Monday, 5 March 2018

Gifted hands too

 

Dr Bvulani with one of the Siamese twins named Mapalo.

Dr Bvulani with the twin girls.

Bonding time with the doctor. Pictures by JACK ZIMBA.
 
 
Gifted hands too

 

JACK ZIMBA,

Lusaka


WHEN Bruce Bvulani was a little boy he had a fascination with frogs.
He kept some in the backyard of his parents’ house and, later, when he learned how to stitch cloth at school, he would cut open the frogs and stitch them up again.
Of course, the poor creatures never lived through the gory procedure.
Today, Dr Bvulani’s subjects are not little frogs, but little humans. He is one of only four paediatric surgeons in the country.
With Zambia’s population of children estimated at eight million, it makes him responsible for two million children, theoretically.
And as head of unit neonatal and paediatric surgery at the country’s biggest health facility, the University Teaching Hospital (UTH), Dr Bvulani was the lead surgeon in the operation that separated conjoined twins Mapalo and Bupe on February 2 this year.
When the Siamese twins arrived at UTH in June last year, Dr Bvulani was on leave, but he knew that was his call.
Following the successful operation that lasted over five hours, the surgeon and his 30-some-member team were celebrated as heroes.
Yet hero is not a description that this unassuming surgeon subscribes to.
“There are so many things I do on a regular basis but I don’t think of myself as a hero,” he tells me, as we sit in the locker-room of the main theatre at D-Block.
He still has his scrubs on.
A devout Baptist, Dr Bvulani sees his work as service to God.
“God is the most important thing in my life followed by my family. I think work is just another way of serving God,” he says.
And at UTH, he has performed many complex operations that never even get picked up by the media.
But the Siamese twins had created media frenzy from the day their birth was announced – unsurprisingly.
Although Siamese twins are seldom heard of in Zambia, they are not a very rare occurrence.
Last year, Dr Bvulani came across two cases of conjoined twins. Unfortunately, one pair died on the way to UTH, while another died a few moments after being admitted to the hospital.
“Usually what kills them is that they have so many other congenital abnormalities like in the heart, which are not compatible with life,” explains Dr Bvulani.
For Mapalo and Bupe, they were born joined at the abdomen.
The doctors relied on CT scan images to see what they were going to encounter during the separation to separate them.
When doctors carried out an investigation at three months, they noticed that the twins’ intestines seemed intertwined. They would later discover during surgery that the twins’ intestines were actually joined and they had to separate them by cutting.
The girls’ livers were separate at birth, but seemed to have fused as the twins grew older, according to Dr Bvulani.
The prospect of a shared liver was most worrying to the medical staff, and it raised the question whether the operation should be done locally.
According to Dr Bvulani, there were suggestions to repatriate the twins abroad fearing their case might be too complicated for UTH to handle.
In 1997, when the country was faced with a similar situation – two boys joined at the top of their heads, they were taken to South Africa because UTH was ill-equipped to undertake such an operation.
The twins, Luka and Joseph, were separated by a team of doctors led by renowned American neurosurgeon Ben Carson, assisted by Zambian and South African doctors.
This, plus other “miraculous” operations on Siamese twins became a subject of Dr Carson’s famous book Gifted Hands.
Today, Luka and Joseph are both alive.
Dr Bvulani, himself, had just graduated from medical school when Luka and Joseph were successfully separated. And later when he worked at the D-Block, he met the two when they came for reviews.
Finally a decision was made to operate the girls locally.
Dr Bvulani says a number of equipment had to be bought in order to prepare for the operation.
“Not everything we would have wanted, there are a number of things we would have wanted on our wish-list, but we are grateful for what we got,” he says.
The operation to separate the twins went on smoothly, but there was one unnerving moment during the operation.
Half-way into the operation, one of the twins had lost IV (intravenous) access, meaning fluids and medication had stopped flowing into her body.
“It just stopped running and we had to stop the operation for a while. That was a bit tense for us,” says Dr Bvulani.
The medical team also had to have a plan B; in case the twins shared a vital organ, they would have to unpleasantly decide who gets it.
Luckily for the two girls, none of the organs was shared.
And while the nation celebrated the separation of the twins on February 2, the medical team could not celebrate yet.
“The first two weeks after the operation was a very tense time for all of us,” says Dr Bvulani.
Would the twins live after the separation?
“They have to survive and they have to live. That is when you can say the operation was successful,” says Dr Bvulani.
On February 26, the twins were removed from the intensive care unit and placed in a nursery.
For Dr Bvulani the successful operation has reinforced the importance of teamwork.
“It has made me realise how important team work is,” he says.
Yet he has also had to deal with critics, who have underplayed the complexity of the operation to separate Mapalo and Bupe.
Dr Bvulani says any operation involving conjoined twins can be complex, unless they are only joined by skin.
“That is why anywhere in the world when there is talk of conjoined twins there is always hype around it,” he says.
But he admits some conditions are less challenging than others.
“I do agree that there are more complex conjoined twins and there are much simpler conjoined twins where they are just joined by skin,” he says.
“When it involves two individuals who are joined, functioning differently and each one needs an anaesthetic team; and then they are sharing organs and blood is flowing between them, it changes the dynamics of the fact that it is a simple procedure,” he says.
Dr Bvulani’s dream is to better the practice of surgery in the country by having more skilled surgeons, especially in paediatrics, as well as having well-equipped theatres.
“We need a lot of equipment to do surgeries like these and even more complex ones. We hope the government will get us the equipment we need,” he says.
Like many nurses and other support staff taking care of Mapalo and Bupe, Dr Bvulani has grown fond of the twin girls.
He visits them every day, sometimes twice, just to check on how they are doing.
When I visited the twins two days later, they looked active and full of life. When Dr Bvulani lifted Mapalo into his arms and played with her, she laughed and reached for the doctor’s nose and beard.
Dr Bvulani says the most fulfilling thing in his work “is to see people walk home.”
“We are looking forward to seeing the twins grow and go to school,” he says.
DRIVEN BY PASSION
Dr Bvulani is driven by the belief that one has to love and enjoy the job they choose.
“I love what I do and I think I can do it for the rest of my life,” he tells me. “I have no regrets. There has never been a time when I thought that maybe I should have done engineering, not even in my lowest moments.”
And in this job, there can be many low moments. Some of Dr Bvulani’s lowest moments have been seeing life slip through his hands.
“I think when you have done a lot for a particular patient and things are looking up and suddenly things tip and suddenly the patient takes a turn for the worst and dies, those are moments in my career when I really feel bad,” he says.
“And sometimes when you have done a good surgery and the child wakes up but later on you hear the patient has died and you can’t understand why,” he says.
As a Christian, Dr Bvulani has come to accept the fragility of life and the supremacy of God over humans.
“We are not in control of things. At the end of the day, whether these children get well or not is not for us to tell. We ought to just do our best,” he says.
Dr Bvulani is also strongly opposed to termination of pregnancy for medical reasons such as abnormality in the foetus. A couple of times, he has had to excuse himself when such decisions are tabled.
“It is not right for one to choose beforehand that you only want good things. I think even in some of these things that God gives us, there is a lesson for us,” he says.
“I know many people would say it’s unfair because I’m not a woman and I can’t carry a pregnancy, but the point is what does the Bible say?”
EARLY LIFE
Dr Bvulani was born in a fairly comfortable family to Jane Chikasa and Reuben Bvulani in 1970 in Lusaka. He is the fourth born in a family of 12.
His father was a banker who once worked for the central bank.
And it was his father who had the strongest influence on him, pushing him to work hard in school. He attended Woodlands A Primary School and later went to Munali Boys Secondary and Hillcrest Technical School.
During his school days, Dr Bvulani seemed torn between engineering and medicine (he still thinks he would have made a good engineer if you ask him).
So despite his earlier fascination with frogs and what lay beneath their skins, he later became interested in electronics, influenced by his older brothers who were making simple radios and electric circuits.
“When I went to secondary school, I was exposed to technical drawing and metal work so at that point that is what I thought was interesting and I thought I should do mechanical engineering,” he says.
But he would soon gravitate back to medical stuff and biology.
His interest to study medicine came from his older sister who was studying medicine at the time.
In 1989, he went to study medicine at the University of Zambia. He then did his internship at Nchanga Mine Hospital in Chingola, and Kitwe Central Hospital.
He then worked for three years for a mine hospital in Chililabombwe.
But his passion was always to do surgery.
“During my medical school days I was inspired to do surgery. Although I had not rotated through paediatric surgery, this became my heart’s desire. This was especially after I visited the paediatric surgical unit to visit a close family friend’s child who was being nursed in the wards there,” he says.
And so in 2000, he was accepted to study for his Master of Medicine in Surgery at the University of Zambia. When he graduated in 2005, he started working at UTH.
In 2009, Dr Bvulani was offered a one year training fellowship by the African Paediatric Fellowship Programme Fund at the University of Cape Town in South Africa.
“The fellowship was very helpful in cementing my paediatric surgical experience and practice, and was an opportunity to interact with paediatric surgical colleagues from around the world who would visit there regularly,” he says.
Dr Bvulani is also a fellow of the College of Surgeons of East Central and Southern Africa having undertaken various examinations and fulfilling the necessary qualifications.
Dr Bvulani is married to Margaret Makani and they have three children, Chibale, Mpungasanu and Mpaso, who is the only one of the three children with interest in medicine.

Unmasking the nyau

Unmasking the nyau The nyau characters represent various forms, but animal figures are the most common. Pictures by JACK ZIMBA ...