Creatures of Habit

New scrubs for a new season

There is something quite comforting about retirement for people like me, who are creatures of habit. Routine is key. Plans vary depending on the weather. But flexibility is vital. Dry days trigger a bike ride or gardening. Wet days set the stage for weather watching, cooking and reading.

Habit is comfortable. Habit and change are not friends. My friend Mike has an approach that might help when it comes to making change happen. Consider. Explore. Do. Mike’s mantra. But habits are habits. Change is not a standard word in my vocabulary. My pledge to spend 30 minutes per day learning Nyanja has come to nothing. I can’t seem to get started. My vow to continue my learning of tropical medicine, with weekly podcasts is still on the back burner. My piano remains dusty. My clarinet reed remains dry. Consider and explore remain my favourite words of 2024.

However, Do was my buzz word for 2021. In 2021 change happened in spades. My old blog chronicles what has been done and changed: https://keithandginnybirre.wixsite.com/intoafrica Momentum takes Keith and I back to our alternate reality. Annually. We leave again for Zambia in June.

Zambian life has a predictability that suits me. The sun will shine. It will be hot. Elephants will come by on a regular basis. The baboons will wake us with their early morning capers on our roof. But this year, I fear, life in Zambia will be harder. For the same reason that our spring has been so miserable here. The weather is all over the place. In Swahili we would call it shagalabagala.

The weather drives the seasons, the behaviour of people and the behaviour of animals. This year Zambia experienced a very dry rainy season. El Nino struck again. It did rain. But not enough. You may remember that last year there was too much rain. It came late and ruined a lot of the crops. This year the rains barely came at all. Once again crops have failed. In February, a national disaster was declared. Officially, there is a drought. The dams are empty. Zambia depends on the dams to power its hydro-electricity programme. Hence, regular power cuts are now the new norm. Climate chaos has ramped up the temperatures. Mid 20s are normal in April, but our Valley is now in the mid 30s. With no electricity for our air-conditioning system, things might get sticky. So much for predictability.

Our good friends, Karen and Alan, are in the valley now. Karen is the Valley doctor. A GP from Glasgow. Alan is an eye doctor. I struggle when writing “ophthalmologist” due to the unpredictability of Ps and Hs. Karen and I were at school together. She was the clever one. We were mostly well behaved. She let me copy her English literature mock “O” level exam answers. My brain couldn’t comprehend the reason to learn Shakespeare speeches off by heart. Our English teacher thought it was important. I still can’t see its relevance as I approach my 58^th birthday. I am not sure it has hindered my life choices. Or my career. I scraped through my English Literature “O” level. With a C grade. Sadly, I was not sat next to Karen in the exam. So, I had to rely on my own limited knowledge. I think Karen got an A.

Now it’s Karen’s chance to copy my work. My blog and our endless enthusiasm eventually wore her down. She has volunteered her literary and medical talents to South Luangwa. Karen and Alan retired from full time work this year and needed a new focus.

Karen and Alan have both worked in Africa before. With fascinating and challenging stints in South Africa and Uganda. Coming to Zambia, they enter the fray eyes wide open. Tricky medicine. Resource constraints. Those things go with the territory. Still, we feel some pressure. We have sold them a life of wild animals. The benefits of a comfortable house. Electricity. Air conditioning. Excellent internet access and easy communication to the outside world. Africa has a habit of taking creature comforts away. Will Karen and Alan hold us accountable for Murphy’s law?

Through the magic of WhatsApp video, we shared a living room with the new Valley doctors last night. They have ventured into the park. The animals are evident. A young male leopard (Lucy’s son – now a year and half of age) posed for Facebook bragging rights. Elephants have graced Alan’s new trail Cam footage. Phew! One job done. Tick.

The medicine is still tricky. How, for example, might we deal with a 22 year old male with unexplained splenomegaly? Bear in mind that our lab can’t even do a full blood count. Answers on a postcard please!

The resources are still meagre. Zambia might just be on the cusp of tackling some of her resource issues. But things are complicated. Some of you will remember that there is now a lovely, spanking new, district hospital near to Mfuwe Airport. 15 miles from our Kakumbi clinic. Built with money on loan from the UK. A beautiful, well designed, fully equipped, state of the art, white elephant. It’s now possible, on a good day, to get a CT scan in the valley. How amazing is that! But last Tuesday was not a good day. The national grid was at a stand-still. A patient was in desperate need of a scan after a stroke. No scan, no transfer. Or so the insurance company stated.

Without electricity the CT scanner is merely a lump of stationary metal. Mysteriously, on Tuesday, there are cool, air conditioned rooms for the hospital management team. Creative minds solve the conundrum. 60 litres of diesel kick a generator into action. The scanner purrs. A wizardly radiographer coaxes pleasing pictures out of his mechanical ward. But what is the catch? Unfortunately, there is no radiologist. Nobody really knows what the pictures show. Furthermore, the disc drive is out of action. There is no way to save the precious images. Fortunately, Karen saves the day with her mobile phone camera. Alan doubles up as a makeshift radiologist. There is a brain he declares.

Two steps forward. One step back. A theme develops. Karen and Alan love their comfortable house. But frequent power cuts have made the air conditioning an elusive dream. Tropical heat and prolonged power cuts challenge our Kapani generator. Karen tells us that power typically goes off the moment she gets home from work at 12:30. Tired, hot and exhausted. Just as the kettle goes on and the toast pops down. The gentle drone of the generator dies. The kettle and toaster pack in. Adding insult to injury, the air conditioning stops. Cold lunch. Hot head.

Cushy lives in the tropics rely on creature comforts. As the power goes down, so does Karen’s connection with the outside world. Our call last night was made using a solar power device. But the call quality was dire. Currently the hardships outweigh the upsides. The scales seem unfairly balanced. Someone is loading the dice.

We travel to Zambia in 4 weeks time. We take over from Karen and Alan mid-July. 3 months of valley doctor work will pin us down to our usual stomping ground. Kakumbi clinic. Kapani lodge (our second home). Anywhere within an hour of the park gate. We hope to review our challenging patients from last year. Joseph the fisherman, our crocodile bite victim, who remains elusive for now. We will also keep our eyes peeled for Precious, with her miraculously fixed heart.

After our stint finishes, we have a holiday planned. Our old time buddies, Caroline and Chris, are coming over from Australia. We used to holiday with them in the 90’s. Well, we gate-crashed their honeymoon in Crete to be honest. We also subjected them to a camping trip in Arran. So we have already jointly survived unbearable heat and midge hell. Ideal preparation for a Zambian camping trip in October. Roof tents. 4 wheel drive. A secret recipe for chaos.

Our 11 months back in the UK have been crammed with busyness. Happily, I passed my Diploma in Tropical Medicine and Hygiene. That gives me 5 more letters after my name. But I still lag behind Keith. I spent a week as a volunteer teacher in Vietnam. Teaching medical staff how to teach. Newborns Vietnam are a charity dedicated to improving care to newborns. A challenging but rewarding week. Teaching through interpreters is not something that I am totally new to. But it still stretches me. I speak far too quickly. So, I slowed down. A huge learning curve. And I’m still working on it. After the teaching week Keith and I had an adventure in the wilds of Northern Vietnam. By car and foot mostly. I started to believe that we might not even get on a bike for our whole 3 week trip. But two rickety, Chinese made bikes, played a cameo on day 18. 2025 promises to entice me back to Ho Chi Minh and Hue for more slow teaching.

Keith has another string to add to our bow this year. He has posted a new edition of our training manual for health care workers in low and middle income countries. https://diagnosisandtreatment.org is available as a free pdf to use in clinics, free from Wi-Fi. It can be used as a reference manual or a study guide. It’s another publication from Kwetu, North Yorkshire, that aims to do what it says on the tin.

In our new blog we look forward to regaling you with stories of our forthcoming adventures. Please bear with us if we don’t manage to get a post out by 9am on a Saturday morning. My sister, Sam, uses this as a sign of life. By 09:01 we get a message from her: Are you OK? Perhaps we don’t respond because of a Zambian mishap (negative or positive). The messages become more frantic: “What’s going on guys?”  But her motive is only now made clear. Sam likes to read the blog with her Saturday morning cup of coffee. “How dare you post it late.” Erratic electricity and dodgy internet permitting. We will write most weeks. Share our tribulations and our triumphs. And perhaps entertain. 

Karen and Alan in the valley