the New Year. We have treated each to an expensive three nights in Tongabezi Lodge including a new years day swim in Devil’s Pool right at the edge of the Victoria Falls if the mighty Zambezi River hasn’t too strong a current after all the rain we have had! They usually don’t allow this activity beyond December. Keep your fingers crossed for us. More of all that in the next blog.
We would like to wish Family and Friends a very Happy and Healthy New Year. Don’t feel you have to register comments on the Blog, but we hope it gives you some entertainment and perhaps insight to life here.