The white is moving!

Back in Lusaka - no pretence of being here for work this time. We have spent the morning hanging out by the pool at one of the hotels, and we are now nursing our mild sunburn in an internet cafe. I love town.

Anyway, more highlights of Mpanshya life to follow. For anyone who is a bit lost by the title of this entry, it is an exclamation that a small boy made to his mother in Chinyanja when I was walking through the hospital on Friday. Thanks to my colleague, Sakala Webster for his prompt translation.

28th March 2006

We have been told that the mobile phone mast for Cellnet will be functioning from today. Finally, text messaging in Mpanshya! I roll out of bed at 6.30 and switch on my phone hopefully. No reception. A bad start.

It gets no better in the ARV clinic – it was meant to be a quiet clinic today, but everything is taking twice as long as it should do. I quickly metamorphose into an obsessive, pill-counting fascist, demanding that people show me their tablets so I can make sure they have swallowed the correct amount. Everyone assures me that they are taking all the doses, but the sums are not adding up. This is pretty disheartening stuff. I feel like I’m back in a Glasgow methadone clinic, policing people’s medication.

29th March 2006

There is thunder and lightning from 5am this morning, and we lie in bed listening to the rain drumming on the roof. I drag myself out of bed and plod over to the hospice in my raincoat.

Kenny, one of the patients has been complaining of a painful hip for a week or so now. We have been a bit lost as to the cause of his problems, but today he seems to have a small abscess forming. He seems keen that I incise it, and after discussion with Maggie, I oblige. I press the scalpel in, and a geyser of green liquid appears. We quickly fill two kidney bowls with the pus. It is splashing on my clothes and on the floor, and it keeps going. Kenny weighs little more than 40kg; I don’t know where this is coming from. My diagnosis of a small abscess is clearly ill founded. Eventually, when it becomes clear that it is not going to stop, I fashion a drain from a giving set and a catheter bag, and stitch it into place. Kenny smiles and tells me “pain is rested”. The clinical room is in chaos, with swabs, bowls and forceps lying everywhere, but Dr Banda is here for the weekly round, so I have to leave it and go.

30th March 2006

Nicole is leaving on Saturday, back home to Switzerland, and Maggie is plotting a surprise party for her. She has been fussing around for days, secretly constructing a banner in honour of the occasion. I go round to her house at six, bearing onion bhajis, and find that I am late and the surprise has already happened. Nicole was understandably overwhelmed by the sight of the 6 ft banner and has had to temporarily leave her own party to compose herself.

The nuns arrive from the convent to join us, and Maggie has organised gifts, which are brought by the caregivers from the hospice. They sing and dance for Nicole, and it is lovely. Sister Sabina is less impressed; a few minutes into the performance she remarks pointedly that some people are getting hungry. Maybe you get a bit less interested in Zambian traditions after 30 years of missionary work.

We eat outside, and then there is more dancing. Nicole takes to the floor with Sister Regina, and the hospice staff. The sisters try to encourage me to join in, but I make excuses, telling them that where I come from people need a lot of persuasion to dance. An old joke comes to my mind – the one about Scottish people not having sex standing up in case someone looks in the window and thinks they’re dancing. Perhaps not one for this company.

1st April 2006

I am having a leisurely start to my Saturday, when there is a knock on the door at 8 o’ clock. A message from Gilbert, the night nurse – “Please come and see a patient who has been attacked by a crocodile”. I dress hurriedly and rush over, uncertain of what I am about to find. On my way, I realise that it’s April Fools’ day. I’d be very happy if this turned out to be an elaborate joke.

I meet Odesta on the ward, and she is not laughing. She takes me to the bedside of a 12 year old boy who had been swimming in a river with his friends 2 days before. The croc attacked him and got a firm grip on his left arm. Miraculously, one of the other boys pulled him free. I peel back his makeshift dressings. The flesh on his limbs is badly torn, and when I lift his forearm I hear the shattered bones grate against one another. I shudder, but he doesn’t protest or whimper.

I am no expert on reptile-inflicted injuries, but I do know that these wounds will inevitably become infected, and there is a good chance that he will need an amputation. I give him some pethidine, and slowly scrub the gouges in his skin as best I can. We splint his arm. He will have to wait until Monday for a transfer to Lusaka. So far, his aptitude for surviving in one piece has been astonishing; I hope it doesn’t fail him now.

5th April 2006

The weather here is slowly shifting at the moment – rainy season ends this month and cold season is coming. In the first few weeks, nights were airless and sticky, but now the evenings are perfect. Everyone is telling us that we will be shivering in our thermals shortly, but I am treating this warning with northern European disdain. This feels like a good time of year to be in Zambia to me.

Just in the last few days, things seem to be falling into place, totally unexpectedly. There is still so much I don’t know and can’t do, but it all seems less unmanageable than before. The newness is subsiding, and I am starting to feel like a member of the team rather than a visiting buffoon. I have grasped a few words of the local language, and can now ask patients about their diarrhoea (although I will admit to being lost with some of the more descriptive responses). I still can’t quite get my head round all the resources that we don’t have here, but I’m trying to shut up about it and concentrate on the stuff that is possible.

And we are settling into the rhythm of days and nights in Mpanshya – the on/off of the generator, the bell for 7 o’ clock Mass, the descent of mosquitoes as the light fades. We are managing to co-exist with the assorted insects which inhabit the kitchen. We are mastering the art of meal preparation and consumption in the darkness (although it must be said that dining by candlelight loses some of its romantic appeal when you are obliged to do it three nights a week). We remain slightly embarrassed and inept with respect to bartering in the market - I suspect that they see us coming, but debating these transactions at length just seems a bit unnecessary.

The lack of communication with the outside world is frustrating in some ways, but it means that when you are here, all you have to deal with is the stuff that is immediately around you. Post is erratic, but the intermittent arrival of the Guardian Weekly is very exciting indeed. And there are no cars, no frustrating hours sitting at the wheel, staring at the number plate ahead.

Chas is increasingly lithe and tanned – the Mcvitie’s Digestives ran out in the first week – while I appear to be maintaining both my ample girth and my Scottish complexion. I guess adaptation to life in the bush is quicker in some respects than others…