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.

Driving in the African Bush – What we’ve Learnt

1.       Driving in Sand – don’t accelerate too hard, don’t expect the steering wheel to do anything when you turn it. But whatever you do, don’t stop

2.       Driving in Mud – accelerate hard. If you stop – you/your wife will probably have to get out and push.  If you feel yourself sinking, be prepared for your wife to shout ‘keep going’ continuously whether it’s helpful or not.

3.       Driving over  small rocks – go slow.

4.       Driving over large rocks – go very slow (especially when the car is carrying twice its capacity), and prepare yourself for awful scrape-y noises. And pray that no vital parts fall off the car.

5.       Driving in long grass – have faith and don’t expect to see where you are going. The long grass may be taller than the car, but it’s generally safe. Don’t be surprised the ‘road’ looks suspiciously like a field.

6.       Driving through rivers – pray

7.       Driving through puddles – attempt to distinguish the difference between a puddle and deep hole. This is usually impossible.

8.       Driving around potholes – dodge, duck, dive, dip and dodge. Don’t hip them at high speed – bits will fall off your car.

9.       Changing a tire on a mud track – put a rock under the jack, or you can expect the jack to impact the floor more than the car!

10.   Driving past pedestrians – wave at anything that moves – they love it and new friends may come in handy when pushing is required!

11.   Driving over snakes – despite being strongly encouraged by locals to mow down the ‘spitting cobra’ in the road, we would advise keeping your distance

Additional – if you end up driving at dark, it can be difficult to distinguish between rocks/sand/mud/rivers, so apply all the above rules simultaneously. Good Luck.

The First Clinic

We were awoken at 6am by a juvenile cough outside the window, and suddenly the whole thing became a bit more real. We’re not sure when they got there or how far they had travelled, but it turns out our concerns about the news of On Call Africa’s first clinics of 2012 not reaching the villages was completely unnecessary!

On paper the concept is simple; we put a load of stuff in a car, drive to a school in a rural village and run a medical clinic. In reality, we have spent the last few weeks frantically, trying to figure out what we would need and how we could best survive for four days in the villages. Amongst the vitals were water, food, tents and an enormous pile of medication/medical kit. With the car loaded to bursting and the suspension complaining loudly, we set off. Despite having visited the villages just two weeks ago, the ‘roads’ were worse than we remembered (or maybe it was just that our car weighed about 8 times as much now). Less mud-track, more pile of rocks with a small river running across/through it. Our progress was slow and our beautiful new 4x4 took a good few knocks, but after many hours we made it to the first school. The school building is basically a concrete box with/without windows.  We erected our tents to provide make-shift mosquito nets and settled down for the night. By 7am we had more than enough patients to see us through the day, by 7:30am we were already starting to turn people away.

At 8am, Mattea & I nervously invited the first patients into our ‘ clinic room’ (a couple of classroom desks in the concrete box we had just slept in). The cheerful locals who could speak a bit of English were more than happy to sit with us for the entire day to translate the problems of the locals. Some serious, some trivial, some – we didn’t have a clue! But we did our best to provide advice and treatment for the patients we saw. At 4pm and 80+ patients later, we piled everything back into the car and set off for the next village. After 3-5 hours driving, we arrived, put up the tents, bed down, and start all over again!

The cultural divide is still massive, and the paucity of worldly belonging still astonishing, but we are learning how to bridge the gap. The ‘village people’ as we call them (still makes me smile as I imagine communities made up entirely of men in fireman/lumbarjack outfits!) are genuinely friendly and the Zambian children are a delighted when you wave and say ‘hello’ .  We are concerned that we’re seen as white outsiders that have come to give out free stuff, and this system of reliance is not helpful – but we’re doing are best to try and balance this with education and helping them to help themselves.

After 3 nights in the bush we returned to the luxury of Livingstone. We were shattered, smelly and desperate for a cold beer, but we are genuinely delighted with how the first week had gone. We have a few nights in Livingstone to get everything cleaned/sorted and re-packed – on Sunday we’re off again!

It's Good to be Home!

Ok, so it’s not quite like being back in the UK, but we’ve finally settled in our new house in Livingstone after 6 weeks of living out of suitcases and moving every few days.  During our time with PEPAIDS, we were based in the small town of Mazabuka with several visits to Zambia’s capital Lusaka.  And then of course there was my flying visit back to the UK for my job interview.  In case you haven’t heard, we got the news through at the end of last week that I was successful in getting a job in Public Health, a huge blessing, so I will start that on our return to the UK in August. 

We got the keys to our new house yesterday and spent the day walking round turning on taps and lights, amazed that water appeared and the lights came on!  Needless to say, we are literally overjoyed to be in a place we can really call home.  Up until now, we’ve been frequenting some of the cheapest guesthouses that Zambia has to offer.  Whilst we’ve both seen worse during our younger backpacking years, there were times over the past few weeks where it’s all seemed too much - mostly on the very hot days where we’ve sat sweating profusely trying to work on over-heating laptops without any form of cooling device, no running water and spiders lurking behind every door.

The first place we stayed was potentially the best, but it knew it, and so charged double what anywhere else was charging.  After a couple of nights in their cheapest rooms, having to trek across the lobby to the bathroom (the lobby was always crowded with the managers and their friends watching TV at top volume, all hours of day and night), we decided we could do better for cheaper.

So we packed up and moved down the road.  For the first few hours, all seemed well.  They had agreed (after some persuasion) that we could use their kitchen to cook in because there were almost no eating-out options in Mazabuka, and we had an en-suite, all for a fraction of the price.  Unfortunately, as the heat of the day developed and we realised there was no fan, we started to feel a little less smug.  But at least we could have a cold shower to cool down.  In fact, a cold shower was all we could have.  Whilst the guest house itself had hot water, for some reason it wasn’t connected up to the hot tap in our room.  That evening, we attempted to use their kitchen.  It turns out they really didn’t want us to use it.  On discovering it was locked (with all our food in the fridge), we enquired and were told the man who had the key was no longer on site.  After a day or so of bugging them, we were finally given almost free access to the kitchen.  But we soon realised we wouldn’t be cooking any gourmet dinners in there.  The whole place was crawling with bugs and looked like it had NEVER been cleaned.  But we’d got a special deal by paying for a whole week so we were kind of stuck there.

Zambian guesthouses seem to have a strange habit of encouraging/employing 5-7 people whose main occupation is to talk loudly outside the guests’ window/door. This complimentary service is provided 24 hours a day, but is especially vocal between the hours of midnight – 2am and then again between 5-7am. That is, all except guest house number 3….

Once the week was up in place number 2, we decided to try somewhere new, because you never know.  A little further down the road, we got an en-suite for the same price in a lovely-looking house with a relatively clean kitchen, which we were very much encouraged to use.  They seemed delighted to have us, as if they’d not seen any customers in quite some time.  Once again, we got a good deal by paying for a whole week up front (why don’t we learn!).  The kitchen was great, and they even had a big TV in the communal lounge, which was empty except for us so we had free range of the satellite TV!  Unfortunately, that didn’t really make up for the lack of running water. The plumbing was quite amazing. Most of the day, there was no water, but occasionally, the water pressure would increase and for no apparent reason, water would start seeping/dripping/spraying out of numerous faults in the pipes. These pipes had varying bits of plaster/plastic bag/rope holding them together – but with little or no effect. The quantity of spiders which had taken up refuge in the place was the horrifying, but the deal breaker for guest house number 3 was that there was no security.  In the previous places we’d been kept up half the night with people constantly chatting outside our room and comings and goings.  So we went to bed that night thinking we would have a lovely quiet night’s sleep because the place was deserted, it was just us, or so we thought.  At around 2am, I was woken by hearing something bang in the kitchen.  I lay there for a few minutes, but became convinced that someone was in the house.  I cautiously woke Dave, and told him.  At first he wasn’t convinced but soon there was more banging and then some conversation, whoever was there was not trying to be quiet.  Whilst we were almost certain it was probably one of the owners, we just weren’t sure, and when they tried the door handle of our locked room, we really weren’t convinced.  Any way, after what seemed like an eternity, we heard people leave.  It’s odd how stupid things seem in the light of the day.  I had been convinced that if we had gone out and confronted whoever was there, we would have been attacked by a machete-wielding maniac.  But the next morning, after 3 hours of larium-fuelled nightmare-filled sleep, we couldn’t for the life of us think why we hadn’t just gone out to see who it was.  It turns out that it was of course one of the owners, who had come back drunk after a football match with a girl from a bar.  But every night for the next week I found myself lying awake longing for the comfort of the all-night noise at the other guest houses.

On my return to the UK, Dave made his way down to Monze to work in the local hospital. True to form, he found the cheapest place in town. His first morning in the hospital, he was asked by the local doctor where he was staying. David proudly announced the name of the establishment only to be told ‘Isn’t that where the prostitutes go?’ and ‘Are you paying by the hour?!’ So Dave spent his week hiding in his room in the brothel (or so he tells me).

This weekend we house-sat for some friends in Mazabuka (they daren’t leave the house unoccupied because they’ve been burgled every time they’ve done so in the past, a fact which I’m sure had a big part to play in fuelling my night time fears).  Whilst it was actually quite a lovely weekend and much more homely than the guest houses, we were woken in the middle of Saturday night by a cockroach rustling in our room (of course I was convinced it was the machete-wielding maniac again).  Our attempts to catch it merely resulted in it running under our bed so we decided it could stay there until the morning.  Unfortunately, it somehow decided, and managed, to get inside our mosquito net!  So after more chasing and herding, we finally managed to trap it in a glass and get it out.  All part of the adventure I guess.

I love night time back in the UK, snuggling under a duvet after a warm shower, in the quiet, secure, cockroach-free haven that is our bedroom.  Come August, I hope I appreciate that a bit more.  Until then we have our new Livingstone house, where we have so far slept wonderfully, certainly a home-from-home.

Our work with PEPAIDS has now come to an end and we’ve begun our work with On Call Africa.  We’ve bought a car, moved down to Livingstone and have set the wheels in motion to start clinics in late March.  We have arranged to visit the village ‘headmen’ next week to let them know the dates of the up-coming clinics.  We can’t wait to get started!

Other peoples money

A month into our stay in Zambia and although we feel like we’ve been pretty busy, it’s hard to say what we’ve been doing.

Our grant proposal teaching went pretty well (we think), and we got a grant application in last Friday to the President’s Fund for AIDs relief, so fingers crossed!

Learning how the the charity sector works has been a steep learning curve. Here’s a little summary of our experiences and what we’ve learnt:

Charity work in Africa hasn’t been very successful. People are still poor, often hungry and disease is rife. Charitable organisations of all descriptions (wherever you are) have a major problem. That problem, be it disease, homelessness or drug abuse is a very difficult, complex problem. If it was an easy problem – somebody would have fixed it already. It’s often a very expensive problem – otherwise somebody would have paid to have it fixed already.

Healthcare is expensive and complicated – just ask Andrew Lansley.

Addressing Africa’s healthcare problems is ridiculously complicated – plus the country (by international standards) is skint. The majority of the population are subsistence farmers and pay nearly no tax. I don’t really blame the government for not being able to supply good quality healthcare when they don’t have any income. Except that in fact I do blame them. They have had some tax income and plenty of international donations – and half of it disappears in corruption/waste.

In step, the charities. NGO’s, FBO’s NFP’s, call them what you like. They have spent the past decades seeing their money stolen by corrupt politicians and wasted by well-meaning but sometimes clueless charity workers. They are fed up with not seeing results from their money and have decided on a change of approach. They now want professionally written proposals, audited accounts with detailed plans regarding how their money will be spent. They want guarantees of results and they want evidence of those results.

This is in a back drop of Africa – the continent that makes things up as it goes a long.

All these things are probably a good idea – but it does create a lot of work. As a result half of the locally-based charities no longer exist – but at least they are not wasting money......

Making the charity-sector a bit more professional and a bit more accountable is probably a good thing. However, it has raised questions of our own work. We, together with On Call Africa are being trusted to spend the hard earned cash of our friends and family. It’s quite a responsibility.

Whilst we have been frustrated at several weeks of not getting seeing patients or doing any hands-on work, we have been able to use the time to plan a little better the On Call Africa clinic structures and how we can make  the impact we have on the communities last as long as possible. Our plan isn’t perfect, but it’s pretty good – now we just need to see if it works.....

Matty enjoyed a brief trip home for an interview in the UK this week. It was bit whistle-stop but she returned with cream eggs and pesto – so I think it was worth it. I entertained myself with a few days at Monze Mission Hospital. The hospital was a step up from what we found in Gulu, but only a small step, and a timely reminder of how bad healthcare is for the majority of people here.

We’ve also invested in a car, partly to make getting around a lot easier and a little less scary, but also so we can hopefully get started on clinic’s whilst On Call Africa’s car is still being fixed in the garage.  Next week we move down to Livingstone, ready to start work full-time for On Call Africa.

For those of you outside of the catchment area of the Coventry Evening Telegraph – you might not know – but I’m now a local celebrity! : http://www.coventrytelegraph.net/news/coventry-news/2012/02/14/former-coventry-schoolboy-returns-to-africa-on-medical-mercy-mission-to-help-poor-92746-30324428/