Update

Despite a rather frustrating couple of weeks with multiple vehicle set-backs and delays, we’re continuing to very much enjoy our time in Zambia and can’t quite believe we’ll be home in less than 6 weeks!

All going well, we should be back out in the villages with a fully-functional Land Rover at the end of next week, and just squeeze in 4 more sets of clinics before we leave.  We’re both desperate to get out and see more patients, partly because we get a bit bored stuck in Livingstone, but mostly because we know there are so many patients out there to be seen.  But we’re managing to make the most of our time in town and are getting stuck into the ‘charity development’ side of things.  Once you dig beneath the surface of somewhere like this it’s amazing how many other charities and NGOs are quietly working away.  There’s some definitely possibilities for future partnerships which is really exciting.

After having three other UK volunteers here in Zambia with us over the past couple of months, we waved goodbye to the last one on Monday.  So it’s just me and Dave for the next four weeks, before we’re joined for our final week by three other doctors who will take over the clinics once we’re gone.

It definitely feels like we’ve entered the final phase of our trip and we’re really starting to look forward to coming home.  But when we think that we’ve got as long left here in Zambia as we had on the cruise ship or in Kosovo, we know our adventures are not over yet.

Malnutriton

Working in rural Africa is more similar to working in Manchester than you might think.  Getting out of bed in the morning is still difficult.  My morning coffee may be made on a charcoal fire, but it’s still an important stage of waking up.  And I still send more time than is necessary figuring out how long the queue of patients is and when I can go home.

The standard of medicine we can deliver is quite basic.  We see about 90 – 120 patients between the three of us per day, which means that time with each one is very limited. Not only do we have to see the patient, but we have to run our own basic laboratory, dispense our own medicines, and attempt to teach the health workers who translate for us.  The story we get from our patients is translated from the local language (Tonga), and we often struggle to get a good description of what’s going on.  Added to that the fact that many of the problems are either un-curable or unfathomable, and the work can be quite frustrating.  But occasionally, something good happens...

It was fair to say that the trip to Manyumunyamu (no, we can’t pronounce it either!) was the toughest so far.  After roughly double the two hour estimated journey time, we arrived at about 9pm, shattered, hungry and worried that we’d done some serious damage to our car (it turns out we actually had, but that’s another story).  The following day began fairly normally, lots of patients, lots of coughs and colds.  Just before lunch a young mum sat down in front of me.  She could only be 15 or 16 years old and was clearly very shy.  As per tradition she had her child strapped to her back and I could see very little when she sat down on the rickety school table.

“Ndipenzizi” I exclaimed (my Tongan “What can I help you with?” is still atrocious and despite my best efforts is still translated by my slightly embarrassed translator).

“Eyes” was the response.

My heart sinks a little, I spent so long in the UK being taught to use open questions and to let the patient tell the story.  Here in Zambia, almost all answers are given as a single word, often completely unrelated to any form of discernible ailment.

“And what is the problem with the eyes?”

After much delay and several sentences exchanged I get the answer “water” from my translator.

All the conversational subtly we normally use at home is lost here and there is little point in using my eyes to tell the translator and/or patient that I’m not impressed with their descriptive efforts. I’m tired and worried that the queue is still lengthy.

“Ok then, let’s have a look” I announce cheerfully and signal for mum to unwrap the child from the cloth baby-carrier on her back.

Gradually and carefully she un-wraps a tiny package of humanity.  The child’s huge bulging eyes gaze around the room from its tiny fragile body.  It’s like watching a Tearfund advert – but somehow it’s in the same room as me.  I double and triple check the child age but it’s obvious that the child is far smaller than it should be.  Its wispy hair and dry skin betray the severe malnutrition that is obviously affecting this child.

We aren’t really set up for this sort of thing but we did what we could.  We weighed the child and confirmed what we knew.  We discussed the problem with the mother.  Breast-feeding is not going well but for some reason (?cultural ?family pride ?money), and no-one seems willing to try anything else.  I spent some time explaining the problems and feeding options to the mother, but she looks at me helplessly and hopelessly.  I give her a multi-vitamin solution and tell her to come and see me when I return next month.  Somewhat disappointingly they leave and we both know that not much can or will change.

The next month, we returned to Manyamunyamu.  The child has never really left my mind since he was brought into the classroom a month ago.  Over the past months we’d made some enquires and established where the nearest feeding centre was and how to get referred there.  

Thankfully the queue is not as long this month, but the young girl and the tiny child are nowhere to be seen.  At lunch, I walk around to try and find her – but no luck.  I find the local health co-ordinator and explain who I’m looking for.  He doesn’t recognise the name but says he’ll ask around.  We can say what we like about Africa and the many many short-comings that blight the continent, but when it comes to mobilising a community – they are second to none!  Within about 20 minutes, word has gone around that we are looking for the child.  Despite having entirely and spectacularly mis-spelt both the first and second names (I blame their pronunciation!), somebody recognises the description.  They confirm that they are not here and don’t think that they’re coming.

So what happens next?  Before I knew it, about seven of us were in the Land Rover – and driving into the bush to find her!  We are miles off any map and driving along footpaths and across fields, but our guides were confident they knew where she would be.  Sure enough, we arrive at a small gathering of mud huts in the middle of nowhere.  We are greeted by bemused but welcoming looks.  The community leaders and health workers start making more enquires and after another 10 or 15 minutes the young girl and the tiny baby appear.

The child looks remarkably cheerful if slightly skinnier than last time I saw him.  There is no messing around this month.  We speak directly with the village leader and explain that if the child doesn’t go to hospital it is likely that he will die.  

On our arrival back in Livingstone later that week, I phoned the community health worker to ask about the baby.  I’m relieved to report that the day after our visit, the mother and the child were admitted to The Zimba Hospitals Severe Malnutrition Unit and initiated on a feeding programme.  Whilst we can’t be certain, there’s a good chance he’ll make a full recovery.

The sad thing is that this isn’t famine-affected West Africa, or an expensive incurable problem.  This is simple stuff.  The government has set up numerous State-run malnutrition/feeding centres. All that needs to happen is that someone needs to notice when a child is malnourished, and then someone needs to get the child to a facility.  Somehow, these tasks which seem so obvious and basic to us, are large and more difficult here.  The roads are a huge part of it, and exactly why we go out to the villages we do, because healthcare there is so lacking.  The poverty and complete absence of spare money also makes it difficult.

Luckily for this little boy, his condition was recognised early enough and he was taken to get help.  We hopeful that the local volunteer health workers will have learnt from what happened to this boy, and will know what to do next time they see a similar case.

Ups and Downs

The past few weeks have certainly had some ups and downs.  We’re happy to say that we can now look back, feeling very much settled in Zambia, and say the ups definitely outweigh the downs.

We were delighted to be able to have both Dave’s and my parents here in Zambia a couple of weeks ago and had an absolutely fantastic holiday.  After some inevitable flights delays and cancellations, my parents arrived in Livingstone and we very much enjoyed exploring Victoria Falls and the town.  We then travelled to Lusaka in time to meet Dave’s parents and fly with them on to South Luangwa National Park in Central Zambia.  Despite the rather large and intrusive population of frogs, and some large, noisy and slightly scary neighbours (in camp hippos!), we had a wonderful time going out each morning and evening on safari. Amongst the highlights were some very close encounters with a couple of leopards.  The six of us then had a few days on the shores of the beautiful Lake Kariba and enjoyed an educational trip to the Kariba Damn (not surprisingly, I think our parents may have enjoyed this part more than us kids, or, at least more than me anyway!).  My parents then travelled back to the UK while Dave’s parents joined us for a few days in Livingstone.

Not wanting to lay any blame on my in-laws, but this is when our real troubles began…..

I got stopped by the police for dangerous driving and had to pay a large fine (an accusation that, whilst I can’t really contest it, I think was possibly slightly unfair given quality of driving from the other drivers on the road and the state of the roads, but anyway, mustn’t dwell).  I was pleased to get away without a gaol sentence or a criminal record.  In fact, they let Dave sign the ‘ADMISSION OF GUILT’ form on my behalf, so really, we are sharing the blame.

The next obstacle was getting our visas so that we could stay in the country for another three months.  I can barely begin to explain how crazy the whole thing was.  The list of documents that we required for the visa changed every time we went to the immigration office so that we were left with a feeling that a successful application had more to do with begging than with protocol.  Apart from being completely and utterly bewildering, the process was one of the single most stressful experiences in our lives.  It had been going on for the previous 10 weeks, but with only 2 working days left of my visiting visa, I spent the first half of our Lusaka-Livingstone journey coming up with elaborate plans of going and hiding out in Botswana whilst Dave went back to the UK with our  passports to apply for visas from there.  This may seem a little melodramatic, but when our car spectacularly broke down 200km away from Livingstone (and the visa office that we were rushing to get to), it all seemed like it might actually be required.

After a very random set of phone calls which finally put us in touch with a Somalian ex-mechanic, followed by 5 hours on the hard shoulder whilst he removed half of the undercarriage from our car, we were on our way.

The next morning began early with a desperate visit to the immigration office, and I am very very happy to report, we were finally granted our visas!

We then had a fantastic day at Vic Falls, followed by the drink of the year – watching the sunset over the Zambezi.  A perfect end to the holiday, and a great way to make it up to Dave’s parents for wasting a day of their trip on a roadside – thank you again for all your support.

And so our adventure continues.  Together with a new volunteer doctor from Scotland, we set off to the villages to re-start clinics.  Thankfully, after 6 months in a garage and an entire engine rebuild, the On Call Africa landrover was finally ready to drive.  We’ve had an absolutely fantastic couple of weeks of clinics.  Having 3 doctors and a bit more experience (and a vehicle which actually performs better off-road than on), has meant that we’ve been able to see all of the patients every day.

Just as everything seemed to be going to plan…..

Sadly, once again, we found ourselves sitting on the hard shoulder of the Lusaka-Livingstone road awaiting a mechanic.  As we were headed back to Livingstone feeling very pleased with another set of successful clinics, the landrover decided it had done enough.  Once again, some random phone calls (I am really starting to miss the AA), and some negotiations with a minibus driver who was offered to tow us, we finally got through to our landrover mechanic in Livingstone.  To our complete relief, he came straight away with a proper tow bar and took us to the garage, where the landrover still sits, awaiting a prognosis.

Meanwhile mine and Dave’s car sits in our driveway awaiting parts from the UK.

Oh well, at least we have our health….and our visas.