Leaving Mpanshya

3rd June 2007

Sunday morning, and I am standing at the back of the church with Bernadette, clutching a large bag of rice. One of the regular features of mass in Mpanshya is that after the offering is collected in cash, some of the women from the village dance up the aisle bearing gifts of food for the priest. Every time we have watched this ritual, Bernadette and I have said that we will do it ourselves one day. There are only two Sundays remaining before I leave, so it’s now or never. We consulted earlier this morning over what we should wear for the occasion, and it was agreed that we should both turn up in traditional Zambian dress. Bernadette is clad in a tasteful brown chitenge suit, but I have selected a slightly more colourful ensemble. I look like an oversized Quality Street. And nobody else seems to be gathering at the back with us, so it appears our dance will be a pas de deux rather than the more anonymous collective effort I had envisaged. We whisper urgently to Mathilda and Agness, and they agree to rescue us from our imminent humiliation by dancing in ahead of us.

The music starts, the congregation stands, and we process down the aisle together. We are a little out of time, but we make it to the front without falling over. Our efforts are greeted with some hilarity by our fellow worshippers, but I think they are laughing with us. I hand over the rice to a slightly surprised Father Leszek and then wonder what to do next. The others are still dancing by the altar, but I have lost my momentum, so I just sway aimlessly for a bit, hoping that the music will stop soon. Luckily it does, so I sprint back to my pew, glad that my performance is finished.

But it is not over yet. At the end of mass, Elias reads out his usual lengthy intimations, and then without warning, starts to talk about how I am leaving. He says in English, “Could Dr June come forward to say a few words?” There is no escape. I trudge back to the front, deliver a short speech (three sentences of nursery Chinyanja without taking a breath) and receive an equally brief round of applause. I return to my seat next to Chas. He leans towards me and whispers “What was that you said?”

5th June 2007

Today is the day of the staff photo. Chas and I decided that the time most people would be likely to come would be just after 7 am, when all the general workers report for work. I have put a notice up in the nurses’ station to let everyone know when it will be happening. I have appointed Brendan as official photographer. I have also had a short debate with Webster as to whether or not the nurses should appear in uniform (I thought not, he disagreed). But no one has ever attempted to take a staff photo at St Luke’s before, and I have no idea if anyone will actually turn up. (Although there have been encouraging signs: yesterday I spotted Brenda from the hospice at work with her hair in rollers.)

So now, Chas and I are out in the morning sunshine, dragging benches into place in front of the hospital with the help of Isaac and Evaristo. A few of our colleagues idly wander over to take a look at what we are doing. It is still not clear if anything will actually happen. And then suddenly, about thirty people arrive, ready to be photographed. The nurses are gleaming in their starched white uniforms. Everyone starts to take up a position on the benches. The photographer arrives last, bleary-eyed and unironed. Within five minutes, the photo has been taken, and everyone has been ordered back to work by Sister Sabina. It is the greatest display of efficiency I have ever witnessed in Mpanshya.

9th June 2007

Our goodbye party is today. Being no great fan of parties in general, and also having spent the previous week constantly feeling like I am about to burst into tears, I am rather ungraciously dreading it. Chas is not looking forward to it either, but as we will be publicly thanked whether we like it or not, we dress up and walk over to the training centre, where the festivities are to be held.

Being the guests of honour, we get to eat at a table with the retired archbishop of Lusaka, who is a charming man, and also the only Zambian I have ever seen consuming nshima with cutlery. Everyone seems a little subdued, and when the music starts up, no one takes to the floor. Luckily, Goliath, the inappropriately named mortuary attendant has had a few beers, so he kicks off the dancing, thrusting his wiry frame around with gay abandon, and some others join in.

Mr Phiri is the master of ceremonies for the day and he ensures that the programme of events does not deviate from the time-tested Mpanshya routine: music, speeches, and then cake. The dancing in of the cake is performed by the hospice dressers, followed by Sister Angelica and Webster, who have been assigned the role of presenting the knives. Webster is sporting a shiny shirt, cowboy boots and a pair of sunglasses that might have been discarded by Deirdre Barlow sometime during the last millennium. He is clearly enjoying his moment in the spotlight, and treats us to all his raunchiest moves, while Sister Angelica bobs demurely beside him. By the time they reach the stage and finally hand over the knife, I am sore with laughing.

And so the party goes on. The music continues, Chas and I are presented with an extraordinary copper clock in the shape of Africa, and we have a partially successful attempt to teach our colleagues some Scottish dancing (at the beginning of Strip the Willow the floor is filled with enthusiastic learners, but by the end there are only eight still standing). In short, against all our expectations, we have a fantastic time.

10th June 2007

Our last day in Mpanshya and we have packed nothing. We spend all morning in dispute about what stuff is destined for home, what should be given away, and what belongs at the bottom of our rubbish pit. We have finally agreed that the enormous drum that Chas inadvertently purchased from a man in Kamwenshya is coming with us, although we are uncertain how this might actually happen.

Deciding to throw things away is much more contentious, and in some cases, actually impossible. I am sorting through some photos when I come across a DVD that my sister sent me, containing photos of my niece set to music. Being in no mood for sentimentality, I chuck it in the pit. Within a few hours, there is a knock at the door, and we open it to find two children standing there. They are holding up the same DVD. The older girl says “You lost this”. They must have been rummaging around in our rubbish, and their mother has told them to bring it back. They hand it back over, and are about to go when the little one, Moses, says excitedly “I saw you!” They have obviously managed to find someone who could play it for them, and as the only photo of us occurs in the last ten seconds, it also appears that they have watched it in its entirety. Somehow, we manage to maintain straight faces until the door is closed again.

At midday, we escape the chaos of our home and head over to Maggie’s for lunch. The hospice dressers, Brendan, Joost, Bernadette and Chris are there as well. We eat in the sunshine, and then the dressers get their drums out. They perform Soli dances for us, which are amazing, and people from the market start to gather to watch. Then some of the patients from the hospice arrive. Yotham, our resident musician, has come with his guitar. He sings one of his own compositions; I don’t know the title, but it could perhaps have been called The Doctor June Song. He strums and sings, and the dressers join in, dancing around him in a circle. Chas and I get up to dance with them, but suddenly it all just seems a little overwhelming. In the interests of averting a public snot-flying incident, I sit down quietly in a corner, and they carry on without me.

But I manage to recover my lost composure quickly, which is just as well, as the repertoire of songs-with-our-names-in keeps on going for some time. (Should we ever wish to run a dictatorship within, for example, a former Soviet state, this afternoon will have been excellent preparation.) It is unbearable, and lovely, and funny, and sad, all at once. I wonder if they have decided that if they massage our egos sufficiently, we might change our minds and stay. Or maybe they are just enjoying the singing. But as we dance with them for the final number, a song about how everyone is crying because we are going, I think that it is the best party I ever had.

And now, kwasira, it is finished. Over the last year, I often thought about and looked forward to leaving, but now that it is happening I’m not so sure I want to go. I am a bit exhausted with saying goodbye, and some of the farewells have been hard. A lot of patients responded to the news of my impending departure by asking me to give them a gift, but a few said chaipa muzayenda [it’s too bad that you’re going]. I don’t know if they thought I was any good as a doctor. I’m not sure that they’d recognise a bad doctor if they saw one. There’s not much scope for comparison, given that there isn’t another one for about 100 miles in any direction around here.

The truth is, I was pretty ill-equipped for working here, and on the whole, I liked writing about being a bush doctor more than I liked having to be one. I was indecisive, I was short-tempered, and at times I was just plain frightened. But I did do this job when nobody else wanted it, and I took responsibility for people who were vulnerable and without other choices. And I think that might amount to more than the sum of all the lopsided surgical scars and badly-set fractures I have left in my wake. The sense of not being good enough was very real and difficult to cope with, but I tried, and sometimes I did get it right. Maybe it was okay in the end.

Since I’ve been in Zambia, I have had the same conversation with other volunteers on a number of occasions: everyone talks about the importance of family and friends understanding what it is like to be here. There is a long precedent for this: Jon Snow wrote of his time in Uganda in the 1960s “In part, VSO inspired me to write, almost every other day I was there, nothing more than letters to loved ones, but each chronicling the smallest detail of everyday life.” This blog was a substitute for postcards home, and we are grateful to everyone who kept reading it, through our black moments and intermittently purple prose. Knowing that other people are interested and supportive of what you are doing is helpful in any situation. In a strange and slightly overwhelming environment it takes on a new importance, and we were both very glad to have people from home travelling some of the way with us.

Those of you who read the blog often may have wondered where Chas had got to. It must be said that after a fairly enthusiastic start, he decided to adopt a minimalist approach to blogging. Being the show-off of this partnership, I was delighted to fill the gaps with long anecdotes about myself. But although writing about our life in Zambia was largely a solo effort, actually living here was very much a shared experience. At times, neither of us found being stuck out in a rural village much fun. Having someone else around to help you locate your sense of perspective when you’ve lost it, and to make you laugh (admittedly, not always intentionally) was essential, as much as was having a large bottle of mosquito repellent or a Swiss army knife. So even though I did most of the telling, I think the story was definitely ours.

Occasionally people said that they found the stuff I wrote about hard to read. I’m not sure what to say about that, other than if I had I hoped for any reaction from you at all, it was probably your anger that I wanted. That a child might die for want of clean water is more injustice than tragedy. It shouldn’t be this way, but it is, and after witnessing it, I felt I had to try and document it somehow. When you live in a small, safe corner of the world, where hunger is only ever a transient state, and the medicines never run out, it is difficult to comprehend the hardship of living in a place like this. I still don’t really get it, even after being here for a year or so. Now I am leaving, maybe only with half an understanding of the things I have seen, but also with the obligation not to forget, and to carry on working for people in Mpanshya. And I think that you have to keep remembering too.

But for now, we’re on our journey home. Two days ago, we took the train to Tanzania, and I’m writing this, my last post, from Dar es Salaam. Last year, just before we left for Zambia, we arranged a screening of Some Like it Hot to raise some funds for VSO, so it seems appropriate that we should have finished off this adventure with a long train journey to the coast (although Chas did decline to travel in drag a la Tony Curtis). So, we’ll be seeing you very soon, although after a year in the bush, our social skills are not what they were. Just humour us for a while. Pretend you haven’t heard all these stories before…

Pimm's and twins

Chris masters lighting a fire with a plastic bag















Mum visits Mulamba school

29th April 2007

Sunday morning in Mpanshya, and I am in isolation ward, along with fourteen cases of suspected cholera. The outbreak began earlier this week, and patients began coming to the hospital on Friday. I have never seen cholera before, but it presents unambiguously and is therefore not hard to recognise. One by one, the patients have arrived, clammy, prostrated and groaning. Everyone who made it to hospital has survived so far, largely thanks to the efforts of the staff, who have worked all day and night. They have kept the IV lines going continuously, and are trying to enforce infection control measures. This is not easy – patients’ relatives wander in and out of the ward, and one woman is insistent in her efforts to keep breastfeeding her baby (despite being in a fairly advanced state of dehydration). My role has been much less hands-on, but all the same, I scrub my fingernails assiduously and disinfect my stethoscope whenever I can. A dose of cholera is not an attractive prospect.

I am just leaving the hospital when a delegation from the district health management team arrives. They have displayed an unusual interest in the hospital during the cholera outbreak; yesterday they came to see us twice. One of them introduces himself to me as Mr Choongo, and asks me to accompany them to isolation. The visitors bustle round with clipboards in hand, surveying the chaos within. Mr Choongo stops by the bed of one of the female patients and interrogates her about the appearance and consistency of her diarrhoea. He considers her reply, and then pronounces that this is not in fact cholera but malaria. Having no particular opinion on the diagnostic relevance of stool colour, I nod silently and follow him as he moves on to the next ward.

Later, I find out he is the human resources manager.

3rd May 2007

It is 6am, and we are at the airport waiting for Mum, Aunt Dianne and Christine. The flight they are arriving on is an auspicious one – not only is the Duke of Gloucester on board, but Sister Sabina is returning from Poland as well. The arrivals hall is full of nuns, not just from Mpanshya, but also from the sister congregations in Makeni and Chilanga. Eventually, I spot my mother in the crowd, warmly embracing Sister Josefa. I wave, trying to attract her attention, “Remember me?” Aunt Dianne follows, trailing an illegal quantity of luggage behind her. “Isn’t this great!” she exclaims. The shabby interior of Lusaka International can seldom have seen this much excitement.

We proceed to the shopping centre, where Aunt Dianne obtains an outsized fly swatter for the purposes of cockroach control. We then board the minibus for the drive back to Mpanshya, which takes slightly longer than anticipated. Just outside Lusaka, we stop at a roadside market to buy tomatoes. Aunt Dianne purchases some inedible-looking roots from one of the stalls. I have no idea how to cook them, but somehow she manages to get the vendor to mime a recipe. Further down the road, we have a tyre blow-out when Chas accidentally hits a pothole at high speed, and we have to enlist the help of a passing cyclist to get the wheel off. I assign myself the task of erecting the emergency triangle, which is about as far as my skills extend in situations such as these.

When we finally get to the house, we are greeted by Corinna, our new cleaner, who has killed a chicken for the visitors. (Chas employed her after getting thoroughly sick of washing clothes by hand in cold water; we don’t really have enough domestic duties to justify having hired help in five mornings a week, but luckily she works slowly.) Aunt Dianne shows her the roots she bought and she wrinkles her nose in horror. Shortly afterwards, there is a similar display of disgust from the guests when they are presented with the cooked chicken. It may only have died this morning, but they reckon that it was likely to have been born many years before.

But everyone is pleased to be in Mpanshya. Chris fulfils her dream of sitting out in the African sunshine, drinking rooibois tea. Aunt Dianne, who has conducted a lifelong crusade against waste, is delighted to discover that the shredded tyre from the minibus is being rapidly recycled into footwear by the general workers. And I am happy because never before was there any prospect of obtaining a decent Pimm’s around here, and at last, this regrettable situation has been rectified.

17th May 2007

I am finishing work for the day when Catherine approaches me in the office. She asks me to see a woman who has arrived in labour. I tell her to get the nurse on duty to see her, but apparently Odesta has gone for one of her extended breaks. With some bad grace, I go to see Joyce, who is heavily pregnant and appears to have left a trail of meconium when she entered labour room a few minutes before. Despite her obvious state of discomfort, she is apologetically wiping it up of the floor.

A quick examination reveals that the umbilical cord is prolapsed. The baby is breech but still alive. I tell Catherine to run for help. I am trying to manoeuvre Joyce so that she is kneeling on all fours, when suddenly the baby’s foot falls out. At this point, it seems that things cannot possibly get worse. Then I discover that nobody actually knows where the keys to theatre are. Mr Phiri has gone to town for the day, and the only other person who has keys is Sister Josefa, who is in Poland. I stare at the little purple toes, hanging in mid-air, and suppress the urge to scream.

Luckily, the ambulance returns from town shortly afterwards, and Mr Phiri is hastily pressed into service. An hour after her arrival, Joyce is wheeled into theatre. It takes me several attempts to get the baby out, because the placenta is lodged in the lower womb, and there is a lot of bleeding when I open it up. We deliver him eventually, but still, something doesn’t seem right. There is a large sac pushing out through the wound. Initially I think it is an ovarian cyst. I am trying to replace it inside her abdomen, when I belatedly realise what is going on.

I say “I think there’s another baby in here.” The sac bursts, and a fat-cheeked girl emerges in a gush of fluid, gasping for air. We had only brought one blanket to theatre, and Esther (the midwife) is still resuscitating the first baby, so Sister Valeria (the anaesthetist) improvises with a discarded gown. I check inside again; definitely no more, so we close up.

As we are putting the final sutures in the skin, Phiri says regretfully that he didn’t bring a camera to commemorate my last operation in Mpanshya. I look down at my bloodstained gown, and tell him that there are some things I’d prefer not to remember.