Chas and June go VSO

Leaving Mpanshya

2007-06-10T20:00:00.000Z

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

2007-06-02T11:26:00.000Z

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.

Three go wild in the Namib Desert

2007-05-20T11:13:00.000Z

On a mokoro in the Okavango Delta, Botswana

In the Naukluft Mountains, Namibia

13th April 2007

Chas and I are in Botswana, travelling from Maun to Ghanzi. We have travelled on many buses this week, but none quite so uncomfortable or dilapidated as this one. Chas is sandwiched between me and an enormous woman who spends most of the journey in loud dispute with the ticket collector over her fare. His misery is palpable.

I am hoping we will reach Ghanzi in time to get a bus to the Namibian border today, so that we will be able to meet Simon in Windhoek tomorrow. However, our attempts to procure a bus timetable have proved fruitless, so we have no idea if there is a connecting bus today, or whether the border will still be open when we get there. The three hour bus journey is still in progress after four hours. I slouch in the corner, watching the flat scrub go by and silently cursing Lonely Planet.

The bus eventually pulls into Ghanzi station. The only other bus there turns out to be leaving imminently for the border, so we retrieve our rucksacks hurriedly and clamber on. The sign at the front of the bus tells us that it was built in Botswana. I wonder if this is a statement of pride or a health warning. However, the journey is uneventful, until we reach a town called Charles Hill, where everyone apart from us gets off. Chas gives me a wary glance. We carry on for ten minutes or so, and then the bus grinds to a halt. This appears to be it. We climb off, and walk towards the border post. We are in the desert, and there is nobody here apart from us. Chas raises his eyebrows at me, and we both start laughing uncontrollably. Maybe this was not one of my better plans.

And then, suddenly, an enormous truck carrying assorted Volvos appears beside us. The driver leans out and asks us what on earth we are doing. We tell him that we are going to Windhoek, and he offers us a lift. We hesitate for a moment, but then we both decide that despite years of maternal advice about situations just like this, an offer of a free ride in the middle of the Kalahari should not be declined. We hang around outside Namibian immigration while he clears customs, and then we climb into the cab together and set off into the dusk.

The journey is memorable for intermittent sightings of kudu at the roadside and also for our driver’s surprising taste in music. As we reach the suburbs of Windhoek, it is late, and the disco version of “Don’t Cry For Me Argentina” is playing for the third time. But we do get there, probably in spite of my planning efforts rather than because of them. After finding a hostel, we celebrate our arrival with pies and beer from the all-night garage, and promise each other never to do this again.

16th April 2007

The alarm goes off at 4.30am. I wake up in darkness and try to remember where I am. Then I realise that I am in tent on top of a 4WD in a campsite in the Namib desert. I also recall the argument that we had the day before, when Chas wanted to stay in Sossuvlei to watch the sunset over the dunes. (Simon and I didn’t, so we made a rather rash offer to get up for the sunrise instead.) Finally, I remember all the wine that was consumed with Simon’s astonishing one-pot cuisine last night. But anyway, a deal is a deal, so I wriggle out of my sleeping bag and set about packing up to go.

After fifteen minutes of stumbling about in the dark, the tents are folded away and we are ready to drive off. I turn to my slightly dishevelled fellow campers and ask who has the car key. Apparently I do. Chas and Simon ignore my muttered apologies as we unpack all the hastily stowed bedding and rummage below the car seats. After what seems like hours, the keys are located at the bottom of my sleeping bag. We jump back into the car and drive into the national park as fast as we can, hoping that we will beat the sunrise despite the false start.

We make it to the dunes just before the morning comes. We march up to the nearest vantage point, sliding in the sand as we go, only stopping when Simon has an attack of petulance and announces he is going no further. We sit together, and we wait for the dawn. Slowly the valley floods with sunshine, illuminating the dunes with a deep red glow. We watch a hot air balloon drifting across the horizon. Eventually, Simon says "Actually, this was worth getting up for."

Abidah's party

2007-04-29T18:36:00.000Z

7th April 2007

Today Bernadette and I are going to Abidah’s kitchen party in Lusaka with our colleagues Esther, Odesta and Mrs Mwale. Abidah worked in Mpanshya as a pharmacist until a few months ago, when she left to join her fiancé in the Copperbelt (to the disappointment of Chas and Joost, who still go slightly misty at the mention of her name). A kitchen party is a kind of bridal shower, where all the female friends of the prospective bride get together and present her with gifts. I have dressed in accordance with the directions on the invitation (which specifies that the colour scheme is black, white and silver) and I go to meet the others at the hospital entrance, only to find Mrs Mwale resplendent in a blue chitambala. Apparently the colour scheme only applies to the gifts. It is too late to change, so I get in the minibus and set off for Lusaka with the others.

We arrive at the address on the invitation to find that the party is being held in the garden rather than the kitchen, so we pick a shady spot and watch the other guests arriving. Soon the garden is full of women in elaborate wigs, tottering round in jewelled sandals and swigging Fanta out of glass bottles. We wait a couple of hours without anything much happening. Then some women begin drumming, and suddenly there is an outbreak of free-form dancing on the lawn. A lady in a red kaftan jigs past, blowing on a whistle. She is a vision of exuberance, apparently oblivious to everything around her her, but she suddenly notices that I have a camera in my hand. She breaks off her dance to pose for me, and then disappears briefly, returning with her friend for a second photo.

Finally Abidah is led in to the centre of the circle, her face obscured by a sheet draped over her head. Zambian tradition dictates that the bride should not look up at her guests, so she keeps her eyes fixed on the ground when she is unveiled by her elders. I struggle to follow most of what follows, but there seems to be a lot of advice given to Abidah on how to keep her husband happy, accompanied by a generous measure of illustrative hip shaking. Everyone laughs and shouts; I feel like I have stepped into a slightly bawdy cartoon. The party carries on even when it starts to rain, encouraged by the woman with the whistle, who declares defiantly “It’s not showers! It’s blessings!”

And then St Luke’s are called forward to present their gifts. I have been briefed on kitchen party etiquette, and I know that I am expected to dance before handing over my coffee pot. I also know that I’ll never be able to shake it like the Zambian girls, but I’d hate to be accused of not trying. So, under the scrutiny of our fellow guests, I dance for Abidah with my colleagues. I catch her glancing upwards as we strut our stuff, and am grateful to note that she is trying not to laugh.

Stopping TB

2007-04-05T18:20:00.000Z

Acting

Dancing

Posing

9th March 2007

I am seeing a patient in the hospice office this afternoon when there is a knock at the door. I open it to find Vincent, who is beaming and clutching an enormous tortoise. He holds it up to my face so I can have a better look. He asks “Is Mr Charles here?” I tell him Chas is in Lusaka and he looks slightly crestfallen. “I was hoping he would take some snaps…” I reassure him that on his return, Chas will come over with a camera, and he goes away again, quite happy.

24th March 2007

Stop TB day. I am waving a visitor off when Sister Valeria comes over and tells me that Mr Phiri has included a speech from the medical officer in his programme for the day’s events. I tell her that this is the first I have heard of it, and then trudge over for the morning round.

By ten-thirty, I am wrestling with a wheezy baby in the nurses’ station. Although he is very breathless, the combined force of three adults will not persuade him to accept a spacer mask on his face. And then Mr Phiri appears. He tells me that he sees I am very busy, but I must come along to the celebrations and say a few words. I tell him that I have no intention of repeating my public speaking disaster of Stop TB Day 2006. He doesn’t give up. Maybe if I would just say hi to the crowd, he suggests. The idea of doing a faux-rock star “Hello Mpanshya!” is not without comic appeal, but I stick to my better instincts and turn him down.

I finish work at the hospital shortly after this, and then walk over to where the celebrations are being held. As usual, the VIPs are on a platform at the front, with the spectators sitting on the ground. I try to settle down unobtrusively on a patch of grass at the back, but the women seated next to me start nudging one another and giggling. Mr Sikazwe spots me and comes running over with his camera. I suddenly realise that because of the way I am sitting, my knickers are probably on display and I attempt to move my legs quickly to avert embarrassment. I am midway through this manoeuvre when I hear the click of his shutter. The women beside me are now snorting with laughter. Then Mr Kapembwa comes to tell me that I must sit on the platform, so I get to my feet as modestly as I can and follow him to the front.

Anyway, aside from this momentary humiliation, it is a good day. The sound system screeches incessantly throughout the proceedings, and every now and then, the stage is invaded by a wandering drunk. But the drama and dancing are great, and everyone seems to be having a good time.

30th March 2007

At 6.30 this morning, I am standing at the kitchen sink, trying to tidy up before driving into town for the weekend, when one of the mothers from children’s ward knocks at the door. She tells me that her daughter Victoria died overnight. I start to tell her that I am sorry, but she is not listening to me. She has come because she needs to get home with the body, and she wants me to help her. I agree to take her, and she nods briskly, as if we have just made a deal over transporting of a piece of luggage, and then she leaves again.

The minibus is overloaded with patients as usually, but the mother and grandmother squeeze in, one with the surviving twin sister tied to her back, the other carrying Victoria wrapped in a sheet. I drive them to Chimusanya and drop them off at the market. I try and offer my sympathies again, but they don’t particularly want them. Limp condolences don’t have much currency around here. Bereaved women seem to alternate between two states: silently busying themselves with funeral arrangements or wailing with grief for hours on end. There isn’t much space for words in between.

5th April 2007

I am in the back of the nurses’ station with Maxwell and his mother. Maxwell came to hospital yesterday, he is horribly undernourished and dehydrated. Today he looks like he is dying. Over the last month I have seen countless children in the back of the nurses’ station, and most of them have been in a similar condition. (The locals call this time hunger season.) The routine is generally the same; I will spend hours trying to locate an entry point in their collapsing circulation. I know that the amount of time spent on this effort is inversely proportional to the chances of success, but I keep doing it anyway. The mothers and I are in collusion; we are both aware that the child will die even if I find a vein, but somehow it makes us both feel better if I keep trying. It’s usually too late for the baby (what exactly am I planning to inject him with? A cure for poverty?) so we might as well console ourselves with some purposeful activity.

Anyway. Today, the cannula eventually goes in. I give some antibiotics, quinine and fluids. I ask his mother if he has been baptised. And then I leave them alone to do the last bit together. Doing these things never feels enough. It isn’t, of course, but it’s not nothing either.

Fernando

2007-03-16T04:51:00.000Z

Five-a-side Mpanshya style

28th February 2007

Three years ago, St Luke’s bought a second-hand minibus in Lusaka for staff transport. It subsequently broke down on its first journey to Mpanshya. It was towed back to the garage, who failed to repair it, or to come up with a refund, despite the best attempts of Sister Sabina. By the time we arrived last year, everyone had just about forgotten this sorry episode. But inadequate transport for hospital workers remained a huge problem, and so last April, Chas was assigned the task of trying to get the vehicle (or the money) back.

This dispute was not resolved quickly. Chas made many visits to the offending garage, and every time, he came back more exasperated. The proprietor started blocking his phone calls. The lowest point came when he turned up for an appointment he had made with the manager to find that the business had relocated to the other side of the city. I think they thought he would go away eventually. But as any North Ayrshire housing officer who has attempted an illegal eviction of a council tenant during the last five years will tell you, he is not someone who gives up easily. The finale was a stand up argument during which Chas accused the manager of swindling the sisters out of their money. Miraculously, the allegation of cheating members of a religious order worked where threats of legal action had previously failed, and the vehicle was returned in something close to working order.

So, today, Chas and Brendan made the maiden voyage back from Lusaka in the minibus (henceforth known as Fernando). It could not be described as the smoothest-running vehicle in the world – the engine generated enough heat to keep the adjacent sausage rolls piping hot until they reached Mpanshya. But it got here this time, and its arrival feels like a small victory for the hospital.

2nd March 2006

Eva and Maria leave Mpanshya tomorrow after two months of making beds and scrubbing floors. They come round to celebrate the end of their voluntary hard labour with pizza and beer. Tonight, everyone is talking about the arrival of the witchfinder in the village. I have heard nothing about this, but I suppose I am regarded as the local woman of science, and am thus kept in the dark about developments of a supernatural nature. Fortunately, Joost seems to be particularly well informed on this topic. The witchfinder has already identified several people as witches, and they are being kept in his custody until they come up with some kind of payment. (Coincidentally, every one of the detainees is in some kind of paid employment while the peasant farming majority have somehow avoided suspicion.) Everyone in the village who has not yet been accused of witchcraft is now going to see him for testing – a procedure which involves having a white line drawn on your forearm while your guilt or innocence is pronounced. Not to go would be a clear admission of wrongdoing, so no one refuses. As an outsider, it’s quite funny to find yourself living on the edges of this, when colleagues whom you regarded as quite rational start re-enacting scenes from The Crucible. But it’s deadly serious for people here, and I can’t begin to understand it.

The Money

2007-02-12T19:10:00.000Z

22nd January 2007

Monday morning at the height of the rainy season, and I am just emerging children’s ward after a particularly challenging round. Malaria is rife at the moment, so it’s standing room only, and the febrile Mpanshya tots greet me with the usual chorus of screams. On this ward I am the bogeyman, and I have long since learned that no amount of gentle coaxing will persuade these children to sit nicely while being examined. But an hour of restraining protesting toddlers is not a good way to start the week.

I press on to female ward, but before I get there, I am intercepted by Emmanuel, who has come out of the labour room looking vaguely worried. Jenny has just been brought in by ambulance, and she gave birth on the way. The baby is fine, but forty-five minutes on, the placenta has yet to make an appearance. She is bleeding. And everyone is looking at me.

Usually, in these situations, I like to start off by bleating that I am not an obstetrician, before grudgingly doing something, but the gravity of Jenny’s condition precludes even the briefest protest. Ten, long minutes later, I am holding the recaltricant afterbirth in my hands. (I will spare you the details of how it got there.) The bleeding has stopped, but Jenny is still shocked, and needs a transfusion urgently. She is unconscious, so I inform the relatives, thus provoking a heated quarrel between her Catholic granny and her Jehovah’s Witness mother. I stand in the corner, watching despondently as the debate proceeds. My resuscitation efforts are about to be scuppered by some obscure piece of theological hokum. But luckily Rome wins. It usually does around here.

31st January 2007

Today, our CD4 counter is working for the first time. It arrived three months ago, and has been sitting in the corner of the lab, draped with a tea towel, unused. Our donors neglected to buy us a vortex mixer, so we had no way of processing our samples for analysis. During this time, we have been sending samples to Lusaka for testing, an unsatisfactory arrangement which generally yields about one result for every three samples dispatched. So most of our decisions we make about our HIV patients are based on educated guesswork, which has its limitations. But no more. The vortex mixer has arrived, and the tea towel has been cast aside. Flouting infection control regulations, and causing mild alarm to Mrs Mwale, I dance into the lab bearing the tray of blood samples. This is real progress, a good day for the ARV clinic.

1st February 2007

Last week, I admitted an elderly man by the name of Cement. He has a multiplicity of medical problems, including, I think, a collection of fluid at the base of his right lung. I asked Elias to X-ray him a couple of days ago to confirm this, but the film he produced only shows the top half of his chest so I am none the wiser. (This is not entirely the fault of Elias; for months now, we have only had comically undersized X-ray films in stock, so imaging an adult chest in its entirety is a tall order. I have protested about this to Sister Sabina, but she insists that these are the only ones available in Lusaka. So, for the time being, I am stuck with peering at tiny, smudgy X-rays, which more resemble Monet miniatures than anything to do with human anatomy.)

Rather than sending Cement back to X-ray for a complimentary film of his lower chest, I decide that I will confirm my suspicions by trying to draw some fluid off his lung with a needle and syringe. I am slightly disconcerted to find that only air is coming out. But there are many more patients to see that morning, and I move onto the next one without giving it much more thought.

Shortly afterwards, Mr Phiri comes rushing through to get me. He tells me that Cement is having an asthma attack. He is in a bad state when I go back to him, hunched over and gasping for air. I check his windpipe and, finding it deviated to the right side, I realise that I have given him a tension pneumothorax. This is a medical emergency, and I have only a vague recollection of the physiology involved. I know that I need to stick a wide bore needle into his chest to relieve his breathlessness, but in my panic, I can’t remember in which side it is meant to go. Eventually I decide on the right, and as I sink the needle in, there is a loud hiss of air, and he is breathing normally within ten seconds. Much relieved, I then set about making an improvised chest drain with a suction catheter and sticky tape. Throughout this debacle, Cement and his wife keep thanking me for all my attention, despite my attempts to explain that I actually caused the problem in the first place. It just proves that the second inverse care law is an international phenomenon: the more disastrous your interventions, the more paradoxically grateful patients tend to be, everywhere in the world.

2nd February 2007

Chas comes home from Lusaka late this evening. Joost and Bernadette are round at the house when he arrives, spilling out of the back of the overloaded ambulance like a veal calf escaping its crate. He had a meeting in town today with a representative from a medical charity to discuss his eye clinic proposal. We ask him how it went, he makes vaguely positive noises, and then we talk about something else.

Later, when J&B have gone home, I ask him again how the meeting was. He is much better at feigning nonchalance than me, but he can’t keep it going any longer. He fails to suppress an enormous grin. “They like it, and they’re going to fund it.” No polite refusal this time. This project, which Chas has spent more time on than anything else in the last year, is going to happen. It is too good for our own words, so we celebrate by reading aloud the new Oor Wullie annual (recently arrived, thanks Henry and Sheena) over large measures of whisky.

Comings and goings

2007-01-27T21:39:00.000Z

Beatrice's leaving party in full swing

On Joost's bridge with David and Gavin

20th January 2007

Chas’ nephew and his friend have arrived in Zambia this week, and we have travelled into Lusaka to meet them. We have shown them the sights of the capital city, but now today we are driving back to Mpanshya in the pouring rain. Dave and Gav are riding in the back of the van, sandwiched between half a dozen sacks of mealie meal, a couple of women complaining loudly to each other in Nyanja, and a baby, just to ensure that they have an real Zambian travel experience. It all gets slightly too authentic when we are driving back along the dirt road to the hospital and encounter a lorry stuck in the mud there. It is blocking most the road. One of the local minibuses has attempted to drive around it and is now stationary in a ditch, with no immediate prospect of moving forward. Some of the passengers are sitting around in the drizzle looking glum, others are trying to push the bus out of the hole. Eventually it rolls backwards, clearing a space for us to drive through. We get out and watch as Chas drives ahead, the vehicle lurching horribly as it ploughs through the ditch. For a moment I think we are going to get bogged down too, but Chas is of farming ancestry, and has clearly inherited some kind of tractor-handling gene. The Landcruiser emerges at the other side spattered with filth, and we run to catch it up, with the stranded minibus passengers in hot pursuit. The overloaded vehicle then proceeds slowly up the road, or rather, where we think the road might be, as it is now submerged under rapidly flowing water. Dave, sitting beside me in front says “This is the real Africa”.

21st January 2007

Beatrice is leaving Mpanshya tomorrow after three years of running the home based care service. It has been a long goodbye – there was a huge party to mark her departure last week, and there have been smaller celebrations for her in many of the surrounding villages – but now it is time for her to return to Switzerland. Father Leschek has invited us all over to the parish house for her last evening. We try to persuade Dave and Gav to come along too, but they decline. (I think their reluctance may be borne of having been persuaded to go to mass this morning, and then being hectored into standing up at the end and receiving a round of applause from the congregation. We may not be forgiven for that one anytime soon.)

But what a party it turns out to be. Sister Sabina force feeds us outsize pieces of gingerbread cake. Chris provides beer and music, although a few of the younger guests are nonplussed at his enthusiasm for the Calamity Jane soundtrack. (Chas tries to explain to one of the new volunteers that it comes from one of those old movies that you see on TV on Sunday afternoons as a kid. Brendan, who is twenty-three, says “Yeah, we had that in the States too, but the old movies were from the eighties”). And suddenly, apropos of nothing, Father gets out his double barrelled shotgun, and gives us a demonstration of how to dissemble and reassemble it. To the increasing alarm of the assembled company, he then decides to go out onto the balcony and fires the gun into the air, mujahadeen style, in Beatrice’s honour. And then, we round off the evening with a heated discussion on Satanism. It is an absolutely appropriate farewell for our friend, an eccentric but warm gathering of people who may have been in Africa for slightly too long.

Auld Lang Syne

2007-01-18T19:35:00.000Z

31st December 2006

Hogmanay. I spend all morning engrossed in Rupert Everett’s autobiography, and having finished it, I have a slightly disconsolate afternoon. It’s partly that bereft feeling that you get after having read a good book too quickly, but maybe it’s also the dispiriting effect of reading endless accounts of international travel and glittering parties when you are stuck out in the bush in Africa. (Rupert does go to rural Zambia near the end of the book, but it only merits one paragraph; Joan Collins’ wedding gets three pages.)

It is a humid, overcast day, and it drags on and on. Chas and I have run out of conversation by about two thirty, and there is no one around to distract us. We are both a bit fidgety and fed up, having planned to go away for New Year and then, predictably, having failed to organise it.

In the evening, there is a small gathering at Beatrice’s house. We are just clearing up the dishes when we hear singing outside. The women of the Santa Anna society are meeting for a retreat tonight. Thirty of them are singing and dancing by Beatrice’s front door. Beatrice is dragged into the middle of the circle, looking over her shoulder with a panicked expression on her face. I take pity and follow her. The women ululate loudly as we join them, doubtlessly anticipating a typically European display of ineptitude on the dance floor. We do not disappoint them, although we do bow out when they try to get us to copy their kneeling-and-rapid-pelvic-thrusting manoeuvre. (I’m not sure what that’s about, but I do know that I’ve never seen them do it in church.)

The singing and dancing carries on until midnight, and we bring in the New Year together. Chas and I then lead the remaining revellers in an off-key version of Auld Lang Syne. Initially, our duet receives an uncertain reception, but by the end, everyone obligingly crosses their arms and runs in and out in the time-honoured fashion. Possibly more of a cultural robbery than an exchange – they gave us their best saucy dancing and we reciprocated with the Caledonian hokey-cokey. But we have a good time together all the same.

3rd January 2007

We arrive in Lukwipa for the mobile clinic. The church where we work sits back from the road, at the other side of a muddy patch of land. There has been a lot of rain over the last few days. I tentatively drive across, and am relieved to make it to the other side without getting bogged down. The church roof has seen better days, and the area where I normally see patients is flooded, so I set up in a corner and start work. Halfway through the clinic the rain starts to fall though the roof immediately above me, and I am forced to retreat further to prevent my notes turning into papier mache.

At the end of the clinic, I realise that Adamson has not shown up. Adamson holds the all-time clinic record for a low CD4 count, and he was recently discharged from the hospice after starting on treatment. I am a bit worried about him, so I decide to pay him a visit. I set off in the Landcruiser, and get completely stuck in the swamp at the roadside. I work my way through the 4WD settings, but every time I rev the engine, I feel the car sinking below me. I look up from fiddling around with the gearstick, and realise that all the men in the market opposite are staring at me. Just as I am beginning to resign myself to a long, humiliating wait in a muddy hole, some of the patients appear. They work quickly together, piling stones below the tyres, and then they assemble at the rear to push me out. I press my foot down on the accelerator, and magically, the vehicle starts to move, onto the safety of the tarmac ahead. When I finally get to Adamson’s house, I find him looking and feeling really well. I sit on the floor with him, checking his medicines, and admiring his new baby girl. Some journeys are worth a bit of sweat.

No tinsel, no Cliff.

2007-01-04T18:54:00.000Z

17th December 2006

Chas and I are standing at the turn off on the Great East Road at 6am on a Sunday morning in the hope of flagging down a bus to Katete. My plan is to go to St Francis’ Mission Hospital for a week to learn something, anything, about obstetrics. It is a long wait. Mr Banda is also at the turn off in a shiny suit, on his way to a church meeting in Luangwa. He manages to hitch a ride from a passing pickup truck and shouts to me to climb in too. I pretend that I don’t hear him properly, smiling enigmatically and waving him off. I don’t think I can cope with four hours of bouncing around in the back of a van.

After two and a half hours, even the local kids have got bored of staring at us, but then a bus finally stops and lets me on. It seems too good to be true – not only have I got the last seat but there is no gospel music playing onboard. I settle back with my i-Pod and try to ignore the intermittent lurching as the bus hurtles round bends at high speed.

When I arrive at St Francis, I find that nobody was actually expecting me to come today. However, after knocking on a few doors, someone comes up with a place for me to sleep – Rondavel No3 will be my home for the next few days. It is a concrete hut with an impressive assortment of dead cockroaches on the floor. However, it does have a functioning hot shower, and later on I discover that sponge and custard are being served in the mess. Small luxuries such as these are not to be disparaged.

19th December 2006

I am introduced to the consultant obstetrician this morning. He had no idea that I was coming either, but is instantly polite and accommodating. I have to break into a trot to keep up with him as he strides round the maternity ward, laying his hands on a succession of swollen bellies. Then, we are off to theatre. Someone asks me if I want to do a tubal ligation. I decline, explaining that I work in a Catholic mission hospital, so it’s not the most useful procedure for me to learn. This only adds to everyone’s confusion about why I am here, so I try to explain in the staffroom midway through the morning, over a cup of tea (served Zambian style: consistency of tar, four sugars). My problem is that no one quite believes that doctors who can’t do surgery exist; in this country every medic can do Caesarean sections and appendicetomies without breaking a sweat.

Nothing much seems to be happening in the afternoon, so I sit around in my rondavel. The only book I brought with me is finished by about half two. This could be a long week. I go back to the ward for the evening round but nobody else turns up, so I trudge back to the hut, slightly dejected.

20th December 2006

I start today on the gynaecology ward with Enock, the medical licentiate, and discover that there were two sections overnight. Nobody called me. I resist the urge to throw a hissy fit. Labour ward is quiet again today, and I hang around in the hope of some unfortunate woman pitching up with complications. My impatience is rewarded in the afternoon when an obstructed labour arrives. I dash to theatre and pull on my blues, but find there are no surgical caps available. Enock hands me a towel to wrap around my head as a substitute and I enter theatre looking like a delegate at a Hamas conference. I scrub to assist him, but I have a fainting episode just after the placenta is delivered and have to be taken to the tea room to recover. Later, I am recounting this tale to Anna, a doctor from New Zealand. She tilts her head back to show me a scar under her chin that she acquired from hitting the floor of an operating theatre at high speed, and I feel slightly better about it.

21st December 2006

Today, I am back in the tea room with my head between my knees again. I managed to get most of the way through assisting an abdominal hysterectomy before this particular attack of the vapours struck, but eventually I had to absent myself before I toppled headfirst into the wound. I return sheepishly to watch the end of the list.

Afterwards, we go to labour ward where there is a woman who is not progressing well. She is wheeled off to theatre and I follow behind. While the anaesthetist is preparing, the theatre nurse glances through the patient’s notes and mutters “elderly primagravida”. I say that actually, I am four years older that the woman on the table and I have no children. This declaration is met by the sound of air being sucked sharply through teeth. I should know better than to openly volunteer evidence of my social deviancy, and I spend the next five minutes being chastised by the theatre staff for my reproductive underachievements.

Enock asks me if I want to do the operation, and I agree, but after much fumbling and hesitation, he takes the scalpel back out of my hand and finishes the job himself. It is all a bit discouraging, but I do manage to stay upright, so it’s progress of sorts.

25th December 2006

Christmas has appeared out of nowhere this year. The usual harbingers of the festive period are conspicuous by their absence in Mpanshya. No decorations, no Cliff Richard singles, no oversized tins of Quality Street. And midnight mass on Christmas Eve is oddly empty, compared to the packed pews at home. Most of the congregation walk for an hour or more to reach the church, so it’s probably not an attractive option in the dead of night.

Anyway, as expats we cling to our traditions. Chas managed to get hold of a turkey from the nuns in Makeni, so we begin the day early, trying to light the ancient woodburning stove. We manage to cram the enormous carcass into the oven before mass, only to find it has gone out again on our return. We hurriedly stoke the fire again, not wanting this Christmas to go down in memory as the year we poisoned our friends.

As usual, it all comes together in the end, and we eat lunch with the other volunteers in the sunshine. The women staying in Alendo House are moderately amused at the sight of eight azungu dining alfresco in paper crowns. We proceed to the hospital for the orphans’ nativity play (the sheep steal the show). And then, onto the hospice party, which is a slightly limp affair until the music starts. Sister Sabina drags Chas and me onto the dancefloor, but we are outshone by Joseph, who has been resident in the hospice for the last seven months. He takes centre stage with his zimmer frame and shows us how it’s done.

Later in the evening we go to the parish house for drinks with Father Leschek and Chris the missionary brickie. We share Polish sausage, Famous Grouse and tall tales before we all stagger off into the darkness. Christmas in Zambia. Maybe not so different really.

World AIDS Day 2006

2006-12-14T20:13:00.000Z

1st December 2006

World AIDS Day. This year we are holding the celebration in Chimusanya. I was meant to be on the organising committee but failed to attend all but one of the planning meetings. Fortunately, Bernadette is in control. She has secured funding and has had two hundred T-shirts of appalling quality printed up for the participants. They bear the slogan “We Can All Do More!” I complain that I am approaching my maximum capacity, but am ignored so I pull one on anyway.

The march is scheduled to begin at eight o’clock. At around eight thirty, we are still hanging around the hospital entrance while last minute negotiations regarding transport of the local youth group take place. Finally we leave, and we arrive at the school in Chimusanya just over an hour late. Nothing is happening yet. We walk down the road to where the march is due to start off, with two hundred schoolchildren following behind us. Then, we hang around a bit more for good measure.

Eventually the procession goes down the road, led off by members of the local support group who sing loudly as we go. We arrive back at the school and the programme begins with some pupils from Mulamba singing. Chas and I stand at the back until it becomes apparent that the empty seats at the front are intended for us. At first the schoolkids stand away from us, but as the morning wears on, they press up behind us to get a better view of the performances. I can cope with children leaning over my shoulders, but when I become aware of small, curious fingers raking through my hair, I decide to resume my standing position.

There are a number of drama and music groups performing through the day. Men dressing as women are a recurrent and much appreciated feature of the entertainment and one play includes a long and intricately choreographed fight sequence. But the best performance of the day is from a group of local schoolgirls who sing and read poems about HIV. One of them talks about how their school is suffering because many of their teachers have died or become sick. Another gets the biggest cheer of the day when she says “what we need is behaviour change”. It’s all just talk, of course. But hearing it said publicly and applauded makes you feel a little hopeful.

Meanwhile, word gets out that Bernadette is in possession on a quantity of T-shirts, and she is harassed relentlessly by a number of people who firmly believe that they are deserving recipients of such a garment. Somehow, she manages to stay calm, in the face of many spurious, but passionately voiced claims. Some people sidle up to Chas and me in the belief that we can influence the distribution process, but we have long since given ours away.

Later in the day, when we are back at the hospital, I am called to the hospice to see one of the HIV patients. He has been bleeding internally for the last few days, and yesterday we agreed with his family that we would stop giving him blood transfusions. Tonight he is having difficulty breathing. There is nothing left to do. I sit by the bed in the darkness with his mother, watching his chest rise and fall until it stops. He is one of the 250 Zambians who will have died of AIDS today. There is real cause for optimism, celebration even, but still people are coming forward for treatment too late.

How to make an African fridge

2006-12-01T19:16:00.000Z

16th October 2006

We fly back to Zambia today. The mercury has climbed some way since we left and we have worked up a good sweat by the time we have dragged our rucksacks off the baggage carousel. The city centre seems very subdued compared to how it was when we were leaving two weeks ago, as the much disputed election results were announced. At that time there were some street protests and reports of tear gas being fired off, and for a very brief moment, it had all seemed quite exciting. Now, there is no obvious sign of dissent anywhere. Everyone has clearly resigned themselves to another five years of the incumbent president. Mwanawasa is a man of no great charisma or vision, but all the same, he’s probably a better choice than the slightly alarming opposition candidate who had been tipped for the job.

We meet up with Joost, who is in town for the day, and we catch up on the news as we drive back to Mpanshya. The hospital has taken delivery of the long-promised CD4 counter, which would be great news if it wasn’t for the fact that we need another piece of equipment in order to use it, and no one knows if or when we are likely to receive it. Joost’s bridge building project is going well, but he is worried about the forthcoming rainy season which may derail his construction if it arrives early. And more ominously, the predicted post-election gas shortages have now happened, so our days of access to refrigeration may be numbered.

It is dark by the time we reach Mpanshya, and we unlock the door to our airless house. The insects are out to welcome us, and they seem to have increased in size considerably during the last fortnight. Despite that, it’s good to be back again. South Africa was lovely, but Zambia is home, for now anyway.

31st October 2006

Chas has managed to persuade World Vision to give us a donation of assorted items which they call Gifts in Kind. After many delays, Chas finally brings his haul of goodies home. The back of the van is stuffed with boxes, and Bernadette and I help him unload them. Our living room is piled high with clothes, nurses’ uniforms, medical equipment and toys, all for Mpanshya.

1st November 2006

Bernadette and I are setting up the clinic in the Catholic church in Lukwipa. My office for the day is behind the altar, while Bernadette stands at the front organising the patients’ files, looking as if she’s about to read the lesson. We have two visitors from JICA, the Japanese development agency – they are trying to assist the district health board with improving access to ARV drugs, and they want to see how our outreach service is working. I chat with one of them, and he tells me he’s just completed three years in Afghanistan where he worked on the national TB programme. Being observed at work by someone with this level of expertise is more than a little intimidating, and I reluctantly invite him and his colleague to sit in on the clinic. The patients are delighted however; both men are wielding expensive-looking cameras, and they willingly pose while being examined.

When we finish (twenty patients and many, many photos later) we go off to visit one of our patients at home with Odester and Mathilda. Andrew was crawling on the floor when Beatrice brought him to hospital a few months back; initially we weren’t certain why, but now we are sure he has cancer, with secondary tumours in his spine. He was discharged in a borrowed wheelchair two months ago, but home is a fifteen minute walk from the road, and his wife is struggling to cope. He cries when he sees us. It takes a long time to persuade him to come to hospital again but eventually he agrees. All we have to do now is get him to the car. He is not a heavy man, but carrying him in his wheelchair over rough ground involves some hard work for us, and considerable discomfort and indignity for him. Eventually we get back to the vehicle, and together, we collapse in a heap at the roadside. Better not to be poor and disabled in Zambia. If your legs stop working here, you’re invisible.

When we come back to the hospital, we find that the distribution of the Gifts in Kind is already underway, under the supervision of Sister Sabina. Several male inpatients are proudly modelling the donated ladies’ blouses. The hospice care givers have never had uniforms for work before, but today they are resplendent in blue polyester. I compliment Mathilda on her workwear, and she beams. “Mr Charles agwira nchito [has done well]. Our own clothes will be resting now.”

2nd November 2006

Our fridge packed up over a week ago, and now its only practical use is displaying the Nelson Mandela magnet that Chas brought back from holiday. All the shopping gets mouldy and ant-infested within a couple of days, and the water comes out of the tap scalding hot. So, today we make an African fridge. I buy some earthenware pots from one of the patients, and we fill them with food and then swathe them in damp tea towels. The idea is that the water slowly evaporates and draws out the heat. Unlike every other physics experiment I ever tried, this one actually works, and we sit outside in the evening heat sipping cool water. My dad would surely have approved.

4th November 2006

There are small signs that you have been out in the bush too long. For example, when you hear a car going past, and you get up and look out of the window to see who it is. Tonight there is a new one. We are watching a DVD at home when suddenly we hear something drumming on the asbestos roof. It is the first rain in months. We go out into the rain with our hands outstretched, upturned, laughing at our own surprise.

23rd November 2006

The hospital is deserted at the moment. Everyone is cultivating, nobody has time for illness. Mother roll their eyes when I tell them that their children need to stay for a few more days, muttering about kulima. My morning ward round is finished by ten thirty. I am idly wondering what I might do next, when Sister Regina says, in her usual vague manner “There is a patient…just arrived, in the side room…pregnant”. I pick up my stethoscope and am moving towards the door when she adds “…and she’s having a fit.”

Hoping that she is somehow mistaken, I walk to the side room. Christine is lying on the bed, bloated and unconscious. Three elderly relatives begin talking at me simultaneously, miming a seizure. As if to reinforce the point, Christine begins to shake violently. I manage to get a line in and give her some diazepam, trying desperately to recall what the textbooks say about eclampsia. (Later, I look it up. They say: Avoid using diazepam.)

I confer with Sister Valeria. After my last near disaster, I have weaselled out of operative obstetrics and referred everyone who needs a section to Lusaka. I try suggesting this again. She frowns back at me. She is right; what this woman needs right now is not a two hour transit on the floor of a Landcruiser.

So, I find myself back in theatre. The anaesthetic doesn’t work properly, and the patient keeps moving while we’re trying to get the baby out. A bit like War and Peace, minus the cannon fire. But they survive, Christine and her tiny daughter, born seven weeks too soon. They don’t die, and I can hardly believe it.

Holidays

2006-11-11T19:01:00.000Z

29th September 2006

Chas has been in Zambia for seven months without seeing an elephant, and this situation grieves him considerably. At the beginning of this week, he started agitating for a safari trip. It is now Friday afternoon and he and I are slumped in plastic chairs in the arrivals hall at Mfuwe airport with Mum and Petrie. We have been travelling since 5am this morning, and it is 380C in the shade. All the other tourists going to South Luangwa have been picked up already, but our driver is showing no inclination to take us anywhere, having disappeared to the bank half an hour ago. I am not certain how we ended up booking with the only local safari company that has to undertake such lengthy financial transactions. Chas made the reservation. I have a bad wife moment and consider reminding him of this.

Eventually the driver returns, so we clamber into the jeep, and set off down the road with hot air and dust blowing in our faces. Along the way, we see a herd of elephants in the bush, and Chas is suitably excited. We arrive at the camp, which sits on the edge of a swamp by the Luangwa river. Shortly afterwards, I am sitting in the swimming pool surveying the impala and vervet monkeys, and I spot a giraffe emerging from the bush and walking towards me. In a fit of giggles, I demand that Chas takes a photo of me in the water with the giraffe approaching, because I suspect that I will never have a moment like this again in my life and it must be commemorated quickly. I am very glad we came to this place.

6th October 2006

We have been in South Africa for five days. So far, negotiations regarding the daily outings have been protracted, but today we have unanimously agreed to go Robben Island. It’s something you can’t leave Cape Town without seeing, we all agree. We don’t really discuss why we feel this is the case. Probably it’s about feeling obliged to remind yourself of the ugly recent history of this beautiful place. And maybe the celebrity associations – like Graceland, but more politically sound. Also, my sister Linda has an unhealthy obsession with prisons.

Chas and I are a bit late for the ferry, having been distracted by a gourmet burger outlet en route to the terminal, and the upper deck is already full of other foreign tourists. We sit downstairs, next to a group of elderly black women who are travelling together. They look like they are having a grand day out. Coming here probably means something entirely different for them.

We are shown around the prison by a former political prisoner, who gives a dignified and restrained account of his incarceration. It is moving stuff. He asks us if we would like to ask any questions before seeing the rest of the buildings. A miserable-looking British woman says “When does the ferry leave? I need to be back by five.” He reassures her there is plenty of time, and we move on to view Comrade Mandela’s cell. I look at the urine bucket through the bars, and am reminded of my first day in Zambia, when VSO took us to Kenneth Kaunda’s former house, and we all squeezed into the bedroom to gaze at his stained mattress.

In the end, the tour goes on longer than scheduled and we miss our return ferry. The miserable woman is apoplectic. She complains loudly about our guide to one of the staff members at the quayside. Linda rolls her eyes. “She’d have him locked up again…” It does seem slightly churlish to complain about being detained on this island for an extra half hour, given that Mandela was stuck here for eighteen years. I ignore her, and instead take some photos of Chas, former anti-apartheid protester, standing outside the prison wall with his hand raised in a not completely ironic victory salute.

Too talking

2006-11-03T20:19:00.000Z

14th September 2006

Jenny calls me to the children’s ward in the morning; Sisko, one of the babies has just died. He had been threatening to do it for the last week. He arrived on the ward in a terrible state, sores in his mouth, ribs almost bursting through his skin, one of these children that might make you reach for the remote control if he appeared on your screen. I lean over his cot to examine his body, while his twin sister sleeps beside him. His auntie is crying, but his grandmother’s face is blank. She has a weary familiarity with this routine, we were both there when his mother died of AIDS three months ago. His death today is not a surprise – most motherless infants do no better than Sisko – but there is something profoundly depressing about watching a young family slowly disappear in this way.

15th September 2006

I go out on my own for a run before work this morning. Usually my erratic attempts at exercise just attract a few curious stares, but today I meet some girls on their way to school. I hear the inevitable giggling and whispering as I thunder past them, and then, less expectedly, I become aware of someone running behind me. One of them has decided to join me in my exertions. Disappointingly, my expensive trainers fail to give me the edge over her, and I try to pick up speed as she overtakes me in her flip-flops. We are joined shortly afterwards by a group of small boys, sprinting ahead on their way to school, beaming at me as though we are sharing some secret joke. I am probably the punchline, but I grin back anyway.

After just a few days of teaching, Mum is achieving something close to rock star status in Mpanshya – everywhere we go, kids from the school come up to greet her. This afternoon, there is a knock at the door. It is Maybeen, one of the older schoolboys. He has been a frequent visitor ever since he received a football from Chas (whom he now refers to as “my father” – I think mainly out of respect, but also in the hope of more donations of sports equipment). Mum comes to the door, and he remonstrates with her for not coming to teach his class today, telling her “We were waiting for you, madam”. Mum smiles and tells him next week, maybe.

18th September 2006

The Landcruiser is packed this morning. Mum, Chas and I are going to town, but we also have to take Sr Josepha to her eye clinic in Mulamba, and one of the patients, Anna, needs a lift home. I am at the wheel, and three minutes into the journey, Sr Josepha comments “Ooh, Dr June is very gentle driver”. I am not certain if she is expressing displeasure at my lack of speed , and then I remember that she usually does outreach work with Father Leschek, who drives like a maniac on these dirt roads. I decide to accept it as a compliment, and proceed slowly.

We reach Sinjela, Anna’s home, and I help her unload her luggage and her food supplements. We now force all our malnourished HIV patients to consume two jars of enriched peanut butter a day, which is fine when they’re still in hospital, but taking a month’s supply home is tricky. She can’t carry all this back to her farm alone, so I pick up her suitcase and follow her through the woods, while she balances the food bag on her head, like an outsized turban. We walk along slowly together, and as we approach her house, two little girls come running towards us, squealing with excitement.

It’s always nice to see your mum again.

19th September 2006

Petrie arrives in Lusaka early in the morning. Barely giving her a chance to get her luggage off the carousel, Mum and I take her straight to Bauleni to meet Ann, another VSO volunteer who is working in an educational project for local streetkids. The school itself is a little oasis of order on the edge of a scruffy compound. Ann takes us for a tour, and we stick our heads around the doors of various classrooms. One of the teachers invites us in, and asks the kids if they would like to sing and dance. Thirty children leap to their feet simultaneously, and perform for their visitors. It is one of these unexpectedly lovely Zambia moments that could reduce you to prickly-eyed embarrassment, but the sleepless newcomer copes admirably.

We arrive back in Mpanshya that evening, and unload our many backs of shopping from the back of the truck. The women staying at Alendo House (the shelter for patients’ relatives) line up to watch as we carry it all into the house, and we feel vaguely ashamed of our supermarket excesses. We have requested various provisions from home – Chas’ order of HP sauce and potato scones has arrived intact, but my pesto has leaked all over Petrie’s suitcase, leaving an oily green residue on everything. Fortunately she has also brought enough duty-free to anaesthetise a horse, so this mishap is soon forgotten in the rush to get the lemons sliced.

24th September 2006

Another big Sunday in Mpanshya, the St Anna Catholic Women’s Society are having their annual celebration. We manage to arrive in time this week, and we all sit together at the back, watching the women sing and dance. Mum has been to church a few times now, but this is Petrie’s first visit to St Joseph’s. I look at her face and I remember how I felt the first day I came here. Like me, she doesn’t understand the sermon, she can’t join in with the singing, and she doesn’t take mass. But she is not one to miss a party, and so she dances, first swaying tentatively in the pew and then getting to her feet to join the other women during the last hymn.

27th September 2006

The mobile clinic goes to Shikabeta today, and Mum and Petrie come along for the ride. Shikabeta is in the mountains, at the other end of a rough gravel road, and it takes about an hour to get there. The visitors travel in the back with Sister Valeria, Maggie and Brenda, and talk about their experiences in Zambia, while I attempt to negotiate the potholes. I grip the wheel and try to concentrate, half aware of the chatter and laughing going on behind me.

We arrive at the rural health centre, and emerge from our airconditioned cocoon into the baking heat of Shikabeta. Chas takes Mum and Petrie off to see the local school, which is notable for having a classroom with a roof and two walls missing. Brenda and I set up the clinic, and I suddenly realise she hasn’t said anything since we left Mpanshya. Her English is pretty good, but not quite up to breakneck Glasgow speed. I smile at her and say “Big talker, my mum” and she laughs. We get started.

By the time the clinic is finished, Mum and Petrie have introduced themselves to the teaching staff, purchased most of the local store’s stock, and done some adventure off-roading with Chas. Mary the cleaner insists we all stay for lunch, and then we set off back through the hills. The pace of conversation in the back does not falter. Halfway home, Brenda nudges me in the ribs and whispers “Your mother, she is too talking”. I find I can’t argue.

Project Proposals

2006-10-26T21:00:00.000Z

26th October 2006

A rare contribution to the blog from me – by way of updating you on the fundraising angle. I have been busy recently, working on Sister Josepha’s mobile eye clinic proposal and entertaining some nice Swiss people (who are going to give us lots of money to build a Nursing School next to the hospital).
All this was going on while I had the joy of my two mothers-in-law staying (seemed like it anyway!) so it was a busy place for a while.
Hard work and mother-in-law visits were rewarded by a couple of weeks holiday albeit still with the mothers-in-law. And sister-in-law as well – very nice to see Londis touch down on African soil. A fine holiday it was and a complete change of scene from Mpanshya. But I’ll leave it to June’s story-telling to fill in the details…
All I will say is that the last minute cheap deal safari in South Luangwa National Park was one of the best things I have ever done. A far cry from Blair Drummond. And then Cape Town was not bad either. So we are well rested and ready to go again.

But Mpanshya is not the same without Mary and Maggie. People have been asking me why they have not come back to do more teaching at the school. And the market sellers are missing them as well, particularly Maggie, who must have bought every pound of tomatoes and packet of crisps in Mpanshya.

I am back into the fundraising with a lot of proposals and projects needing time and attention. Our Swiss friends have agreed to fund construction of a Nursing School here so that is very exciting for Mpanshya. Work on water and power for the site will start very soon and we should see some construction starting in the next two months. It is a great long term project for Mpanshya and there will be a lot of jobs for local people.
But for the next four months or so my goal is to raise money to help build some more houses/improve existing housing here for nurses and future doctors (it seems that I can’t escape the housing world). One of the key issues in improving and expanding services here is attracting and retaining doctors and nurses - housing conditions need to be improved.

Fundraising back home seems to be highly successful!
I want to pass on greetings and many thanks from the Sisters to all those who have donated generously to the hospital. There have been some hard times financially this year in terms of keeping day to day operations going.
I want to give a special mention to St Mark’s for the huge amount they raised. And thank you to those who ate of Mary’s soup and sandwiches to help her to come up with an enormous cheque. Sister Sabina delightedly informed me the other day that it translates into 15 million Kwacha.
And thanks to those who have promised more and are still collecting. It is a wonderful thing. It all goes to good use.
Some of the money has gone to buy equipment for June’s clinic; some has purchased oxygen for the labour ward, a nebuliser, scales etc. We are going to buy mosquito nets so that young children who get malaria can be given one free (we are coming up to rainy season – which means malaria); we are buying milk for the babies at the Nutrition Centre (see below) and some of the money is going towards starting to build a new staff house (we need another £5000 if you know someone with spare cash who wants a house named after them).
Another proposal that kept me busy recently was for a Small Grant Fund at the US Embassy. I asked for money to fund the Nutrition Centre so here are some of the photos I took to go with the proposal. The Centre runs a feeding programme for malnourished children who are admitted to the hospital and has a training programme to help mothers/care givers to grow and cook more nutritious food. We want to upgrade it and run some training on care for orphans.
The photos are of June and Clementina (the nutritionist) and of Atasha and her Grandmother (who has another four grandchildren at home to look after). Atasha has not really put any weight on over the past 6 months but she is starting to improve now. She probably has TB and is HIV+.

By the way, thanks to those who have left a comment on the blog - and sorry Jeremy, I forgot you had asked for my email: chazgay@yahoo.co.uk

Safari Mary

2006-10-19T19:31:00.000Z

Addressing an imported vegetarian haggis

5th September 2006

We are at Lusaka airport, waiting for my mother’s delayed arrival. The plane was late, and there is a certain lack of urgency in the immigration procedures. Mum texts me from the other side of the sliding doors to report on her slow progress in the queue. I reply “welcome 2 zambia”.

Finally she appears, just visible behind a huge mound of luggage. We load up the Landcruiser, run around Shoprite, and then we hit the Great East Road. Chas and I apologise in advance for the appalling state of untidiness that we have left behind at home – there is a motorbike in the kitchen, the wonky desk that won’t go through the hallway door has been abandoned in the sitting room, and 40kg of rice and beans for Joost’s bridge building project have been deposited somewhere in between. Mum shrugs, distracted by the mud huts and people walking on the side of the road. There is no great novelty in my housekeeping failures, but the view through the windscreen is something entirely new.

We arrive in Mpanshya a couple of hours later, and when we open the front door to our house, we are greeted by an overwhelming aroma of floor polish. We are all slightly taken aback at the pristine interior, and we later discover that Sister Sabina has dispatched a ground force of cleaning ladies this morning in honour of the new guest. Sister S greets Mum with a similar speech to the one I was given on arrival (“Amai, you will never leave!”) and Mum then has her first experience of Zambian hospitality at the convent. Sisters Martha and Regina are summoned to sit around the table with us, and there is a slightly awkward silence as we breach local etiquette by eating our nshima with knives and forks.

6th September 2006

Bernadette and I are in Lukwipa for the mobile clinic. We are sharing a dilapidated concrete shack behind the church with the home based care team, a collaboration which might have been less problematic had the building been equipped with doors. It quickly degenerates into a shouting match, and I am very happy indeed when the last patient departs.

We receive a message that Brenda, a patient of ours, has given birth at home yesterday and she is having some problems. One of the home based care team offers to show us where her house is. We park the van at the roadside and follow her as she disappears into the grass. After ten very agreeable minutes of strolling along in the bush, we come to a stream. There is a narrow plank of wood balanced between its banks, about three feet above the water. Our guide, a lady in her late fifties, runs across without hesitation. Bernadettte edges over, freezes midway and needs a hand up for the final steps. My crossing is no more elegant. We trudge up the hill on the other side and finally reach Brenda’s home.

She doesn’t seem to be particularly surprised by her unexpected visitors, and she brings out her best chairs for us to sit on, then disappears again into her tiny hut. We sit and wait, and wait, uncertain what preparations are going on inside. Eventually she emerges, holding baby John. We carry her suitcase, her bag of maize, her cooking utensils and her bamboo mat back down the hill again. A small gathering of children has assembled on the opposite side of the stream in the hope of witnessing the ARV outreach team swimming. I attempt to cross holding the rolled-up mat in my arms in the style of a tightrope artiste, but three steps in I begin to wobble and am rescued by Brenda’s husband. The kids shriek with laughter. I have executed a few nifty manoeuvres in getting to patients’ houses in the past – high speed U-turns, precision reverse parking, running up twelve flights of stairs to avoid the toxic puddles in the bottom of high rise lifts – but the repertoire of a Glasgow GP doesn’t get you very far round here.

10th September 2006

Mass in Mpanshya is seldom a sedate affair, but this particular Sabbath is much more uproarious than any I have seen before. We are late for the service, and we hover in the doorway, trying to identify a vacant seat. The place is jammed with people, celebrating the end of an annual retreat for a local Catholic society. Eventually we sneak in, and I perch on the end of a bench with Mum sitting behind me. There is dancing everywhere, in the pews and the aisle and at the altar. I twist round to look at Mum’s face, and find her beaming.

Afterwards, we head off to Luangwa Bridge for a picnic with some other people who are visiting Mpanshya. We sit beside the river, watching a crocodile basking while Kurt plays his guitar. A small boy appears, paddling in a dugout canoe, and he clambers up the bank to join us. Someone hands him an apple, which he bites into enthusiastically and then promptly regurgitates down the front of his T-shirt in distaste. He stays around for a little while to duet with Kurt, and then jumps back in his canoe, and paddles over to the sandbank where the crocodile is resting. Playing to his increasingly horrified audience, he throws stones at the enormous reptile. It responds by meekly sliding into the river. The boy turns round to just make sure we were watching, and then disappears.

Songs of praise

2006-09-11T19:19:00.000Z

19th August 2006

Chas and I are out on a morning jog, and as we pant our way down the home strait, we spot the police vehicle at the hospital entrance. We stagger back to the house, reasoning that if it is anything important, someone will come to get me. The error of this assumption only becomes apparent after I have had a leisurely breakfast and strolled over to the main building an hour later. The A&E ward is jammed with dazed looking casualties from the latest road traffic accident. I am ushered through to the dressing room next door to attend to the individual who is deemed to be most seriously injured. He has a skull fracture, and he is reeking of alcohol. The driver, obviously. I make sure he is breathing, and I get him to grunt a few reasonably coherent sentences. I decide that the scope for further intervention is limited, and move on to the next one.

About an hour later, Esnart and Esther return from the scene of the accident with a patient whom they have managed to retrieve from the wreckage of the vehicle, which now lies 50ft below the road, down a steep slope. The woman has the most appalling chest wound I have ever seen, but she is conscious and able to speak to us. I put up a drip and wonder what to do next. Her elderly mother asks to see her, and I bow my head as she prays beside the trolley. I’m sure I should be doing something smarter and more doctor-like than this, but the correct course of action eludes me again.

The last casualty arrives in the afternoon, after all the patients with serious injuries have been dispatched to Lusaka. He had the misfortune of being thrown from the truck and then rolling to the bottom of the precipice, so nobody found him for hours. He has a number of head wounds, and is totally confused. I bend over him to put a needle in his arm, and he protests by kicking me in the side of the head. I hear myself swearing loudly, and look up to meet the disapproving glare of Mrs Lipalille. I get Catherine to sit on his chest while I piece together the jigsaw of his scalp, a process which occupies me for the next couple of hours.

20th August 2006

Sisters Martha and Regina are taking Dineke to Lukwipa to see the waterfall, and they ask Chas and me if we would like to come along. We climb into the back of the pickup and set off. We stop at the church to collect some extra people, and we look on with a sense of mild dismay as the whole of Lukwipa Girls’ Choir scrambles into the van with us. Leg room completely eradicated, the vehicle bounces slowly down the dirt road, the engine straining against the weight of its passengers. The girls begin to sing and do not stop until we reach our destination half an hour later. It is picture postcard Africa, travelling in the back of an open vehicle under an enormous blue sky, squashed together with singing children.

23rd August 2006

I am having a sweaty moment. It is midnight, and I am back in theatre again, trying to extract a baby from the abdomen of a very tired teenager called Queen. A case of obstructed labour – not such an emergency this time, and I could have insisted that we referred her to Lusaka for a Caesarean. But somehow, I was persuaded that doing it myself was the best course of action, for reasons that are suddenly seeming less robust.

The baby’s head is stuck in his mother’s pelvis, and I can’t get my hand in far enough to lift it out. Trying to suppress a growing feeling of desperation, I hook my finger under a foetal armpit and tug, but still nothing happens. The inside of my surgical mask is sticky with perspiration. I look blankly at Mr Phiri, who suggests that a bigger hole is required. Reluctantly, I extend our already large abdominal incision up the midline.

Queen’s son then enters the world bum first, and stubbornly refuses to breathe. I leave the midwife to resuscitate him, and try to concentrate on piecing together the gaping wound in his mother’s belly. I am wondering if all this cutting has actually achieved anything when I hear the baby cry. Sister Valeria murmurs “Hallelujah”, a word which I have only ever used to express sarcastic weariness. But at this moment it seems appropriate, a long sigh of relief. I spend the next hour stitching, and then go back to bed to enjoy several hours of insomnia and an intermittent urge to get up to perform blood pressure checks.

24th August 2006

The babies keep on coming. I return from lunch break to find that two were born simultaneously in my hour long absence, and there is an ambulance call for the third. I spot the pickup driving towards the hospital at top speed with Esnart crouching in the back. I walk round to the grandiosely titled Casualty entrance (which is actually just a door with a wheelchair stored behind it). There is a startled new mother sitting in the truck, and Esnart is jumping out with a bloodied bundle in her arms. Her chitenge falls off, but like a consummate professional, she leaps out of it, hardly breaking her stride as she runs towards the delivery room with the baby.

On the pulses

2006-08-18T17:36:00.000Z

We are settling down for a quiet Friday evening after a lovely meal of lentils and spaghetti. It was all that was left in the cupboard. It would be wrong of me to imply that the dire state of our larder has occurred a result of local food insecurity; in fact, we had a trip to Shoprite in Lusaka only a week ago. The truth is that we are a pair of gannets who cannot be trusted to make a piece of cheese last more than two days. This unfortunate mutual character trait is problematic enough in the world of 24-hour supermarkets, here in the bush it gets a little more tricky. My repertoire of bean recipes is close to exhaustion - any suggestions gratefully received.

Anyway, enough of of my culinary crisis for now. More diary entries:

6th August 2006

The Bembas are taking on the Easterners at the school football field this afternoon and kick off is scheduled for 3 o’ clock. We walk down to the pitch at about 3.30 with Joost, Bernadette and Dineke, and find both tribes wandering around aimlessly. Apparently no one remembered to bring a football. We sit on the grass, waiting for something to happen. Someone spots us sprawling on the ground and runs over to the Christian Children’s Fund office to get a bench for us to sit on. We are all vaguely embarrassed by this display of solicitude, but to decline would seem rude somehow, so Chas and Joost relocate to the seating provided

Then three footballs arrive simultaneously, and there is an outbreak of anarchy on the pitch, with several games going on at the same time. The referee attempts to restore order, and eventually the two teams line up to shake hands before the kick off. Mr Mwanza, the dentist, takes possession of the ball early on, but loses his flip-flops in the process, to the amusement of the assembled crowd. It is a game high on enthusiasm and low on skill, and I am soon distracted by some kids practising high jump behind us. They are a collection of boys, about ten years of age, who are leaping their own height across a bar, with only hard ground to meet them on the other side. It is an astonishing display of athletic talent, much more impressive than anything going on over at the football pitch, but no-one else seems to be looking.

14th August 2006

A policeman arrives at the hospital in the afternoon. There has been a road traffic accident, and he has brought the only casualty to the hospital. On further questioning, it transpires that the casualty is, in fact, deceased, and my only duty is to verify her passing. He beckons me to follow him outside, where I find a pick up truck, and a small group of people milling around. Everyone looks at me expectantly. I am not sure what the right thing to do is, so I just clamber into the back of the truck. There is a crumpled body lying on the floor, wrapped in a chitenge. I kneel in the dust and tug back the bloodstained sheets. She is an elderly woman, and she is very obviously dead. Despite this, I go through the time honoured routine of checking her pupils and listening to her heart, not wanting to let my audience down, and then I jump out again. Examining the dead is always a slightly surreal experience, but never more so than today.

16th July 2006

We are back in Chimusanya for a second attempt at holding a mobile clinic there. There is a funeral in the church today, so we have been allocated two concrete huts to work in instead. My makeshift office is crammed with a table and two chairs, a rack bearing assorted altar boys’ cassocks, and a portrait of Pope Benedict. The walls only meet with the roof intermittently. Undeterred by the structural hazards, the patients file in one by one and obediently lift their T-shirts to be examined.

We have been given new forms to fill in for all our HIV patients, and I am attempting to record the required sociodemographic data for a couple who are attending for the first time today. Brenda is translating for me, and she is trying her best, but somehow the answers don’t quite fit the questions. It doesn’t help that many of the questions are ludicrous. I ask how long it took them to travel to clinic from home today, and the answer comes back “Sunday”. I rephrase, we try again, but somewhere in the chain of communication the question goes astray. On the third attempt I get my answer – they have no idea how long it took, neither of them have watches. I decide to skip that section. I didn’t come to Africa to tick boxes.

In the drink

2006-08-07T19:16:00.000Z

Apologies to our mothers in advance for this one...

28th July 2006

Simon’s world tour is about to touch down in Zambia, and we are waiting in Livingstone airport for him. We hang around by immigration, debating whether he will arrive trailing his beloved mini suitcase on wheels, like an unusually hairy air stewardess. And then we spot him, nonchalantly handing his passport over to the officials, in the manner of someone who has done this too many times of late. Disappointingly, the mini suitcase is nowhere to be seen, and he is much more tanned than we are.

Ten minutes later we are bumping along a dirt road in a clapped out safari vehicle, heading for a mystery destination. I have arranged for us to stay in a posh lodge by the Batoka Gorge – ostensibly a birthday surprise for Chas and Simon, but in reality, a big fat treat for me. The drive there is not promising – all flat, scrubby bush – but the place itself is amazing, perched on the edge of the gorge, high above the Zambezi. We take in the view and nod at each other smugly, before settling down to the first beer of the day.

Later, we sit out in the darkness together, and Chas and Simon contemplate their imminence of their forties. And we drink to our friend Iain, whose funeral we didn’t go to today, and who, if he were able to hear us, might have laughed at our anxieties about ageing.

29th July 2006

It is early on Saturday morning and we are sitting in a draughty tent being briefed on safety procedures for our white water rafting trip. The instructor is berating the group for not responding to his greeting with sufficient volume, and like sheep, we all bellow “Good morning!” I look around at my rafting companions and realise that most of them look like gap year students. This activity was my idea, and I am starting to regret it already.

We clamber down a steep slope to the foot of the Vic Falls, where our rafts are lined up for us. Chas and I are put in a raft with a couple and their two teenage sons. The mother is chewing her lower lip anxiously. She tells me that she actually wanted to go jet boating, but was outvoted. Our instructor, who styles himself as Babyface, takes us through the various manoeuvres, the detail of which I forget instantly. Simon is the first to go, and we look on with some dismay as his raft tips over and he disappears below the surface of the Zambezi. He eventually emerges above the rapids and is hauled aboard.

Then it is our turn to take on the first rapid. I am in the water within ten seconds, and as I try to grab onto the raft, it flips over, spilling Chas into the river as well. I drift downstream, unsure what to do next, and then a man in a kayak paddles over and tells me to swim over to the rocks. I drag myself out of the murky water and sit there, waiting to be rescued. It is all rather more exciting than I had anticipated.

I climb back in the raft just before rapid number two, which is discouragingly named the Washing Machine. Somehow we manage to remain upright over this one, but we flip again attempting to take on the might of rapid number four. We are like human Pooh sticks, adrift in the downstream current. I have no idea where Chas is, or how I am going to get out of the water. The water crashes over my head intermittently, and then I bob to the surface again, gasping. Eventually I meet another man in a kayak, who directs me to a nearby raft. Two young American blokes drag me aboard. They beam at me excitedly, and I realise that they are having the time of their lives. I also realise that I am definitely not. Moments later, my raft hoves into view, with Chas clinging onto the edge. We agree that we have both had enough, and we abandon Simon to the horror of rapid number five, taking the long walk of shame back out of the gorge.

Simon stays to the end, and when he returns to meet us, he seems slightly uncertain as to whether he enjoyed himself or not. But we are all satisfied at having witnessed the making of another joint birthday legend, which will be told in bars around Glasgow for many years to come. Somehow, it seems only fitting that they should celebrate their 40th with another minor fiasco, after the 21st birthday party which was attended by one other person, and the 30th birthday trip to Loch Lomond where Tim pioneered a new technique for horizontal waterskiing. I think it’s definitely croquet next year though.

On the road

2006-07-23T19:19:00.000Z

More diary stuff...

15th July 2006

A few weeks ago, Catholic Relief Services donated a brand new Toyota Landcruiser to the hospital for outreach work. Lukwipa HIV support group have invited us to visit them, so Sister Martha, Bernadette and I hit the road with Mr Banda at the wheel. I have never been to one of these meetings before so I am not entirely certain what to expect. The road to Lukwipa is hilly, and within a few minutes I am feeling decidedly queasy. We arrive at the support group meeting and are invited to sit on the only bench, while the support group members are sitting on mats on the ground. Nobody seems to know what to say at first, and we all smile brightly at each other in the silence.

The discussion starts with some easy questions about nutrition, and Sister Martha is translating for me. I think I am doing all right. And then someone asks if it is OK to get married if you are taking ARV drugs. I say that these issues are for individuals to decide, my job is to help people to try and live as normal a life as possible. This answer satisfies nobody, and soon we are on to a debate about whether it is a sin to have a relationship if you are HIV positive. I am completely out of my depth with this. I talk a bit about risk reduction, condom use, disclosure of HIV status, rights and responsibilities but I am speaking a foreign language in more ways than one. I think what the group really wants to know is how God might judge them for their behaviour, and my vague answers about individual conscience are not up to scratch. I look desperately at Sister Martha, hoping she can do better than me.

The meeting then descends into complaints about our failure to ensure that blankets are distributed equitably, and the difficulties they have in finding enough food to eat. Like good international NGO workers, we tell them that we cannot help them with these problems, and then we climb into our shiny $45,000 4WD and go home. They seem pleased that we came to see them, although I don’t know if anything I said was helpful. But maybe our presence is more important than our advice.

18th July 2006

The first day of the mobile clinic – the hospice team are finally on the road. Although the team is somewhat depleted today – Bernadette is sick, so Cecelia and I go along with Joost driving. One of the many rules of using of the CRS vehicle is that all occupants have to sign a disclaimer before getting in, as the insurance doesn’t cover personal injury. We are giving a lift to four women who are going home from the hospital, and so I start the day with my clipboard and pen in hand, asking our non-literate passengers to sign a form that they are unable to read. There is much confusion, until eventually Cecelia signs for all of them. Conditions of use duly satisfied, we set off down the dirt road.

We arrive in Chimusanya, at a tiny church where the clinic is to be held. A small queue has already formed outside. We unload our boxes of drugs, and the first patient comes in. Predictably, it is total chaos. We see three times as many patients as we were expecting, and everyone seems to have a come with a ripe bronchitic cough today, so it all takes ages to sort out. We haven’t brought the right drugs with us, and we count out the pills crouched over the tiny wooden pews in the semi-darkness. I run out of paper halfway through the morning and end up writing notes on spare pieces of cardboard. And the patients keep on coming.

But in the midst of all the disarray, I am genuinely pleased to see the last patient arrive. Norah, the woman who had the Cesaerean section last month, turns up with her baby daughter Blessing, and when she tells me that they are both doing fine, the day suddenly doesn’t seem so bad. We emerge from the gloom of the church to find that Joost has achieved some celebrity amongst the children of Chimusanya – the Landcruiser is surrounded by admiring five year old boys. Somehow we manage to leave without causing serious injury to any of them. Not an auspicious start to our outreach service, but a start nonetheless.

Online and dangerous

2006-07-12T19:44:00.000Z

This post comes in the wake of two wonderful events - one of these is the recent arrival of internet access in Mpanshya. More significantly, my sister gave birth to a baby girl this morning, thus continuing the family tradition of female domestic dominance. Never mind Stephen, there's always the Playstation if it gets too much. And welcome to the world Rebecca, today I am wishing I was in a less far flung corner of it.

26th June 2006

It is a chilly Monday morning. Chas gets up at 5am to get a lift into Lusaka with the ambulance. I grunt a goodbye and take possession of his half of the blanket in an effort to stay warm. I get up not one moment before I have to, and I brace myself for the cold shower. My standards of personal hygiene have declined with the ambient temperature; these days I only wash if I really, really need to.

27th June 2006

Today is another momentous day for technology in Mpanshya. There has been talk of a satellite internet link being installed since we arrived, courtesy of a Swiss donor. I come home at lunchtime to find a ragged looking hole has been drilled in the wall of the back bedroom, and a mysterious box with blue lights has been deposited within. I discover later that the only place where you can actually get online is the convent, but the power for the connection is in our house, so any would-be surfers are obliged to knock on our door and request that we plug in. There is something distinctly Zambian about this arrangement, but it would seem churlish to dwell on a minor inconvenience in the face of such astonishing developments. Before we came here, we prepared ourselves somewhat glumly for a life without access to modern communications; now it seems that we will soon have broadband in our house. If I was actually bothering to follow the World Cup, I’d be resolving to cheer for Switzerland now.

And then Rachel arrives. She is a widow, and I have seen her several times over the last few months, since she and her two young children were diagnosed with HIV. She was one of five siblings, but is the only surviving member of her own family. She is very pregnant at the moment. Her oldest child died suddenly at home two weeks ago, she is here to collect medication for her little boy, who seems to be doing well. I have never seen this woman not smiling, and today, she beams and assures me that she is fine. I think she knows that my language skills would not withstand a more accurate description of how she feels at the moment, even if she felt inclined to discuss it, so we stick to business. Even after being here for a while, surrounded by evidence of sickness and shortened lives, some people’s stories get beneath your thickened skin.

I leave the clinic and am greeted by Theresa, who has been in the hospice for a few weeks. She has been getting in trouble from the carers for various misdemeanours – spitting on the floor, shouting at other patients, failing to put any clothes on. She would not seem out of place in an A&E department in the west of Scotland, but her disinhibition is pretty incongruous around here. I can’t help liking her, but then again, I don’t have to clean her saliva off the lino. She is sitting on the ground cradling a cooking pot between her legs. She grins at me and shouts “Hello sister!” I am pleased to note that she is fully dressed today, but as I come closer I realise that this uncharacteristic attempt at modesty has not included underwear. Still, it’s progress.

6th July 2006

The long planned fact finding mission to St Francis in Katete finally happens today. There have been weeks of negotiation with Sister Sabina as to how we might get there. She managed to beat us down from the new Landcruiser to the ancient vanette, but she did concede the services of the hospital driver, Mr Banda. We squeeze into the pickup with Joost, Bernadette, several members of the Banda family and some unidentified boxes. We set off only an hour late, waved off by Sister Sabina who tells us that we must not forget about Mpanshya. I think she is worried that we will have our heads turned by the Katete metropolis.

Before long we are bouncing along the Great East Road, which seems to be more potholes than tarmac in some places. We pass Luangwa Bridge and we are in new territory. Mr Banda maintains a steady commentary on the various fatal bus crashes which have occurred along the way (“and just here…came right off the road…many, many people dead”). I doze past the villages and farms, and five hours later, we reach St Francis.

We are staying at the Tikondane community centre next to the hospital, which is a great place, although sadly devoid of hot showers. We meet up with the medical director and she shows us around the hospital. It is enormous, with about fifty patients tightly packed into every ward, and it takes us the best part of an hour to see everything. Mpanshya feels sleepy compared to this place. Bernadette and I arrange to return in the morning to sit in on the ARV clinic, and we head back to Tikondane for enormous plates of nshima and Malawian Carlsberg.

7th July 2006

Bernadette and I show up at outpatients at 9am, and find it is already heaving with patients. We sit in with a British doctor called Rachel who manages to see about thirty people over the morning, and they are still queuing up when she leaves to go for lunch. She is incredibly busy, but she has other doctors, pharmacists and counsellors working with her; at St Luke’s we have a slightly more DIY approach.

We travel to Chipata later in the day, which is near the border with Malawi. We are staying with Richard, another VSO person. He is a man of rare generosity in the notoriously penny pinching volunteer community. He takes us out for fish and chips at what he describes as the best restaurant in town, although he concedes that the title of Chipata’s finest eaterie is not hotly contested. We are joined by Dennis, another volunteer who has recently arrived from Uganda, and we chat in the darkness when the power fails. He tells me that I bear a striking resemblance to the late Princess Diana. Time for a haircut, perhaps.

8th July 2006

We are in Malawi for the weekend, courtesy of our tour guide Richard. We have a brief visit to Lilongwe, where Chas becomes slightly overexcited about the availability of digestive biscuits and Hula Hoops. Richard takes us to Senga Bay on Lake Malawi, which is a lovely place. We check into a lodge there, and decide to take up the offer of a sunset cruise on the lake. It all seems like a very good idea until we are two minutes from the jetty, and large waves start slapping into the side of the boat. After 45 minutes of pitching and tossing our way across the lake, we stagger off the boat and make a brisk retreat to the nearest bar for stiff measures of Malawi gin.

We return to the lodge for dinner, and are greeted by our host, who is formerly of the RAF. Initially I am too busy picking unidentified foreign bodies out of my food to pay much attention to what he is saying, but eventually he gets onto the subject of politics, and expresses his nostalgia for the eras of British colonial rule and of Hastings Banda. Chas challenges him, and he responds with the usual strategy of stupid right wing bores, the Winston Churchill quote. I know that what he is saying is offensive nonsense, but I don’t know enough about African history to argue with him, so I have to content myself with a bit of theatrical eye rolling until he finally goes away.

The problem with Africa is that it is full of people who never tire of expounding on what the problem with Africa is, who seem to think that the British built an empire out of some altruistic impulse, and it’s all hit the skids since we left. It’s always on the tip of my tongue to ask why they stay if they find it all so disagreeable, but I know the answer. People like these are marooned on a continent that they don’t particularly like because they have nowhere else to go; they would find their homelands unrecognisable if they ever returned. So they stay on in Zambia and Malawi, preserving their own small empires and mourning some mythical golden age.

I'm hoping they call her June

2006-06-28T09:34:00.000Z

It only seems right. Read this week's entry with some hankies at the ready I warn you now.

8th June 2006

There is a new admission on the children’s ward. I smell her before I see her; she is a nine year old girl with gas gangrene. She has come from Shikabeta, which is a two day walk away. I take a look at her left hand, which is grossly swollen, but salvageable, however her ring finger is black and needs to be amputated urgently. I explain this to the mother, who responds to my suggestion that they should go to UTH as though I had proposed a lunar expedition. She has never been to the city before, and she has no money to go. I try to persuade her and she shakes her head. Exasperated, I ask Gilbert how much the bus fare to Lusaka is.

I have not given anyone any money since I came here, mainly because I decided that I had come to Zambia to give my time rather than my cash, but also because I’m not sure when you would stop giving if you ever started. I still don’t know if this policy is entirely justifiable. I am, however, certain that I can’t let this child lose her hand for the want of £3.50, so I quietly give some money to Webster and ask him to pass it on.

In the afternoon I am seeing a woman in the ARV clinic with Bernadette. Mathilda is translating for us. We are starting her on therapy, and I am explaining to her that when the drugs will help her to gain some weight. Mathilda beams in agreement. “Yes, soon she will be fat like both of you!” Bernadette and I look at each other and laugh. This observation is intended as a compliment. Back home, I would never have considered myself as possessing a shape that other women might aspire to, but here, big girls walk tall.

9th June 2006

Two days ago, the Lusaka-Mpanshya minibus toppled off the Great East Road into a ditch, killing three passengers. Since then, there has been a steady stream of casualties coming to St Luke’s with assorted fractures and lacerations. Today begins with an inspection of the damage on A&E ward. I send most of the new admissions limping off to X-ray, uncertain what I am going to do with them on their return.

The morning ward round is then derailed by the arrival of an unconscious teenager with a high fever, and a breathless baby. As usual, I spend ages trying to find an appropriate place to stick a drip in. The grandmother holds the gasping baby down as I shave her scalp looking for a vein, even chipping in occasionally with suggestions of appropriate anatomical locations to attempt. She is stoicism personified.

Things fail to improve in the afternoon, when another critically ill baby appears, and then the X-rays confirm three fractures and one posterior shoulder dislocation. I haven’t reduced a shoulder for a long time, and I am feeling less than gung-ho today. But Elias is horrified by my suggestion that we should send him to Lusaka for this procedure, so I reluctantly fill him up with pethidine, and summon the hospital heavies to assist me. There is a beautiful clunk as his humerus hits home. I am so pleased that I give a moment’s consideration to doing a victory lap of the treatment room, but I content myself with applying a plaster to his shattered forearm.

And then horribly, inevitably, both of the children I admitted today stop breathing. I go to the side ward to certify the little boy’s death. I hear the nurse trying to persuade his father not to take him home tonight, a journey that would involve walking for four hours in the dark with his son’s body on his back. I try to think of something to say, and fail, so I just look at the floor.

11th June 2006

I go out for a bike ride in the afternoon, and I meet two men who are having their photo taken along the way. I hang back so as not to intrude on the picture. One of them shouts to me to come and join them. I can’t think of a reason to refuse, so I pose with these strangers, squinting into the sun. I go to pedal off when the snap has been taken and they tell me to hang on. One of my new friends swaps places with the photographer, and in the manner of a man anticipating a firm slap, he tentatively puts his hand on my shoulder for the next picture. There is then one final rearrangement of the line up for the third shot, and I bid them farewell. Why they would wish to be pictured next to a red faced woman in a sweaty T-shirt is unclear to me, but I am learning just to go with these situations.

21st June 2006

Esnart, the midwife, asks me to come to labour room mid morning to see a patient who has just been admitted. I reluctantly follow her, and find Norah lying on a blood soaked sheet. Her waters broke that morning and she has been bleeding heavily since then. We agree she will need to be referred, and then we examine her to make sure she is not going to deliver imminently. I realise that what I am feeling is a small hand and a prolapsed umbilical cord. This baby will not survive the transfer to Lusaka; it needs to be delivered here, now.

I knew this would happen to me sooner or later, but I wasn’t quite certain what I would do when the moment arrived. I have an overwhelming urge to burst into tears and run away, but instead I say, tentatively “Shall we take her to theatre?” I am half hoping that the suggestion will be dismissed as ridiculous by my colleagues. To my dismay, they seem quite enthusiastic. Mr Phiri runs to open up the operating room, which has not seen a scalpel in action for at least a year. I pace up and down in the manner of an expectant father, until I remember that I am meant to be in control of this situation and stop.

I go along to theatre where Gilbert and Phiri are preparing. The only anaesthetic we have is ketamine, which is mainly used for horses in Britain, and when I go to scrub up, there is no water in the tap. Norah is wheeled and we sedate her and drape her abdomen. I take a deep breath and I cut through her flesh as steadily as I can. With some difficulty, we lift out a small limp girl, whose cord is wrapped round her neck. She is premature, and dopey from the anaesthetic, but Esnart manages to get her breathing. Closing up seems to take forever, and Phiri patiently guides me through the suturing and tying. It could only be described as an inelegant procedure, but eventually we finish. I am grinning like a madwoman, promising beers all round and hardly believing that I have managed to get away with it.

I suppose that since I have been here, I have got used to seeing people die and being unable to do anything to help. It feels incredibly good to be able to do something for once, to make a difference. But I still hope that today marks the beginning and end of my career as an amateur obstetrician.

24th June 2006

We go walking with Beatrice today after work. I am ready for a gentle stroll, but she strides off at lightning pace with Chas and me in her wake. We meet an elderly lady who greets us and asks us where we are going. Beatrice tells her that we are going to climb a hill, and her only response is an astonished “Chifukwa?”(“Why?”) Walking for leisure is definitely a minority pastime here. We walk past some boys who are digging a large hole in a field. They tell us that they are catching mice - apparently rodents are considered to be something of a delicacy. We decide not to stay and watch.

Half an hour later we are puffing up a hillside though dense undergrowth, shredding our forearms on the vegetation. I am beginning to question the leisure value of this activity as well, but then we reach the top. There is a lopsided metal cross there, erected by Mpanshya parish to commemorate the millennium, and evidently neglected ever since. The view is rather more impressive; we can see all the way down the valley to the hospital compound and beyond, and there is not another person in sight. We celebrate the conclusion of our climb with a traditional cup of tea from a thermos, and then head home.

Mall rats

2006-06-18T12:23:00.000Z

Ok, just a quickie - I've forgotten to upload this week's diary entries onto the memory stick, so here's some photos instead. We're in Lusaka again, hanging out at the mall, which is as exciting as it sounds. At least they have broadband here.

Me modelling a prize pumpkin and a dodgy mullet in the back yard.

The road between Mpanshya and Rufunsa villages

The local market

Chas lighting the wood burning stove - there is a problem with the supply of bottled gas in Zambia, and since our cooker ran out two weeks ago, we've been using the old oven. My firelighting attempts are laughable, but Chas is increasingly adept at getting it going - he can now produce a cup of tea within an hour of a request.

Prostates and Plane Crashes

2006-06-12T12:58:00.000Z

Children's Ward

28th May 2006

We have been in Lusaka for the weekend, for cinema and swimming and internet access. Unfortunately we end up seeing the Da Vinci Code, a film that is exciting daily correspondence from outraged Christians in the Zambian national press. It is a long two and a half hours, however, the Maltesers are excellent.

We are staying in Wendy and Akke Jeanne’s flat while they are away in Chipata. They return in the evening and are full of stories about safaris and lakeside lodges. Wendy produces a packet of chocolate digestives that she bought for Chas in Malawi, and thus secures herself a place in his affections for all eternity.

31st May 2006

Another ward round which seemed it was never going to end this morning. Two women had been admitted, both with grossly swollen bellies. Neither of them have a diagnosis, but whatever is going on in their abdomens is probably beyond any intervention that I can offer. A woman who I am certain has TB is sent home because we don’t have the right drugs to give her. She will come back next week to start treatment. I consider telling her not to cough on her neighbours meantime but decide that the joke is too near the bone to be funny. A little girl with meningitis is not getting better quickly enough for my liking and I am worried she has TB as well. Her mother doesn’t have any money to go to Lusaka where they can do a lumbar puncture to diagnose this. I don’t know what to do.

In the afternoon, I go over to the hospice, where there is a small party to mark the departure of Jeanette, a volunteer who has come here for a couple of weeks. As usual, there is music and an elaborate presentation of the cake. The patients sit outside and join in the celebration. One of them, Evaristo, has been with us for a few weeks. He nearly died just after his admission because he was so badly malnourished and dehydrated. Since then, we have managed to get his diarrhoea to stop and have started him on treatment for his TB and HIV. He just started walking again last week. Today, he gets out of his chair and dances. It is a good moment.

1st June 2006

We are engaged in a state of conflict with the army of ants which inhabits our kitchen, and we seem to be losing. We are both fairly ruthless in our attempts to drown, squash and asphyxiate the invaders, but every day a new platoon arrives. Today, we are finishing off our toast when Chas remarks that there are a lot of ants crawling in the lid of the jam jar. I inspect the remains of my breakfast closely, and find that the seeds in the raspberry jam are moving. It is small incidents like these that make you question the wisdom of moving to Zambia. I know that Livingstone had to endure greater privations than ants on toast, but really…

3rd June 2006

I am walking over to the hospital when I see Agness shouting excitedly into her mobile phone. I run back to the house and switch mine on. We are suddenly and unexpectedly connected to the outside world. There was much talk of local reception being imminent when we arrived, but the anticipation seemed to have died down lately. My pleasure at this development abates temporarily when halfway through a round of the children’s ward, I hear a loud ringtone and my colleague disappears to take a call. It is a sharp reminder of the fact that mobile phones are actually really irritating when anyone else is using them.

5th June 2006

I come across a man groaning in pain while doing my morning round with Odesta. He was admitted the previous night with difficulty passing urine. I put my hand on his belly and find that his bladder is horribly distended. We locate a urinary catheter and I attempt to pass it in, but it is going nowhere. His prostate must be football sized. And there is no transport to Lusaka until tomorrow. I have to do something, so with a slightly shaky hand, I stick a large needle into his bladder through his abdominal wall. There is a gratifyingly large gush of liquid, and both he and I sigh in relief.

6th June 2006

I go home from the ARV clinic after 5 o’clock (or seventeen, as we like to say in Zambia). The house is locked and Chas is nowhere to be found. I walk to the market to see if he is there, with the usual spontaneous assembly of giggling five year olds trailing behind me. No Chas. I walk up to the hospital again, but he is not there either. I meet Mathilda, one of the hospice caregivers, and I tell her I have lost my husband. She laughs and thinks for a moment, and then suggests “Perhaps he went to see the plane that crashed”. I ask her to repeat this, and she tells me that a small plane has crashed by the school this afternoon. She doesn’t know if anyone is injured.

I trudge over to the school, hoping that she is profoundly mistaken. As I approach the school buildings, I see a huge gathering of people in the distance. It turns out that Mathilda got part of the story wrong – it was a microlight that got into trouble and came down in the field. The two occupants are looking slightly shaky but are in the process of gathering up their battered equipment with the aid of their ground team. They are a British/South African group who had been planning to fly a circuit around Southern Africa, but it looks like they may be grounded for the immediate future.

While all this is has been going on, the whole of Mpanshya has gathered to watch. Everyone is intrigued at this spectacle, and the children are crowding forward to get a better look. Father Leschek is beside himself with excitement, shaking his head and repeating “Coo-ool”. If an alien landing had taken place in the field, it would hardly have aroused greater interest. We watch until it begins to get dark and cold, and then we leave for home, but our fellow villagers show no inclination to abandon the party. Mpanshya has never seen anything like this, and it’s not going to look away in a hurry.

New Rhodesians

2006-05-27T14:23:00.000Z

We got back into town this morning in the mission vanette. It was possibly the most uncomfortable journey yet - I was sharing the passenger seat with Maggie, so I had to balance on my left buttock every time Mr Banda shifted the gearstick into second. Meanwhile, Chas was obliged to perch on top of a large pile of cassava on the back, wrapped in a government issue blanket. I think I got the best deal.

We spent the morning at the Kabulonga market - a monthly event where all the well-off residents of Lusaka assemble to eat cake and haggle over traditional African crafts. Nearly all of the people who go are Afrikaans or expats. It is nice, but slightly odd at the same time. It is by no means the worst excess of white Lusaka society - I have heard an eyewitness account of an impromptu Gilbert and Sullivan recital in one of the posher cafes - but at times you are left wondering if 1964 ever happened. However, despite vague worries about neo-colonialist behaviour, we went along, as there aren't many opportunities to purchase handmade farmhouse cheddar in this part of the world. Very good too.

Back to the diary:

17th May 2006

Violet is two years old and severely anaemic following a bout of malaria. She was transfused on admission, but the situation has not improved. We have been trying to get venous access to re-transfuse her, but we didn't manage yesterday. Today, to my irritation, her parents are agitating to take her home. Sister Valeria and I take them to the office for a chat.

I explain that if she gets another bout of malaria in the near future, it will probably kill her. The father tells me that they live in a village far from here (there are only two terms of geographical description in Mpanshya - a place is either "near" or "far"). During the week that they have been in hospital with Violet, they have missed the harvest and the monkeys have eaten all their maize. So, their choice is either to take their seriously ill child home and salvage what food they can, or to starve. I suddenly lose my appetite for strongarm tactics, and write a prescription for iron and vitamins.

24th May 2006

I am doing a round with Mrs Lipalile, one of the nurses, and she asks me to see some triplets who have been admitted to the nutrition centre. She tells me they are from a nearby village, Lukwipa, and their mother gave birth to them on her own at home. She didn't know it was a multiple pregnancy. They are now 17 months old, and are frequent attenders at the nutrition centre.

We arrive at the centre, and are greeted by the howls of three tiny toddlers. They are competing for a nipple. Taonga and Mary win the fight and snuggle into their mother contentedly; Natasha cries even more loudly. The older brother, who looks about five, picks her up and tries unsuccessfully to console her. I think I only spend 10 minutes examining this family but it seems like a long, long time.

As we leave, Mrs Lipalile asks me if I have children of my own. When I tell her no, she says "You must have one here! We will deliver you, we are very good midwives." I thank her for the kind offer, and tell her I will let her know. Hmm.

26th May 2006

Joost has been the first of us to get malaria. He was feeling ill earlier this week and went to the lab to get tested. He seems remarkably cheerful despite his affliction. I start to feel slightly dodgy a couple of days later. Nothing specific, just a woolly head and a short fuse. Arguably not a huge variation from my normal state. I put off going to the lab, hoping it might get better, but it doesn't. Eventually I go along to see Mrs Mwale, the technician, and sheepishly offer up my digit for a blood slide. I am passed the result a couple of hours later in a sealed envelope marked "Dr June". One trophozooite. It's malaria but only just. I nick the only remaining course of combination antimalarials in the hospital, and take the afternoon off.

The Medical Council fiasco and other stories

2006-05-19T12:58:00.000Z

8th May - We have an extra couple of days in the big city for reasons that June goes into in some detail below. Bit nerve-wracking for her but only a formality I think.
So here is another quick note to say we are doing fine and we have just had a few days off (which was much needed if you have read June’s last blog entry).
I am steadily getting busier as time goes on – the more research I do on potential funders for the hospital the more complicated it gets. Right now I am on the look out for an NGO who will fund the new buildings and refurbishment needed at the hospital. The plan is that if we can build some more accommodation and start to build a nurses training school next to the hospital then we will solve the staffing problems, provide somewhere for them to live, and pull in a lot more funds for training programmes as well.
As I have said before the money from Scotland has been warmly welcomed here and we are hoping to buy some new equipment, pay for food and medicines as well as put some into the new ambulance fund (or maybe just some new tyres for the old ambulance – vehicles are expensive here! Anyone know any good car dealers in South Africa?).
The weather is cooling off so the nights are a bit more comfortable – getting into winter which means putting a blanket on the bed. And less bugs – hurrah!

June:
8th May 2006

We have been in Lusaka for the weekend, and are preparing to head back this afternoon. Chas goes to the VSO office to do some work; I head to CHAZ to find out what has happened with my medical registration paperwork. I hang about in reception waiting to see the human resources manager. Eventually I am ushered through.

I greet Mr Zulu, and I start to explain where I have come from. Suddenly he recognises me. He pulls a bundle of papers out of the top drawer of his desk. My passport photo is clipped to the front. I realise with some dismay that this is the paperwork I sent to Zambia five months ago with my application to register with the medical council. Something has gone wrong here.

Mr Zulu explains that my application has been bounced back because there is a new regulation that all overseas doctors have to sit an oral exam before registering. I have, in fact, been practicing illegally for two months. I ask him why nobody thought to inform me of this, and he shrugs and tells me that he assumed I had left the country. But he assures me that there will be no problem, I will just have to go to the medical school and take the exam as soon as possible. This sounds like a bit of a problem to me – I say to him “What if I fail?” He smiles back and tells me that I am so cute, I cannot possibly fail. I look at him. I decide I am not in a good position to be extravagantly rude to him at the moment and say nothing.

I am dispatched with a driver to go to the medical council. I am met there by a dour admin assistant, who provides me with a letter to take to the dean of the medical school. I ask him about the content and length of the exam. He dismisses my questions, telling me that if I am a practising doctor then I am unlikely to fail. I am not particularly reassured by this answer.

I duly head to the medical school, which is within UTH. There is a junior doctors’ strike on this week, and the wards are deserted. After a good twenty minutes of being completely lost, I stumble upon the dean’s office. The secretary tells me that interviews will be held the following day, and I can attend if I get photocopies of all my documents submitted this afternoon. She is not forthcoming about what happens at the interview either.

Chas is in the computer room at VSO when I get back. I relate all the irritations of the morning. He tries to calm me down as usual, but I am not to be placated. It is bad enough discovering that you have inadvertently committed a criminal offence; to then be told that you must jump a hurdle of unknown height in order to correct the situation is even worse.

9th May 2006

I arrive ridiculously early for my interview. I have spent all morning reading malaria guidelines on the internet. I can’t remember any of it. I know that this is probably just a formality, and that Zambia probably can’t afford to be terribly exacting about the quality of doctors that it allows in. But it is still an opportunity for me to make a complete idiot of myself.

A GP from Uzbekistan is the next to arrive. She has been practising here for ten years and still has come for interview before she can renew her licence. It puts my situation in some perspective. A compatriot of hers comes in, an anaesthetist who bears an uncanny resemblance to Suggs. The Tashkent émigrés seem nonplussed about being subjected to this process, and they joke with one another in Russian. An Indian paediatrician and a young Congolese doctor join us. We all hand over our interview fee of Kw 300,000, and one by one, we are called through.

I am number four on the list, and I have been waiting for a couple of hours by the time they call me. The dean of the medical school is slightly apologetic as he explains the purpose of the interview – apparently it is to check my English language skills are satisfactory, and my knowledge is of the required standard. I smile and nod brightly.

He hands over to his colleague, an obstetrician who asks me about current UK practice with respect to hormone replacement therapy. A surprising question, given that surviving long enough to be troubled by hot flushes is something of an achievement in this country. Anyway, better to be asked this than have your woeful ignorance of schistosomiasis exposed. She seems to think my response is okay, and we move on. Another consultant idly asks me about management of heroin addiction. I suspect I may have more experience with this than anyone else in the room, but am uncertain how this might relate to being competent to practice in a rural Catholic mission hospital.

Finally, the dean asks me to wait outside and I am given a letter stating that I have been found to be satisfactory. Later, I reflect with some amazement that during the second week of industrial action by the resident medical staff, three consultants have spent an entire afternoon subjecting foreign doctors to this apparently pointless assessment. At the time I am just relieved to get out with my piece of paper and my dignity intact.

12th May 2006

Friday evening. Chas and I are sitting out on our rickety patio furniture when the night watchman comes over to fetch me. He is unusually insistent that I hurry. The police van is outside the entrance. I walk into the dressing room and am instantly hit by the familiar smell of a Glasgow A&E department – fresh blood and stale alcohol. There is a big bloke lying face down on a trolley. He has been stabbed in the chest. I am not clear if his unconscious state is because of beer or haemorrhage. Outside the sun is setting, and although the generator has come on, the strip light refuses to work. Isaac is summoned to rectify the situation. He clambers onto the patient’s trolley and fiddles with the light overhead. Meanwhile, I am prodding the hole between this unfortunate man’s ribs in the darkness. Eventually the fluorescent bulb begins to blink, and it gradually becomes evident that the knife has failed to reach anything of importance. I leave him to his evolving hangover and go home.

At two-thirty, there is a knock on the window. The night watchman again – a pickup truck carrying several people on the back has crashed. Five people have arrived with assorted cuts and contusions. The A&E ward is in chaos. Runa is already suturing and jabbing like a woman possessed, so I roll my sleeves up and join in. Nobody seems to have particularly serious injuries, and when things appear to be under control, I head for home again. Within an hour, I am hauled from my slumber again. One more casualty from the same accident has arrived. This one is really sick – fractures and internal bleeding. We can’t do anything for him here, and Runa has hauled Mr Banda out of bed to drive him to Lusaka immediately. We decide which of the other casualties need to go with him and I scrawl some incoherent referral letters to accompany them. I go back to the house exhausted, but my head is full of accidents and emergencies and I can’t go back to bed.

Before I came here, I worried terribly about having to deal with exotic diseases and nasty viruses. I didn’t think at all about being expected to mop up the results of dodgy driving and knife-wielding drunken belligerence. But perhaps that was just as well.

14th May 2006

I have been given an enormous pumpkin by one of the patients from the ARV clinic. I am very appreciative of this kind gesture, but it is presenting some culinary challenges. A bit like an oversized Christmas turkey that keeps returning to the dinner table in various guises. We had pumpkin risotto last night. After mass this morning, I experiment with pumpkin jam. Chas is polite about it, but I would say it is not an unqualified success. At least there is pumpkin curry to look forward to tomorrow.

It is a beautiful day, and Chas suggests we go for a bike ride. We ask Joost if we can take his pushbike. He suggests that we could go out on the motorbikes instead. My reluctance to get on my Honda is something of a running joke. A week of misery skidding about in an industrial estate in Kidderminster with my L-plates was never likely to spark a great love affair with motorcycling. Since I have been here, I have ridden my motorbike once, for five minutes, and managed to get it so stuck in a rut that two men passing by had to stop and lift me out. I decline Joost’s offer.

We set off on our pushbikes, ploughing determinedly through the sand, and head for Rufunsa, the neighbouring village. We pass through fields of maize and cotton, and children practice their sole English phrase as we pedal past (“how are you, how are you?”). We eventually arrive at the village and find ourselves at the market. There is a large group of people sitting out in the late afternoon sun. The village drunk staggers towards us at an impressive speed. We swerve past him, and the crowd bursts into laughter. We keep going past the local hostelry, a concrete shack which styles itself as the George Best Drinking Place. Anywhere else, you would suspect that this title had been chosen in cynical bad taste, in rural Zambia, you can be certain that it was inspired by pure admiration for the great man. I’m sure he would have approved.

p.s. from Chas - 19th May - as I publish this my family are gathering for the big get-together for Mum's birthday. So - Happy Birthday Mum! Wish we were there. (Its about time you got a mention on the blog - I know you are a keen reader)

Lessons in statistics

2006-05-08T14:22:00.000Z

One in ten Zambian children die before reaching the age of five; the average life expectancy here is 33; the third most common cause of death in this country is road traffic accidents. You’ve probably heard these statistics, or something like them before. They are unpalatable enough from a distance, but being here in the middle of it all is an uncomfortable situation at times.

The diary extracts are a bit grim this week. But I figured you’ve stayed with us this long, and you can probably cope. Me, I’m trying to keep a sense of proportion about it all – most of these deaths are certainly preventable, but probably not through my efforts alone. They are less my personal failures than the product of systematic disadvantage, from the womb onwards. It doesn't always feel like that at the time though.

27th April 2006

An unbelievably awful day. I spent half my morning trying to get a line into an anaemic 10 month old baby. I finally succeeded after about 20 attempts, and we got blood for cross matching this afternoon. Unfortunately the cannula was blocked by the time the blood came. I spent another hour trying every place I could think of – scalp, groins, everywhere – and couldn’t do it. Being able to find a vein is sometimes the difference between life and death here. Today, it wasn’t possible.

Another little girl, one of my HIV patients, collapsed and died a few hours later. She had appeared to be getting better from a chest infection, but she was badly undernourished. She was severely anaemic too, but the only blood we had was cross matched for the other baby. I know that the lack of available blood probably didn’t make much difference to the outcome for this child. But I can’t help feeling angry and frustrated about having to watch her die.

I knew when I came here that stuff like this would happen. I suspected that I would gain an unsettling familiarity with the sound of the paediatric death rattle. I suppose I had hoped that I might rise to meet these challenges when I was here; that I would somehow acquire an air of calm authority in the face of such crises. However, my diffidence and indecisiveness are proving to be portable qualities. And in retrospect, the notion that international relocation might induce a sudden professional metamorphosis was perhaps based in something other than reality.

People who do this kind of work often talk in vague terms about “doing your best”, but everyone neatly avoids discussing the possibility that one’s best might not be terribly good at all. These children deserve better than me. Unfortunately, in the absence of a paediatric intensive care specialist, they will have to endure the improvisations of a bewildered GP. I did choose to do this, I opted to place myself at the sharp end, and I am not sure if my decision is currently serving anyone’s interests.

2nd May 2006

The first day of the course for antiretroviral treatment supporters. This is the next stage of the ARV rollout programme; improving support for people on treatment for HIV in the community. This group consists mainly of local teachers, and I am training with three colleagues.

I arrive for my slot, clutching my pieces of flip chart with my wobbly marker pen diagrams. I stand up and introduce myself. My colleague, Hateyo, leaps to his feet and translates my introduction into Chinyanja. I am a bit taken aback – I was told that this group would all be fluent in English – but I let him carry on.

I proceed to explaining the cellular biology of HIV in as close to layman’s terms as I can manage. Hateyo enthusiastically translates for me, and his explanation goes on for some time. I don’t understand what he is saying, but I can hear the words “reverse transcriptase”, “CD4 lymphocyte” and “messenger RNA”. Evidently he has decided to correct the deficiencies in my presentation with a bit of added scientific jargon. In the absence of any idea of how to bring things under control again, I opt for a fixed grin and I plough on through my material. Hateyo continues in much the same vein, like a Springer spaniel who has just been allowed off the leash. I finish exactly on time, feeling completely demoralised, and head back to ART clinic.

Later, I discover that the slot immediately before mine was delivered by a Zambian colleague in English with no translation. I don’t generally have much of a problem making myself understood amongst English speakers here. I think the problem is that being able to talk before an audience is seen as something of an honour here, and any potential opportunity for public speaking has to be seized. I am training again tomorrow. Time to be assertive, I think, even at the expense of cultural sensitivities.

3rd May 2006

Back to the training centre. I am introduced by Hateyo, and I stand and say good morning. Hateyo does not sit down. I gesture towards an empty seat nearby. He walks over and picks up some notes that are lying on the chair and offers them to me. I catch his eye, he finally realises what I mean, and sits. I get through the next 90 minutes with only two or three spontaneous contributions from him, which I consider to be a small triumph. Hopefully this marks the end of my training career.

4th May 2006

Today, five people are coming from the orphanage in Nyampande for medicals. I begin seeing them one by one, hopeful that a cursory examination will suffice. But predictably, they all have some ailment or other that needs attention, and the process takes forever. I have to run off to attend a death in the hospice midway though the morning. I am feeling a bit harassed.

Paperwork finally completed, I bump into Sister Valeria who apologetically tells me that eight Catholic Brothers have arrived from Lusaka in anticipation of a full medical examination as well. I make no attempt to veil my displeasure at this news. If I was interested in this type of work, I’d be on BUPA’s payroll rather than here.

In the afternoon, I am trying to locate a translator so I can see some outpatients when I see a commotion at the emergency admission door. Some people are unloading a man from a minibus. He is groaning. I try to obtain a story about what has happened, but everyone is talking at once. Having dumped the casualty on the bed, the minibus occupants disappear.

I take stock of the situation. Obvious right femoral fracture, blood pressure unrecordable. Not good. Even if through some miracle, I managed to open up his leg and tie off the bleeding artery, we do not have enough blood in the hospital to replace what he has already lost. And we are three hours from Lusaka. The implications are obvious. He is twenty-four years old.

Despite this, Sister Valeria and I get to work, putting in lines, cross matching blood, debating whether he needs a chest drain or not. He is begging me to give him some water. I refuse, because somewhere in my head I have convinced myself that it will be okay, that we will get him to an operating theatre somehow, and we must keep his stomach empty in preparation. We continue: antibiotics, tetanus prophylaxis, chest X-ray. He tells me he is going to die and I emphatically contradict him.

Two hours after he arrives, we are forced to acknowledge the futility of all this activity. We stand by the bed as he dies. I am a mess of blood (his) and snot (mine) but I am past caring. I am wishing I had just given him some water.

There is still a queue of patients waiting to be seen. I examine a baby who pees on my foot, and throw antibiotics at the others. Then the Brothers arrive for their medicals. I do it on autopilot. On another day, the idea of asking a series of trainee priests to drop their trousers might have made me smile a little. Not today.

Ignore the screams / Easter in Livingstone

2006-04-28T09:36:00.000Z

Welcome to another episode - this one a mix of June's gorey medical stories (I thank the good lord that I don't have to do such things) and rather cheerier tales of our Easter - we went to the Victoria Falls which are great. I loved it. Our fellow VSO, Joost, was so excited that he jumped off the bridge. A drop of 111 metres. Just crazy.

Friday 7th April

Another week in. All a bit more hands on than I might have liked. This week I have attempted to reduce a dislocated elbow (unsuccessful), remove a twig from a baby’s pectoral area (again didn’t manage – not sure how it got there, but I’m suspecting that the local witch doctor may have something to do with it) and opened up abscesses on the buttocks of no fewer than three toddlers (mission accomplished, although in truth there was little surgical skill involved). None of these patients got anaesthetics, because there are no suitable drugs available. I am learning to concentrate on the scalpel and the skin, doing it quickly, and ignoring the screams. This is not feelgood medicine. Empathising with your patients is not helpful in certain situations here. What is required is the ability to distance yourself. Perhaps good bush doctors are all latent psychopaths.

We Treat - Jesus Heals

Saturday 8th April

Off to Lusaka today in the ambulance – the first trip for 2 weeks. Our larder is bare, and I am dying for a day off. There is a trade off to this free ride though – we are transporting patients to UTH. One of them is Usonje, who arrived yesterday with a fever and acute abdominal pain. Another is Brenda, a hospice patient who is pregnant, and has complicated HIV-related problems. I don’t know what to do with her, and so have decided to refer her for specialist advice. We load them in the back, with Usonje lying on the floor on a mattress. Chas and I sit up in front with Mr Banda, and we set off for town.

We arrive at UTH a couple of hours later. The lady with abdominal pain is deposited at the discouragingly named High Cost Casualty department, but we are told we need to take Brenda to the Filter Clinic. There is nothing obviously costly about this department – we bounce down the rutted road on our way to the entrance. As we approach, we see a woman lying on the floor in the doorway. No one is helping her. We go to the desk where an impassive-looking receptionist takes down Brenda’s name and are directed to room nine. There is a long queue of patients waiting to be seen there. Someone is groaning loudly behind a curtain. I watch a young doctor and a nurse attempting to get a line into a struggling patient.

Eventually one of the nurses calls us forward. I decide to dispense with my usual just-call-me-June schtick and announce myself as Dr McIntyre from St Luke’s. I succeed in getting her to make eye contact. I try to summarise Brenda’s problems, she listens until I say she is pregnant. “She must go to Maternity.” I try to explain that this is not an obstetric problem; that I have brought her here to see an HIV specialist. Apparently this is the rule, and this nurse is not going to bend it on my behalf. Defeated, we leave this miserable room for Maternity.

We make it past the next reception unobstructed, and are directed down a long dark series of corridors. We arrive at our Brenda’s destination, and I find her a seat in a room full of unhappy looking women with varying degrees of abdominal swelling. I say goodbye and tell her I will see her soon. I don’t really want to leave her here, but I do. I walk back down the corridor with Chas. I think we are both enormously relieved at being able to escape from this monster of a hospital.

Monday 10th April

I get up early to catch the 6am bus back to Mpanshya. The taxi to the bus station is late, and I get there 10 minutes before the coach is due to leave. I squeeze my way on, and I locate a seat at the back, between two women. My modest rump is no match for the more generously proportioned African ones on either side, and I am forced to perch on the edge of my seat.

Astonishingly, the bus departs only 5 minutes after the scheduled time. As we are leaving Lusaka, the travel manager, who surely does rejoice in the name of Ablessing, requests a volunteer to give a prayer for the journey. A woman at the front is quick to oblige with a few words. I scan around the bus, and find that every head is obediently bent. I plug in my i-Pod headphones when the moment of worship is over. A few seconds later, an ear-shatteringly loud gospel song is piped through the bus, drowning out my music. The idea of personal music, like that of personal space, is not recognised or respected in this part of the world, I think.

I am dropped off by the roadside at the turn off for Mpanshya, and I set off up the dirt road with my backpack. It feels like a small adventure. Farmers stop and stare at me through the maize, mildly amused at the sight of a mzungu travelling on foot. I smile and greet everyone. It takes me an hour to walk home, and I am sticky with dust and sweat when I arrive. I feel absurdly pleased with myself for managing to get home independently, and I have a celebratory cup of tea and some Jungle Oats (like Scot’s Porridge Oats, but with a tiger on the front instead of a bloke throwing a hammer). Back to work then.

Friday 14th April

Good Friday starts with another early trip to Lusaka intercity station. Joost, Bernadette, Chas and I are off to Livingstone for Easter weekend. The Zambezi is at its highest at this time of year, and we are told that the Victoria Falls are at their most spectacular around now, so it’s a good time to go. Also, Joost and Bernadette went to Mass on Palm Sunday last week, and apparently it lasted 3 hours. If a donkey ride can inspire such fulsome worship, I’m not sure how long the celebration of the resurrection will take. And those benches are very hard.

We arrive in Livingstone, the former capital of Zambia, just after lunchtime. It is basically one road, lined by low colonial-era buildings. It looks very much like smalltown Australia. It is also incredibly hot. We find our friend Val’s house, say our hellos and go out for cold beers and food. It feels like we are on holiday.

We are staying at a backpackers’ place in town, and the owner tells us that if we go to the falls that evening we will see lunar rainbows. After Kerry and Akke Jeanne arrive from Lusaka, we all head down together, and walk along the narrow path to the viewing point. You hear the roar of the water a few minutes before you see it. And as promised, we see a halo of light encircling the spray from the waterfall. It is not like anything I have seen before, and we stand in the warm darkness for some time, eyes fixed on the cascade.

Saturday 15th April

Back to the Victoria Falls this morning for another look. On our way, we stop to get Chas kitted out with a band new pair of flip flops (he opts for a pair with a football motif over the equally cheap ones with the New York skyline on the soles). We go back to the viewpoint where we had been standing last night, and bump into a bloke in a Celtic strip. Chas strikes up a conversation in his best Glaswegian accent, and soon they are trading fond reminiscences of the Calton on the banks of the Zambezi.

We walk around the side of the gorge and over the Knife Edge Bridge. It soon becomes clear that there is no way of doing this without getting soaked through. There is something of the thrill of the fairground here – everyone around us is shrieking and laughing, throwing their arms in the air as they walk though the spray. It is an amazing place, incredibly beautiful.

Joost texts us to say he is planning to do a bungee jump from the bridge that spans the river. Bernadette is afraid of heights and is disinclined to watch from the top of the bridge, so she and I retreat to the other side of the gorge where there is a good view. Chas is charged with phoning us from the bridge to let us know when the jump is imminent. As we anticipate the call, some Zambian women come over and join us where we are sitting. We watch a succession of jumpers bouncing upside down from the bridge. Bernadette tells one of the women that her boyfriend is next. The woman shakes her head, saying “Crazy mzungus”. We concede that she has a point. Suddenly we see Joost making his descent, and then his ascent. We all giggle together as he is hoisted back up to the bridge. When we meet him afterwards, he is smiling uncontrollably, while Chas looks vaguely traumatised by the experience.

Tuesday 18th April

Sister Valeria is in town to pick up some medical students (they are coming to St Luke’s for their elective). We are meeting up at 11, and we rush around to the post office and SuperSpar, getting our last fix of civilisation before we return to the wilds. We meet Robert and Saira from Birmingham University at the shopping mall. They arrived on the overnight flight and are understandably uncommunicative. I bag the front seat in the ambulance on the pretext of having important clinical matters to discuss with Sister Valeria. Chas is unimpressed.

We head home, Sister filling me in on the events over the weekend. Half the hospice patients have taken a celestial discharge in my absence. Abdominal pain lady reappeared, having been given short shrift by the UTH surgical department. Her family brought her to hospital in a wheelbarrow in a moribund state, and she died shortly afterwards. I am beginning to understand why my colleagues roll their eyes when I suggest referring anything on to Lusaka.

It suddenly occurs to me that I don’t know where the students are staying, and when I ask, Sister tells me that one will be with Maggie and one with James the dentist. We have a much bigger house than either of them, and I suggest that they could both come and stay with us. This plan has to be okayed by Sister Sabina when we arrive (I’m uncertain if this is because she requires oversight of all domestic arrangements, or if there are concerns about impropriety) but she seems quite happy. We are all invited for dinner at the convent that evening.

We walk over in the dark with our sleepy houseguests, and meet a large group of Americans accompanied by Maggie. They are teachers from Washington DC, who have been brought here by Luke, a former member of the Zambian Peace Corps and a friend of Maggie’s. They are doing a tour of various Zambian religious institutions (one of them tells me enthusiastically about the leper colony they visited on the previous day – “like, totally amazing!”). We eat together, and when dinner is over, Luke announces that his girlfriend, a professional singer and actress, will perform for us. She resists momentarily, and then she belts out a shrill showtune at full volume. It is a moment of breathtaking incongruity. I study Sister Sabina’s face to try to determine her reaction to this impromptu performance, but she is wearing an unreadable expression.

The visitors request a song from the nuns, who oblige them with a Chinyanja hymn. I get that familiar uneasy feeling that I have whenever there is the possibility of having to engage in public performance. Fortunately, the sisters are getting into their stride. Sisters Valeria and Martha produce some drums, and Sister Regina starts off the dancing. Reprieved from potential humiliation, we depart shortly afterwards.

The childen's ward

The white is moving!

2006-04-09T12:29:00.000Z

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…

Luangwa Bridge

2006-03-31T11:03:00.000Z

Another posting so soon - hope you are all keeping up with this!

Here is a picture of June's birthday bash> She's sporting her new T-Shirt and Chitenge. Above is the dancing-in of the birthday cake. Sister Josepha is the one presenting the cake for June.

Last weekend we went to Luangwa Bridge - a great day out - and I have to add this in to June's account below (Important Note: Alison - do not read this next sentence). While lazing up at the campsite a tree snake was spotted in the trees 15 feet away. It must have been at least 5 feet long - it's life was cut short soon after being spotted. A few whacks on the head by a very brave man called Chris put paid to its chances. I thought it was very exciting and definitely worthy of mention alongside June's story. I also saw a Baboon! And a Monkey!

Chas

25th March 2006

A day out – Beatrice has suggested a trip to Luangwa Bridge in her 4WD, and we agree, eagerly. We set off in her pickup, 4 of us seatbelted inside and 3 perched on the flatbed. Beatrice stops by the roadside for hitchers, who clamber into the back – one of them is a man who I diagnosed with TB two days before. I mutter this to Chas, and he instantly rolls up the window in horror.

The Great East Road is beautiful, rolling hills and greenery all the way. We drive for about an hour, by which time I am feeling distinctly nauseous. We have our picnic on the banks of the Luangwa River, which is high after the rainy season. Across the water is Mozambique. Maggie tells us that the last time she was here, she spotted crocodiles basking at the river’s edge.

After lazing for a while, we walk up to a campsite in search of cold beer. The owners are a Dutch/English couple who have come to Zambia after living in South Africa for several years. They are a bit pissed and talk imperiously to their staff. My hackles are up within about 5 minutes. We have a beer, and then the guy suggests going for a boat ride. Everyone is enthusiastic about this, apart from me. The man is having problems forming sentences, and we are to go for a trip in crocodile infested waters with him at the helm. I try to quietly voice my reservations, but no one agrees that this is a bad idea. I stay behind as they all walk down to the jetty, pleading a predisposition to seasickness, and defining myself as the tedious stick-in-the-mud yet again.

I am left on the terrace with his wife, who pours herself another glass of wine and talks to me about medical matters. Soon she is informing me of the many occasions on which she has had to supply first aid to the locals. She confides “they’re a very clumsy race, y’know”. I grit my teeth and say nothing. A guest distracts her from her monologue, and I take the opportunity to bury my face in my book. She returns, and I don’t look up. Better that she thinks I am impolite than that I actually agree with her. I maintain this for the next half hour, until the adventurers return. They are all smiling, having seen a hippo in the water. We leave soon after, to my relief.

I feel like I’m back in Australia, having to endure this. And again, I am complicit in my silence.

27th March 2006

Our Chinyanga tutor comes to visit – a shy trainee teacher called Gladys. Our first lesson is on pronunciation. We struggle our way through our dipthongs and fricatives. I construct a sentence “the cow is entering the church”. I am reminded of Eddie Izzard and his “the monkey is in the tree” skit. All the Zambians I have met tell me that it is an easy language, but on the evidence so far, I am dubious.

June

Mpanshya - Nia Roo

2006-03-30T13:11:00.000Z

Some pictures of St Luke's and our new pad (you can't see the pool - its round the back!)

Living the high life

2006-03-30T12:55:00.000Z

Its all luxury lifestyles and celebrations!

June has been writing again - I would write too but she runs the battery down on the laptop every night! Thats my excuse anyway. I'm in Lusaka today researching the funding criteria for small grants from DFID and trying to chase up a promised (and much needed) new vehicle from CRS - the American CAFOD. It has to be bought in Baltimore and shipped over as opposd to just buying it here in Zambia and getting it next week. The whole development funding business can be a bit crazy at times.
St Luke's is very ambitious to expand, update and improve all its services but the priorities are competing and I just hope some of my big funding proposals are accepted. As for day to day running I am not sure how the Sisters manage - they are never certain of how much income they will have from one month to the next. From that point of view money from Scotland is very much welcomed, so thanks again to all you givers. I am in the process of sorting out a way people can support St Luke's from back home but its slow work for me at the moment. June definitely got the tough job - and speaking of June, here are the latest series of tales and exploits:

15th March 2006

My birthday. Also the day I get to meet the famous Dr Banda – sadly not the dead Malawian despot, but the doctor from the district medical office who comes to do a round once a week. He eventually arrives at ten. He is all smiles when we meet, telling me that there is a Chinyanga proverb “it takes 2 fingers to pick a louse”. I think this means he is pleased I am here.

The ward round is long, with rather more bedside teaching than I might have liked.
After four hours, word arrives that the chief has come to the hospital to be seen and so the round is briefly abandoned for the local royalty to be attended to. I take my opportunity and leg it.

Father Eugene has finished his workshop, and we pile into his van for the trip to Lusaka. I get the front seat, because I am the birthday girl. We chat on assorted topics on our way into Lusaka – one of these pleasant conversations where the participants take it in turns to relate a piece of received wisdom earnestly and at some length. Islamic fundamentalism (“very worrying”), the rise in house prices in Dublin (“surely not sustainable”) and the modern wonder of text messaging (“so convenient!”) are all covered. I enjoy myself thoroughly.

He drops us off at the Fairview hotel in Lusaka, where the VSO volunteers meet up on a Wednesday night. Cold beer on the terrace, and then some of the other volunteers begin to arrive. We swap stories about our new jobs. Nobody is happy with how things are going at the moment; everyone is struggling to find out exactly what their role is. A couple of beers into the evening, I tell the story about the man I saw on my first day who needed a litre of fluid aspirated from his scrotum (I replicate his gait shamelessly in the interests of raising a cheap laugh).

I text home; no reply from Mum. I try my most reliable family member for mobile communications – Linda, and sure enough she sends me a message straight back. I phone her, and then find I can’t talk. I hear the Scotrail announcements in the background (“Polmont…Falkirk High…). In normal circumstances, you might feel a sense of satisfaction in knowing that you are several thousand miles from public transport in the central belt, but at that moment, the distance seems unbearable. I tell her about the sisters dancing for my birthday and my refrigeration problems and then she is cut off. Mum rings a bit later and we talk. I am struggling to summarise the last two weeks into this expensive phone conversation. I detail my refrigeration problems once more for good measure, and then we say goodbye.

We go for Indian food, and then we go back to Akke Jeanne and Wendy’s flat to sleep. They have a tiled lino floor, which is our bed for the night. I eventually drift off to sleep, and then wake to find Chas plastering mosquito repellent onto my face. The window is jammed open and the bugs are having a party. I am too old for this.

16th March 2006

I wake up at 6, a bit hung over and very tired. Bernadette and Joost have had a similarly sleepless night in the neighbouring room. Our hosts go off to work, and we go to the nearest café for breakfast. We end up in this place which appears to sell croissants and coffee. It proves impossible to order both these items at the same counter, so we Chas and I go off to the coffee counter in search of refreshment. We are served with a level of indifference that I thought did not exist outside of independent hotels in the Highlands. I am not feeling patient today, but expressing annoyance will not help. I am turning into a tetchy expat, and I have only been here 2 weeks.

Bernadette and Joost return with the croissants, which disappointingly turn out to be pieces of crescent shaped stale bread. We sit there in silence, chewing our breakfast. We are all a bit dejected.

We cheer ourselves up with a long session in the local internet café, and then we head into Cairo Road and the VSO office. Dorothy the receptionist greets us like we are long lost relatives. Maurice, whom I had been hoping to discuss my placement with, is in South Africa. I have nothing much to do, and hang around aimlessly while the others sort out their admin, and check more e-mails.

Everything seems wrong today. I make tea in the kitchen. No reasonable adult would burst into tears spontaneously during hot beverage preparation, but my talent for inappropriate displays of emotion shines again. And I can’t stop. Chas and Bernadette come though and are understandably bemused. I can’t explain myself. I decide that drastic action is required, and demand to be taken to a posh hotel for gin and tonic and swimming. Chas is in no position to refuse.

A couple of hours later, we are sweating in the lobby of the Lusaka Intercontinental Hotel, having lugged our rucksacks down the road from our friends’ flat. A man in a terrible uniform presents us with lurid pink cocktails, and there is muzak in the air. We are both aware that this is pathetic, soft behaviour, but we don’t care. I sign the Visa imprint with a flourish, and stride off in search of the pool.

Sometimes, you just have to do things that you can’t really justify.

17th March 2006

We go to the bank again today – having completed a sheaf of forms the day before, we are given new forms to apply for an ATM card. We are advised that it will not be possible to fit both our names on the card – one surname has to be dropped. I yield to patriarchal tradition and sign June Gay. Chas is gracious in this small triumph. Anything to get us out of this bank.

Maggie arrives from Mpanshya in the ambulance, and we start the long journey home. We make several stops on the way – the first one is to pick up mail. I unwrap my birthday parcel from Jane in the dingy, crowded post office. It is Jordan’s autobiography, a shiny, fuschia pink tome. I laugh out loud, Maggie is bemused.

Then more shopping – I have a moment of triumph in Shoprite when I locate a wedge of Parmesan cheese (a bargain at only Kw 44,000!) Finally we get on the road. We are home after dark, and I surprise myself when I am pleased to arrive. We unpack all our shopping, and I become sadly overexcited about arranging my clothing in my new wardrobe organiser. Chas points out that in two weeks time I will be leaving everything on the floor as usual. I ignore him, and carry on folding like a woman in a Persil ad. Mrs Gay, indeed.

19th March 2006

I wear my new chitenge to mass this morning, but I have problems securing it adequately, and every time I get up from kneeling I am convinced it is going to fall off. I look around me at all the other women whose clothing seems to be staying miraculously in place, and wonder what the secret is.

We are invited round to the convent to celebrate Sister Josepha’s feast day after mass – yet more food, and dancing. We sit round in the garden, eating together, and it is a beautiful day. Sister Josepha is wearing a leopard print chitenge over her nun’s habit, and she tells me of her disappointment that the recent series of “Strictly Come Dancing” has come to an end (they have a satellite TV in the convent). I ask her to show us round the garden, and it is amazing – we pick grapefruits and avocadoes from the trees.

We decide to go out for a walk in the afternoon and head out in the direction that Maggie had taken us the week before. We miss the turn off for the cave and are not sure where we are heading. We find ourselves standing in someone’s front yard. A group of women are sitting on the ground with their children. They laugh at us, two lost sweaty foreigners. One of the women, who is midway through having her hair braided, asks us if we are looking for the cave. We nod, and she gets up and leads us the way, with half her hair sticking out. We go though the cassava fields, past the banana plantation, and then we are in the right place. It takes about 10 minutes. She smiles and says goodbye. We would never have found this on our own.

20th March 2006

The day of the hospice celebration. It was supposed to be a party to mark the opening of the new building, but despite Joost’s best efforts, there is only half a roof. So the event is rebranded as a fifth anniversary celebration for the existing hospice. I try to cut my ward round short in order to join in, but Agness is having none of it, telling me that there are patients to be discharged. It is a frustrating morning, with long bedside conversations being conducted in Nyanga, and little translation. I try to be patient – it must be a pain having to translate while doing your normal job – but at time it feels like there is little point in me being there.

I glumly join the lunchtime festivities. The garden in front of the hospice is filled with people, eating nshima in the sunshine. Chas is taking photos. Beatrice, Maggie, Nicole and Irene been practising a dance routine for the celebration, and they perform it, to “I Will Survive”. The dubious choice of backing track does not stop the hospice inpatients from loving it, and they whoop in appreciation. More dancing follows, with the guests swaying to the music on the front steps of the new hospice building. Bernadette gamely gets up and joins in; I sit at the back, concentrating on ploughing my way through my plateful of mealie pap. This diet will take some getting used to.

21st March 2006.

Back in the ARV clinic. Webster, one of the nurses is helping me out with translation today. It is a long morning again, and there are lots of problems to sort out. Just before lunch a small boy comes in. He looks about 12 years old, and I wonder where his parents are. I look at his notes and realise that he is 17. I flick back through his record and I read that he is an orphan and he has been on treatment for 18 months. During this time, he has gained only 2kg in weight. Something is not right.

I ask him if he is remembering to take his drugs, and he nods. Then I ask him what he is eating. It transpires that he only has one meal a day, usually nshima and cabbage. I don’t know whether the drugs are not working, or if he is just not growing because he doesn’t have enough to eat. I ask Webster if there is some way to provide him with extra food, and he shakes his head. I say “There must be something…” and he looks away. I realise that he thinking the same things as I am, and he is probably just as frustrated. And I realise that expressing it is just self indulgence; my despair will not fill this young man’s belly. So I shut up, I count out the pills, and we scratch around in the back for an extra bag of soya beans from him to take away.

24th March 2006

It is World Stop TB Day, and Mpanshya Mission has organised a day of events to celebrate the fight against the deadly bacillus. I am beginning to wonder if there is ever a lull in the festivities here. About 200 people from the surrounding communities have come for the party. Everyone has a “Stop TB” T-shirt, apart from me.

I join in the march around the hospital grounds. Mr Phiri, one of the nurses who organised the day is there, and I express mock outrage at not being allocated the appropriate clothing. He is all contrition, and then, an idea occurs to him. Perhaps I will make a speech. I tell him I will do no such thing, but he persists. As the hospital doctor, I must say something. My protestations are ineffective. I acquiesce, and instantly regret it.

I sit with assorted invited guests on the platform. There is a programme for the morning, manually typed with such vehemence that there are holes where the full stops should be. At the bottom of the page it says “N.B – The programme of events will inevitably change”. The master of ceremonies is less than slick in his presentation, and there are long gaps in the proceedings during which the organisers consult urgently while Zambian pop is played over the tannoy. I hope that my contribution will be forgotten in the chaos.

There are a number of speeches, and music and drama from community groups. One group, from Chimusanya, enact the stages of TB, from hacking cough to submission of sputum samples. At the end, they each give a personal statement about living with HIV. This is quite something; there is still a huge stigma attached to being HIV positive here, and people do not generally disclose their status publicly. There is dancing, and some local schoolgirls do a TB rap. The MC encourages us all in our applause - “Big up for Rufunsa Drama Group!”

Then it is my turn – I am introduced as Dr June, and I take the mike. I am sweaty and unironed. I have left my toothbrush in Lusaka, so I also have the breath of Beelzebub. I say how pleased I am to be here, and suddenly Sister Sabina hoves into view with her camera, to commemorate the moment. I forget what I was going to say. I stammer something about joining the community in the fight against TB, and finish with a loud “Zikomo Kwambiri!” I return to my still warm seat, and three people applaud. No big up for Dr June, then.

I am happy to be left alone to cringe quietly in my chair, but before long I am pressed into service again. Chief Mpanshya is presenting certificates to home treatment supporters, and for some reason, the MC insists that I stand next to him to shake the hands of the presentees. I see Maggie laughing at the back of the crowd, and I pull a face. I am so glad that Chas is in Lusaka, and that there will be no photographic record of this part of the ceremony.
I can now go to my grave knowing that I have achieved minor celebrity in Mpanshya. Even if it was celebrity of a slightly tawdry and undeserved nature.

Thirty-three

2006-03-16T07:27:00.000Z

Well, we finally made it back from Mpanshya - Father Eugene from the Lusaka Archdiocese was doing a workshop at the hospital, and generously offered to give us a lift back to town yesterday. It's good to be in the city again.

I've been writing a kind of diary on our laptop in the evenings - it's always a bit frantic because we only have mains electricity for 2 hours on alternate evenings, so it's a bit of a race against time to get the day's events down before the battery goes. There is a strange comfort to be had in cataloguing the small details of your everyday existence, especially when everything is so strange. So, please don't feel any obligation to read it - it's more for me than any of you. (My mother excepted, obviously.)

It was my birthday yesterday - we celebrated on the day with beer and curry, so no different from any other year really. I did however have a more unusual pre-birthday celebration at the convent - the nuns threw a party with coca-cola, cake and traditional Zambian dancing (see photo). They are trying very hard to make us feel at home, and it is hard not to be won over by all their goodwill.

And now some edited highlights from the bush diary:

4th March 2006

The day starts at 7. All the other volunteers are heading to their placements today, so we say goodbye and wish each other good luck. Another goodbye so soon after the last round at home.

Sister Valeria arrives just before Bernadette, Joost, Chas and I head off for last minute shopping. She’s in a fancy Landcruiser, and we are all quietly pleased – a comfortable journey ahead. We head to the mall for last minute supplies and I spend 10 minutes frantically e-mailing a sequence of nonsensical typos home.

We get back to the Commonwealth Centre and pack our stuff in a rush, and return downstairs. There’s no driver. Sister V doesn’t know where he is. Eventually it emerges that he’d arrived at the neighbouring church (some 100 metres from where we are) and couldn’t find us so he drove back to a convent 20km away. He returns, but not in the fancy 4WD – some battered old ambulance with a wooden bench in the back. We climb in resignedly, surrounded by piles of shopping bags.

We crawl into central Lusaka – the Saturday traffic is the worst I’ve seen so far. After a confusing stop at the post office, we arrive at Kamwala market. It’s great – a muddy warren of stalls and shops. We busy some pots and Sister V does some hard bargaining for us for some wooden spoons. We then get back in the ambulance and crawl up Cairo Road. My bum is aching already and we’re not out of Lusaka yet.
Another stop for petrol, then one for Sister V to buy bread for the patients. We get greasy cheese toasties from a café that looks like it might be a place of ill repute.

Back in the van again, and we head out on the Great East Road. Everything is green when we get out of the city. I try to imagine what it will look like after the rains have gone. We head into the Zambezi Valley, and the surrounding land becomes more hilly. The driver points out the roof of Chief Mpanshya’s palace (the head of the local kingdom).

Eventually we turn off onto a gravel road and ascend 6km to the hospital. It seems to go on and on. Having dozed and stared blankly out of the window for most of the trip, I now feel suddenly anxious. What on earth are we doing here? We reach the hospital gate and it looks nice – tidy low buildings, a mural saying “We Treat, Jesus Heals”. We get out of the van and stretch. Sister Sabina is there to greet us. She smiles and shakes our hands. Sister V explains about the mix up with the driver earlier. Sister S: “Ah but there is always something with Mr Banda. If he had just gone in the church and prayed he would have found you”. We laugh, relieved that our new boss cracks jokes, even if it is at Mr Banda’s expense.

We are taken to out new houses. Both are nice, but we get one that is obviously much bigger. The doctor’s house I suppose. Chas looks pleased but I am just worrying that the magnitude of the house reflects the size of the expectations of their new doctor. Sister S shows us round – there is a wood burning stove (“So old we say that Adam and Eve must have left us it!” – the jokes keep coming).

Dinner at the convent – I am working myself up to explain that I don’t eat meat, but I find out that Maggie, the Polish hospice nurse is vegetarian. I am relieved that I don’t have to explain myself elaborately. Thanks for our meal is given in song, and the four newcomers fail to cross themselves at the conclusion. We sit and eat, and Sister S details her grand plans for us. She has many fundraising projects in mind for Chas, but Joost seems to be getting the worst deal – the hospice roof needs to be completed within the next 2 weeks, and she is expecting him to sort it all out. She tries to reassure me about what I will be doing. I realise that despite my attempts to project an air of polite bonhomie, I must look terrified. The evening finishes with an invitation to church in the morning – an offer we can’t refuse.

We go home and have a half-hearted game of travel Scrabble with double measures of duty free whisky. Chas has insects dropping in his hair. He eventually can’t stand it any more, and the game is abandoned. We find BBC World Service on our radio, loud and clear, and are very happy. We can do this, maybe.

5th March 2006.

We wake early and spend some time trying to switch on the gas stove. No success. The first of many domestic technical problems, I’m sure. Maggie comes to get us and we walk to church in the rain. We pass the village market, a row of stalls with a thatched canopy.

Beyond this, we see the church – a surprisingly solid looking red brick building. We shuffle in and choose a pew at the back. The service begins. Father Leschek, the Polish priest gives the sermon in apparently fluent Nyanga. The singing is astonishingly good, but no dancing today – the first Sunday of Lent. People come and go throughout the service. I think there are more than 200 people there.

A member of the congregation gets up to give what I assume to be the intimations. We become aware that everyone has turned round to look at us, and we are asked to come up to the front to be greeted. No choice. We walk to the altar and stand in a line, grinning sheepishly. We are invited to give our names and titles, and I blurt out that I am “an ARV support doctor”, and instantly regret it. (Maggie tells me that no one could hear what I said later.)

The choir begin to sing “Muli Bwanje” and the whole congregation comes forward to shake our hands. The men first, who look straight at us and smile, then the women, who are mostly reluctant to make eye contact. And the children, stretching up for a handshake with each of us. This lasts about five minutes, I think. This could be the oddest experience of my life so far, but it would be impossible not to be moved by the welcome of all these people in this small church. Even if you are a cynical backsliding Presbyterian…

6th March 2006

Sister Sabina comes to the house first thing, with Joost and Bernadette trailing behind her. She sits down with all of us and outlines her plans for us. Joost is assigned a major construction project, including the building of a computer centre and a nursing school. Chas is to find finance for all these schemes, and arrange a satellite internet connection at the request of a Swiss doctor who is coming to work here at some nebulous point in the future. I am required to do nothing but strut around the wards in the manner of a doctor, laying my hands on the suffering poor of the parish. I think she thinks I am going to run if she asks any more of me.

Then the tour of the hospital. The four of us are marched through the wards and introduced to patients. I can’t imagine what they are thinking of us, a gaggle of mzungus smiling and nodding nervously. My worst fears are not confirmed however – the hospital is less than half full, and there is a definite absence of festering wounds, wailing patients and all the other 10 o’ clock news horrors that I had imagined there might be. Chas reckons Sister S had thrown all the sick ones out in advance of our visit.

The buildings seem to go on forever – we are taken to see the new hospice building which Joost is charged with completing within the next 2 weeks. It’s not looking hopeful – there is no sign of a roof and even to my untutored eye, the walls look a bit wonky. I begin to feel that I might have the easy option here.

We go by the baby clinic, and there is a queue of women standing outside with children on their backs. They are here for the babies to be vaccinated. Some of them have probably walked for an hour or more to be there. I think of all those long consultations with anxious parents back home, trying to convince them about MMR safety. The women here need no such persuasion.

In the afternoon, we visit the hospital workers’ homes, and some poor woman who had given birth the day before is obliged to invite us in to her tiny house. More smiling and nodding from us as Sister pinches the baby’s cheek approvingly, and then onto the next attraction – the Mpanshya police station. I can’t imagine what the local constabulary do all day, but Sister is very keen that we inspect the cell at the side of the police house. A cursory glance over the police record book reveals that a third of detainees manage to escape lawful custody.

After a visit to the boreholes and the mission farm, the tour is over. I think we are all taken aback at the scale of the hospital. We cook by candlelight as the generator doesn’t come on until 8 on Mondays. I suspect this is the end of the induction period now.

Friday 10th March

The end of the first week. We are still here. It has been an interesting time. I am trying not to think about the remaining 51 weeks to which we have committed ourselves. I am thinking in little units of time, because being here for the long haul just seems too hard at the moment.

As we thought, the induction period was notable only for its brevity, and the real work started on Tuesday. It’s not the staff’s fault, everyone on the wards is incredibly busy, and there’s no time for extended welcoming and orientation. So, we are getting on with it, as much as our pigeon Nyanga will allow.

I am rapidly acquiring expertise in the management of malaria (number of cases seen in last 8 years: 2; number of cases seen in last 4 days: possibly 30). Until now, the nursing staff have been managing all these patients with the aid of the clinical officer. I’m not sure what I can add to all their skills, but the nurses are being polite and kind despite my constant indecisiveness. I think it’s probably a relief to pass ultimate responsibility on to someone else. There have been several moments this week when the extreme desirability of being able to pass the buck has occurred to me as well.

The HIV work is less of an issue than the general management of the hospital at the moment, but I think I will be able to become more involved in this. Maggie runs the hospice and the ARV clinic, and has plans for an outreach service, if the funding for a 4WD comes through. The clinic is a bit low tech for my liking, even as a GP with Luddite tendencies – no chest X-rays, CD4 counts or even basic biochemistry, the things I would consider the bare minimum in order to prescribe safely. But seeing the condition of the hospice patients who are not receiving treatment, perhaps some calculated risk taking is necessary. I’m not sure.

Chas is having a more leisurely week – he’s been thinking and writing for most of the time. Sister Sabina has set him his first task – to apply to the World Bank for funding. The woman is not lacking in ambition. As Chas said, she’ll have him ringing up Kofi Annan next.

We really need to make some contact with the outside world soon. The promised trip to Lusaka did not materialise this week, so we’re hoping to travel there on Wednesday. I have had moments of feeling like a hostage this week – we are completely reliant on hospital transport in order to come and go here. And I think that the sisters will prefer that we are here rather than larging it in Lusaka. Some assertiveness may be called for.

Anyway, there are some treats to be had here – we had banana cake from Maggie tonight, followed by watching the first episode of Shameless on the laptop (thank you, thank you, Simon). Maybe not one to share with the nuns though.

Sunday 12th March

It’s Sunday afternoon and we’re just back from a rather sweaty cycle along the road to Rufunsa. In retrospect, it was a bit daft to go out on our bikes in the middle of the day, but it did feel good to escape Mpanshya mission and do a little exploring. The VSO issue bikes have no gears, so next time you see me I may be endowed with thighs that would put Kelly Holmes to shame.

There is now a serious thunderstorm going on outside, and Chas is getting panicky about the house flooding. (As much as he ever panics about anything.)

It’s been a nice weekend – after a cursory ward round on Saturday morning, we went for a walk with Bernadette, Joost and Maggie. The area around here is quite hilly, and everything is so green at the moment; it was the first time since getting here I felt really happy about my new home. My inner hippy was clearly needing a bit of tree hugging time.

We also discovered the local off licence – a concrete shack with a pool table and about 12 blokes crammed around it, in varying stages of inebriation. The local market is full of men weaving uncertainly by late Saturday afternoon – we’re a long way from the Gallowgate, but it does feel strangely familiar here. Anyway, it was a huge relief to be able to source Mosi beer here, as we were down to our last bottle with no prospect of more supplies until we go back to Lusaka.

The beer situation was not the only emergency I had to contend with yesterday – I got called over to the hospital in the evening to see someone who had been in an RTA. Grabbing my auroscope (still not sure why – in case the casualty had an ear wax problem in addition to his multiple fractures? More likely because arriving on the ward with some fancy kit might give people the impression that I’m a real doctor) I went over, dreading what I might be about to find.

I came in to find Runa, one of the European nurses capably stitching up an enormous head wound. She had called me for a second opinion on the nasty looking crush injury he had sustained to his left lower leg, suggesting we might do a fasciotomy to prevent him from developing compartment syndrome. Huh? I was not expecting this. At no time during my preparation for coming here had I considered that there might be Swiss nurses who would be infinitely more competent than me. I had nothing useful to suggest – well, nothing that she hadn’t thought of already. I am glad for the patient that he is being looked after by someone who knows what they’re doing, but I feel completely incompetent. I left her to get on with it, although not before I had managed to get my left foot liberally doused in the patient’s blood, just in case anyone in the room hadn’t noticed that the new doctor is a klutz.

And this is the problem I have here. The hospital has been functioning without medical supervision for almost 2 years now. I don’t know what I can do here that the staff aren’t doing very effectively already. I think they had hoped that they would get a doctor who was a bit more handy with a scalpel than I am. In my arrogance, I had thought I would be overburdened with demands for my care here; perhaps the reality is that they don’t really need me at all.

Tuesday 14th March

Half an hour to go until my birthday party – I think the instigator (Maggie) had intended it to be a surprise, but Sister Sabina collared me outside the hospice today to tell me of the plans. So, we’re off to the convent this evening for a celebration. I don’t know what to expect (party hats over wimples maybe? I can only hope) but it’s a nice gesture, if a slightly embarrassing one. I will try and obtain photographic evidence of what ensues.

My first day of manning the ARV clinic today – six solid hours of people coming and going in various stages of ill health. People travel for miles on foot to come to the clinic, and sit outside the tiny room on plastic chairs until they are seen. No one grumbles about the wait. One woman brought me an outsize cucumber as a thank you for her medicine. Some people look fantastic – the ones who have been on therapy for 6 months or more – but others look like thin limbed children, with their eyes sunken deep into their skulls. They know that this is the last chance, and they put up with the horrible side effects that the crap drugs we have here bring them. I desperately want to get this right, and I am not sure if I am doing everything that I should be.

Ok, it's 7 o' clock - time to go.

One week on.

2006-03-03T06:34:00.000Z

We've been here in Lusaka for 6 days now, and this is the first time I've got around to sitting down to post something. It's been a busy time, and I'm not sure if I can really communicate the experience of being here in any kind of adequate way. Admittedly that may be partly due to a red wine-related fuzzy head this morning, but I'll have a go.

Three things I have learned this week:

I got my first paycheque this week for Kw 1, 700, 000. One of the other volunteers told me that when Zambia first had its own currency in 1967, you could buy a pound for Kw 1.60. Now you need Kw 5,900. If you know nothing else about modern Zambia, I think that alone probably gives you an idea of what's going on here.

Another thing that has amazed us is that Chas's surname is much admired here. We went to immigration this week and the official who was stamping his identity card said "Gay - what a beautiful name, you must be smiling always".

Disappointingly, Powerpoint has reached Zambia. The VSO staff are definitely in their first flush of love with this technology, although the presenter generally favours having a minion to press the button for the next slide rather than doing it themselves. So, during most presentations, there doesn't appear to be any obvious relationship between what is being said and the current slide. Not for the first time, I am feeling a profound sense of nostalgia for flipchart.

Anyway, time to go now. Ssiter Valeria is waiting for us with her big truck to whisk us of to Mpanshya. I've no idea what will greet us there, but I'm excited in a masochistic kind of way. I hope to be in Lusaka nesxt week, so I'll update you then.

2006-02-21T21:00:00.000Z

Safety First.

So. We leave for Zambia on Friday. It's been an odd week so far, and I think it may get stranger over the next couple of days. I know that I really have to get organised, but I keep thinking that maybe I should go and watch German arthouse films, or drink overpriced cocktails, or do any of the things that I won't be able to do for the next 12 months. Then again, I'll probably regret squandering this time when I'm stranded in Mpanshya with no knickers left, so I'd better get on with it.

I'm not decisive at the best of times, but I'm finding the process of working out what to take really tricky. Clearly the crash helmets will be coming with us (if only because we both look so darn sexy in them). I've been told that skirts have to be below the knee for work, so I spent ages today trying on various clothes in front of a mirror to assess whether they concealed my tibial tubercles adequately. I've also managed to waste several hours fiddling with my i-Pod, just to make sure that no essential tune is left behind.

So, I'm doing a good job of being busy without actually achieving much, and it's all a wonderful distraction from the scary stuff (i.e. leaving everyone here and going to a strange country where people may have inflated expectations of our limited abilities). But let's not talk about that. Must go and sort through my socks...