Grant and Johnny in Zambia December 2005 to March 2006

New Year's Day to January 12

New Year's Day, Sunday, January 1, 2006. 

        The New Year dawned bright and clear as it always does here.  We were hangover-free and had a lovely day just mooching about the campsite.  There were a few people sleeping till the afternoon on the floor of the manager's house.  We went to the river in the late afternoon and watched a hippo come out of the river really early and graze on the bank - she, one presumes she's a she, they all have such a maternal shape but I suppose in the natural order of things they can't all be she's - she pottered about gorging on grass for ages till she saw us when she took a nasty fright and walked back to the river's edge.  This is the first time we have seen one so close,  and so early in the evening well before sunset. There has been a hippo feeding on the grass that is kept short around the house for most nights this week.  They are terribly noisy eaters and wake us but we don't go near them.

        It's fairly normal for me, Johnny, to meet animals on my way to work - elephants, zebra, buffalo and antelope are the norm but recently there has been a group of giraffes on the road - I just love them.

        We had two days holiday at New Year and I really enjoyed them.  I had to make two visits to a neighbouring camp that prides itself on being up-market which was good fun as the patient was not terribly ill and had in any case imported the illness from the UK so it was well within my expertise  and having a snoop around another camp is interesting.  They are on the very edge of the river bank which does make for wonderful views - the newer lodges aren't allowed to build in such a way to limit the environmental effect of the safaris on the environment.  I am not sure that the extra huge amount of money is worth it - the game one sees is the same.

The new era dawns in the clinic.  Progress at last - to-day I went into work and the laboratory has been tidied, cleaned and the equipment covered with a dustsheet without even asking.  I am thrilled!  When the water comes in we will start on the lab work and the ward cleanliness.

        We had a bad few days with some deaths, one of a child with dehydration - we were horribly busy and although had done everything we should we weren't about to check and oversee the parental care of the child (nurses here instruct patient's carers in care and don't mop fevered brows themselves) and when we saw her again it was too late; one premature baby of 7 months who had been out of hospital for a week but had lost weight - why she ever went home I can't imagine, doing so was sealing her fate and a new mother who died of a fit on coming home from our referral hospital four days post-partum with a sky-high blood pressure and terribly pale.  We started her on treatment (we actually have a lot of a not too inappropriate drug donated to us - we have literally millions of certain other drugs donated to us and they are completely useless!) and she had a fit in the night and died.  The story does not end there as according to local tradition if a woman dies on delivery of the placenta she has been mucking about in pregnancy but if she dies on seeing her husband he has been philandering.  She saw her husband the day/night of her death - it is not normal for men to have anything to do with delivery/labour - so at the funeral the woman's family demanded three million kwacha (that sounds a lot but my work permit cost one million) as compensation. They will now have the cost bringing up the child.  In the ensuing row that took place at the funeral the father of the husband died - was it witch-craft or poisoning or just emotion?, one will never know.

Tuesday, January 3, 2006  Grant's Dad goes into hospital

        I think this e-mail that I got from my sister Sharon says it all:

"I just got a call from Pat.  She's with Dad in the Red Deer Hospital. He has complained of abdominal pain these past couple of days.  Pat was going to take him to the hospital herself but the pain was so bad he couldn't make it out the door so Pat called an ambulance.  He's had all the usual blood work, ECG, x-rays and CT scan.  He has a section of his bowel that is hypoxic and because the surgeon couldn't tell exactly what is going on from the tests, is taking Dad to surgery tonight.  There is a risk of bowel rupture.  Pat will phone in about an hour or so to give me any updates.  She's on her cell but can't use it in the hospital so you can't phone her there.  When she phones back, I'll give her the phone number of Flatdogs.  Can you make yourself available for a call in the next couple of hours.  Or, she will go back to Mom's when she knows more and you can call there.
Before Pat called me, she had talked to Mom and Mom was going to bed so don't phone there just yet.  Mom won't know the outcome of the surgery and it may only upset her more."
 

        Well Dad was operated on the next day, and he had one huge tumour in his descending colon.  It was removed along with a couple of other small tumours and all went well.  The next day he was sitting on the edge of the bed teasing the nurses.  Whew!  [He's now back home and is full of good spirits!]

Wednesday, January 4, 2006  Our first dinner party

    Our house is quite cute and well-appointed now and the new Italians are fun so in a fit of adventure we invited them for dinner to be cooked on a two ring electric stove on the table with the computer where Grant works.  We decided on pasta con zucca - squash is easy to buy in the market and we have some parmesan cheese - relatively easy though it does require a bit of juggling with the rings and pans.  Then a fish course.  There's lots of fish in the river and a lot of fishermen in town but what to buy and how to get it and go to work too?  Problem solved by coming up with an arrangement with Winnie, the Nature Reserve gate guard - if she got me four decent fish out of ten thousand kwachas she could keep the rest.  In the event it wasn't a good day for fishermen so we got one large and two smaller fish all of different varieties - and Winnie got some horrid cat-fish and one each of several different species and was very pleased with her part of the bargain.  We photographed the fish before cleaning and cooking them so we would know which was best and be able to get that variety again - see below - the biggest was by far the best out of a trio that tasted very different, mild in flavour and firm in texture.  I had to clean them in the bath - the scales on the best fish and the one without the rows of horrid teeth were enormous - for ease of preparation the tiger fish would have won easily.  The plughole is still being choked by scales one week later - we do NOT bath in the bath!  When I cook them next time I will grill them in foil and avoid all that trauma.  The next course was easy - tomatoes and avocado salad with basil.  A good menu and a good evening, they are interesting people. Couldn't face washing up in the washhand basin so Rogers did it outside the next day.  In Botswana that would have meant an invasion of ants of such a scale that it would have been impossible to even think of it - ants aren't a great problem here.

Thursday, January 5, 2006  Grant goes to Lusaka

        I took Grant to the airport on the way to work and at the same time got my work permit.  I would have combined it with a trip to the local hospital to be "supervised" but Dr Tshibumbu is on holiday till February - I rather look forward to that trip so that I can get an idea of what my patients go to when they go there - I get the impression that it is very basic but not as basic as us - rather like Maun in Botswana where I was in another life.  On the way Grant and I saw roadside stalls selling mats - there was a particularly impressive one and I was told to get it on the way back so I checked at the local bar what would be a decent price - 10 to 12 thousand but definitely no more than 15 was the consensus.  He wanted 25!  Too much! So I went to work and checked at the bar later with some locals what they would expect to pay (the previous people were ex-pats) - 20 to 25 thousand, probably 25 seeing it was so big.  [Grant here:  What Johnny's saying is that for a 3 metre diameter mat that £4 =$8 was too much!!  I think we should have paid the poor man twice as much.

This photo, taken prior to departure from Mfuwe Airport, is for Pat who's a sometime paramedic.

        The good news:  The pressure in Grant's right eye (the one that had the cataract operation) is lower than it's ever been.  The pressure in the left eye is exactly the same as it was when leaving Edinburgh - so that makes a good control of their equipment and methods.  I'm really pleased that the pressure is down and that I won't therefore loose any more sight in that eye.  I also did a lot of shopping and came back with tools, Parmesan cheese, chocolate, ink-jet cartridges, etc. etc.

Friday, January 6, 2006  Grant comes back from Lusaka and gets the news that his mother has broken her hip

        There's a fantastically hard, black wood that comes from a tree called the leadwood tree.  Like lignum vitae it is heavier than water and sinks.  There are two leadwood trees at the entrance to the drive of some people we have met here so we stopped to saw off a piece to see what it was like.  Well it was very hard and it took ages to saw off a tiny piece!!  We've since found out that one of the lodges have lots of off-cuts that we can have.  So we'll send back a suitcase full of leadwood when we return.  Should make good sharps (instead of ebony) for our instruments.  May get some for Ian Burn in Canada and, if possible, some African blackwood as well.  Its a fantastically beautiful wood. 

        We called in at the second mat sellers shop on the way home after the leadwood adventure because the best mat had been sold to a lady who was boarding the flight that Grant was getting off.  "25 thousand for one mat" and just as we were about to agree the deal he beat himself down and said "20 thousand" - not a great haggler!  We have ordered some baskets too and he is making one for us to see before he makes the rest - all you who are expecting presents had better fit a basket of traditional African design into your kitchen scheme.

        When we got back I had the following series of e-mails:

"Mom fell broke right hip.  More later.  Get a flight.  P"
"Doing better with pain control.  Will be admitted.  Intratrochanteric fracture no comminution.  Surgery likely tomorrow.  When can we call?   Still think about coming.  Not emergent as originally feared.  Pat"
"Hi Grant  Dad doing very well.  Up for long walks, they've started ostomy teaching.  Mom had a good lunch.  Her INR at 5.8 so got plasma and vitamin K.  no time for surgery yet.  Pls call.  Don't know what you should do re coming back.  Pat "

        A series of frantic telephone calls ensued.  The pressure to go back to Canada went down slightly.  Dad continued to improve; Mom has gone on to have some real problems.  Time to go to Canada to give the poor sisters a hand.  Time to book a flight.

Saturday, January 7, 2006 - Roger's going away party

        Grant has been very clever and when in Lusaka bought a picture frame and inserted into it a photo of Rogers.  This is the photo that we think captures the personality of this sweet, gentle, profound and very intelligent person:

  At the party later I saw him stroking it!  It was a very handsome and accurate photograph of the gentle man that he is. The party turned out to be a great success despite my misgivings - would we mix?, would they go?, would they eat us out of house and home?  Grant asked Rogers to invite his friends and he made up a small party of eight, all personable.  The Italian couple who are coming into partnership with the present management came too, Jacqueline is wonderfully natural.  We ate all the goodies that Grant had brought at great expense from Lusaka - peanuts, cashew nuts, biscuits and Cadbury's chocolate - now that was a sacrifice, and drank soft drinks and beer.  At the end a joiner improvised a short song wishing him farewell and the party broke into harmonious accompaniment.  Zambians can sing.  We think we did him proud.

Sunday, January 8, 2006  0ur trip to Roger's village

        Sunday we went with Rogers to his village accompanied by Valentino and Jacqueline.  It was quite a long way off the main road but along a really good quality dirt road.  It was 47 Km there and back.  Normally when Rogers starts a weeks duty he gets up at four o'clock and sets out on his bicycle as soon as he can see - it takes him two hours to get here.  This time he had all his accumulated possessions and bits of foam and cushions that he had cannibalised from a horrid old sofa that used to be in the doctor's house.  Previously when he had been told that he was to be kept on for another two years on retirement from the kitchen where he was a cook he put a double bed that he could now afford on his bike and pushed it all the way home.  The bicycle is the means of transport here - it's flat and the roads are reasonable.  We meet people carrying amazing loads - there was a man carrying a small wooden garden bench on the rack behind the saddle and on that sat his son; two children and an adult is a normal amount to carry.  To-day, Monday 9th of January is the beginning of school term - I bet that will be revealing. The poor kids go to school from six thirty till four o'clock and there are up to 60 in a class.

        The road wound its way through fields and past villages that got ever better - the houses by the main road are shabby and poorly constructed and laid out, some of them are now flooded with puddles from the recent rains.  There were fields of really good corn, rather small groundnuts, cotton and rice - no animals apart from chickens.  Eventually we climbed a little hill and at the top was Rogers' house - it was really smart and had a little shop attached to the side of it. See the photo's (there are more:  look at photos 15 to 28).

       While we were at Roger's village, I, Johnny, went to see the granny of a personable young man called Gaston who works in the gift shop in the camp, he is one of Rogers' neighbours.  I met his wife in her compound - he has to live with her family for a probationary two years after marriage - and then we walked to see his granny in his family compound.  He was really proud of his new son and calls him "Amazing"  because of the events surrounding the time of his delivery - see photos below. 

        Poor Granny has had an ulcer on her leg for a long time and now it has cut off the blood supply to the foot and it's gone gangrenous.  She is in little pain and terrible general condition and is old.  I can see that she would die if she had the leg amputated mid-thigh  and will die when the not very viable tissues above the dead bit get infected.  It's too late for a decent medical intervention - it's up to the old lady to find her own solution in the form of care and pain-relief.  Gaston will talk to her and the relatives about it.

        Gaston will build a larger house in his compound as soon as the rains are over this year and he, his wife and his First Born will move there - he has passed his in-law's family scrutiny.  His wife built the earlier house entirely by herself, made the bricks (there are kilns all over the countryside in which bricks are fired), put up the walls, got the wood for the roof beams and thatched it - now it's his turn.  Seems fair to me.

There were no calls whilst I was out of radio contact.

Sunday lunch same day

        It started out like any other lunch.  Everyone happily chattering and gossiping outside at the picnic tables in the shade.  Suddenly Adie, the camp manager stiffened, jumped up and burst toward the end of the table.

        A cobra!  A black spitting cobra.  They can spit their venom up to 3 metres and cause blindness.

        Adie radioed to one of the mechanics to bring a long-handled shovel.  A lot of poking in the woodpile beside the barbeque ensued and the bloody thing seemed to have disappeared for a while.  Then it appeared out of the covered woodstore at the end of the barbeque.  Blazing action!  It was summarily dispatched and everyone lived happily ever after!

 And an eventful game drive on Sunday evening

         Sunday evening we decided to go on a game drive - they start at four pm and last three to four hours so they span the sunset period. An open-topped four wheel drive vehicle has three ranked benches welded on the back and the clients sit up there in Raj-like majesty.  The guide drives and a spotter helps with the drinks and after dark shines a light into the bush and spots the animals whilst the driver negotiates the road.  The roads can be flooded but we went on a really good one this time.  We saw a decent amount of the usual stuff but then stumbled upon a trio of lions - two males and a female who was in heat - another coalition group.  It seems that when a traditional pride gets a new alpha male he kills all the recent cubs of the previous male to make his brides come into season early,  Some of the older cubs escape this slaughter and get together - a coalition group, I suppose made up of half-brothers and sisters.  They form the nucleus of a new pride when the females start to breed. We went deep into the park and up a hill - one of the few hills around here - and had drinks in the open watching the sun go down and the lightening flash in the clouds around the horizon.  On the way back there was a little smell of rubber and then a boil over - no water in the radiator.  So on a lovely moonlit night we were filling bottles in a puddle to refill the vehicle, the air was filled with the scent of wild jasmine and the sound of bell frogs - it was a lovely adventure.  We got home late having seen a hyena (ugly and mean), genets (funny little nocturnal animals of a mongoose type) and a civet but still no porcupine or leopard.

Just another day at Flatdogs!

 Monday 9 and Tuesday 10 January, Two rules broken in two days

        We had been given the advice never to lend money and never give lifts - these two rules have now been broken.  There was a young lass at the clinic with one child and then another, the children were thin and had malaria and on each occasion I tried to interest her in her health too.  On Monday she came with all the family - two elderly women (probably forty to fifty), her husband (thirty) and one child.  The husband was so ill he just coughed all the time and slept, she sweated loads and looked even thinner and the child coughed too - I am sure she has widespread tuberculosis but how was I to prove it and start the treatment given our clinic's lack of anything?  I "bargained" with them that I would give them the 'bus fare, £3.75, if they would all go to the local hospital as a family and get looked at.  For this the old ladies had to cook a meal for the family (£1 for enough for all of them for then and the likely time at hospital).  I just couldn't bear looking at her so uncomplainingly worn down by illness and caring for others and so young - she's fifteen.

        The other rule is not to give lifts.  Most people break this one as another person in the vehicle over mud and potholes can be helpful if things go wrong.  There is an exception to this not giving lifts rule - elephant infested areas. 

        On the way to work I saw a large knot of people in the village - they looked rather like a church crowd or a funeral but they were going nowhere whereas funerals make their noisy way somewhere.  Much nearer to me were two lads carrying fish seemingly going into town who waved frantically at me so I stopped - elephant on the road barring traffic.  In they popped - oh boy did they smell - and we carried on into town.  On the side of the road with his ears flapping and trunk raised was a huge male solitary elephant and it was a bit scary to drive past. In town they go out and I went to work - those going in the other direction would have to wait for a vehicle going their way.

Wed. 11 January 2006 - Amaryllis hunting.

        I went to see a patient at a nearby camp and on the way saw some wild amaryllis in the bush.  We had a bit of a heavy night last night at another camp, a lot to eat and drink including Robert's mother's Christmas pudding and then dancing till 2 30am - we were going to go to find them early this morning but it has taken me a supreme effort to pull myself out of bed on a cool morning.  Yesterday we had 55 millimetres of rain and a few days before that 85mm which explains the flowering of the bush and the coolness of the mornings. When I went to work one of the guides hitched a lift into town and I went the long way round and visited the "Amaryllis" - the observant ones amongst the readers will notice the quotation marks creeping in - and he was unable to identify them.  Grant and I went at lunchtime and the photos are below.  Later to-day we were to learn that they are called swamp or rain lilies.  Aren't they lovely whatever their name?

        Tomorrow we move to Wildlife Camp because Flatdogs closes for two months.  A strange feeling as we have got used to the place and it's a nice home from home, "another day, another adventure" is what I always say - nothing like a good platitude.

        But there is more to report first - my first accident waiting to happen.  I got a radio call - Dr Johnny please go to BP - there's been an accident.  So off I go - it's not far down the road at the beginning of the village.  No accident, no crowd, no wailing sirens - a normal peaceful night in Mfuwe. So thinking that the patient could have been scooped up and taken to the clinic I go there to find Cecilia in hot debate with the inspection team (more of that later) - basically she was saying that having waited for them all day and having been told at two pm that they would be with us in half an hour that six o'clock at night was not a good time to start and that she didn't really care that they wanted to get half way through their work that night.  Then the radio went off again - go back to BP, park with your lights across the road and wait for the accident to arrive.  Eventually someone who could explain it arrived - a lass in the far north of the park had fallen off her motorbike, badly fractured her arm and was being flown down by her father in a microlight aircraft and was about to land at the petrol station as darkness was falling and they would not be able to land at the airport.  Imagine the excitement when it did land - hundreds of people all flooding onto the road, crowds twenty deep around the 'plane.  It was almost impossible to see the poor girl.  By the time the 'plane was tidied away it was dark and as I needed to see her to make any sort of assessment I had to go back to the clinic, now empty of rowing health worker, and look at her in good light.  She was as plucky as a Zambian - have I mentioned how stoical they are? Her mother arranged for medical evacuation, the father packed away the 'plane and I practised medicine getting rid of her pain and making her fit for travel.  In the event she went out at ten o'clock the next day and is reported to be well.  All the valley knew of the incident in minutes and what was not known was made up - I heard about the accident from everyone and details of her injuries were passed to me or asked of me in a way that would make a St Andrews patient's blood boil.  There is little secrecy or discretion here but it's not malicious.

Thursday 12 January 2006  The day of the great inspection.

        As alluded to above we were inspected.  A great deal of polishing and cleaning and accounting and tallying preceded this visit.  We had been given one day's notice on the Tuesday and expected them at eight o'clock on Wednesday.  By twelve o'clock they weren't here but were reported to be on their way, at two o'clock they said they were arriving in half an hour and at four o'clock they were nowhere to be seen - we went home and I arrived early the following day.  Their vehicle had been commandeered by their superior officer but nevertheless they hoped to get through our inspection in the morning and go to a neighbouring clinic in the afternoon.  Fat chance! - they had done only half of it by lunchtime but all the same sent a message to the next clinic to be ready for them.  I wonder if they realise the resentment that this sort of behaviour causes.

In the event it was an occasion not to be missed - for its futility, its misdirection and its demonstration of all the wrong ways of doing an inspection  and also as an opportunity for getting something positive done to get the clinic functioning again. We were taken around the buildings and various comments were made - on being told that the staff fear for their lives during a high wind because the roof corrugated iron lifts off no comment was made, when they noticed that there were pit latrines as well as water closets we were asked why - because the water tower has fallen down and not yet replaced is the answer, they commented that the floors of water closets look much better if cardinal polished, when it was noticed that the planting of lilies around the building was inconsistent in the north aspect that was criticised but no comment was made to praise the staff for all the area that is in good order.  Then we went and sat around a table and the reports were gone through - it was awful - we were expected to wrong-foot ourselves and confess our deficiencies, almost a parody of the school teacher who asks "who's that laughing at the back?"  The staff were very tolerant but I being not used to such treatment and not in their thrall and secure was able to answer back, ask follow-on questions that exposed the error of their arguments for example on being asked why there were bicycles in the lab awaiting being given out to volunteer health workers we replied that they were defective in not having brakes and the chains were broken on some so we felt that the government would not want to be associated with giving out death-trap machines. "Well, ask for funds to repair them". "We have done so since May 2005 and nothing is forthcoming"  "Take the money from user funds (the fees paid by patients to see us - about 30p)"  At this point I pipe up - "That's great but what is the mechanism - do we bank the money and keep in the accounts a note explaining the shortfall as being the amount spent on bicycle repairs? or do we have to bank it all and indent for money back?"  "The latter"  At which point the staff cry out with one voice "That's what we have been doing since May 2005 and permission to withdraw funds has never been granted!"

In the end they left at about five pm - the clinic to which they were going was told not to expect them after all at four o'clock having been told twice during the day that they were coming.  The staff were shattered, dispirited and cross but united in the enemy - the government.  All the positive messages had been lost, the valid criticisms too painful to remember and good tips lost in bureaucratic wrangles.  I hope that I can see Cecilia soon and make a plan with her to redeem the situation and use some of the day's work to our advantage as there is certainly an awful lot wrong with the place that with a bit of guidance could be put right.  I would love to get the place working with a hum of goodwill and a standard of medicine and nursing that one could be proud of and I think they would too - getting there will be fun and hard work and very worthwhile.

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