Chepetsani - Reduce (my chance of stroke)

Zambia is under our feet

Highlight of the week: Rabbie Burns is wrong for once: Our best laid plans are unblemished: our permits come through; our kit squares away; our flight is flawless. We reach Mfuwe unscathed.

Lowlight of the week: We say au revoir to friends and family. Until Halloween.

Maximum temperature: 26 degrees Celsius

Rainfall: In Mfuwe? Are you kidding?

Zambia is real again. Tangible. Under our feet. In the air. Hot and dry. We have arrived.

In 4 weeks’ time we will be putting our noses back to the valley doctor grindstone. Committed contractually to stay within half an hour of the national park gate. Tied to our flock, so to speak. On call 24/7. But for now, we have 4 weeks grace. Leeway to do our peripatetic clinics in the bush. Licence to explore.

Our mission, should we accept it, is to root out high blood pressure, diabetes and other health time bombs. Wherever they lurk. Peoples’ place of work is a favourite place to hide. Our flock of safari staff are captive. In their camps 25 days per month. Unable to see us doctors in our normal place of work. Tourist industry work schedules usually preclude anything except for reactive and emergency care. Safari staff have no idea when a time bomb marks them out. Blood pressures stay high. Diabetes stays sweet. As time marches on, some of them stop marching. A stroke here, a heart attack there.

Here in Zambia, high blood pressure and diabetes are offered care when unearthed. But no one really goes looking for it. And when found, treatment is usually only consistent in its inconsistency. We aim to change all of that.

Keith has created a website called: Chepetsani mwai wanga wodwala sitoloko (Reduce my chance of Stroke). A Nyanja version of his original toolkit. Part calculator, part educator. The website aims to do what it says on the tin. It will be our main weapon. But we also need to measure and test our flock. And to support them to choose lifestyle options and medications that are right for them. And to make sure that any medications chosen, stay available to them. The devil is in the detail.

We search for those marks of future ill health. But I suspect we won’t need to look very far. Last year we saw 142 people in safari camps. 39% with high blood pressure. 70% physically unfit (their waist sizes are more than half their height). 6% with diabetes. 15% smokers 14% with suspected sleep apnoea. Plenty of treatable woes.

We won’t need to look far. But we will look far. This year we will be venturing up to 4 hours from the park gate. We aim to see 200 people in this time. To understand their vulnerabilities to future ill health. And to use the new Nyanja website to deliver personal care. 12 people can be seen in a day. So, 16 busy workdays. That might leave us with 14 days latitude. Bearing in mind that we are using a foreign language website, in a world without consistent electricity and that we need the internet to play nicely. What could possibly go wrong?

We will tag peoples’ invisible risk factors. Offer options to tackle their Achilles heels. We will see people, not patients. In the lottery of life, some of these people are marked. Marked for future ill health. We hope to support people, to choose what works for them. To stay people. Not patients. When we find high blood pressure, high cholesterol or big waists, our mission is to help people to know what will work for them to stay well.

The last 2 weeks have been fraught. Preparations for our work shift have appeared chaotic. It’s not quite a standard commute. It’s not just a matter of remembering a pen, a stethoscope and a packed lunch. But closer to planning a moon shot. We shift from one perfect universe to our alternate nirvana. So much to think about, and to do. Two rooms of kit to rationalise into 4 bags. Space and weight at a premium. There are no shops to speak of in Mfuwe. No Amazon delivery. Commit and make do. Ken and Barbie will be dressing for the clinic and the bush.

We have done this commute twice before. But yet we vex. Our bags strain at the seams. We each play 3 vetoes. Excess is jettisoned. But still our bags weigh in at 150 kg.

150 kilograms. That doesn’t quite sound like 2 outfits each. Indeed, we carry several bulky bags of tricks. Kind donations from Dene Healthcare and others. Ways and means to uncover hidden risks for strokes and heart attacks. Blood pressure machines, cholesterol kits and other diagnostic tests.  

You may recall that we started this quest last year. https://keithandginnybirre.wixsite.com/intoafrica/post/faith-and-hope-and-charity The 2024 version has been rather souped up. But before I tell you about that, let me revisit last year’s exploits.

Last year’s programme “Reduce my chance of stroke and heart attack” had rave reviews. Spread over 8 camps. 142 local staff and expats. A routine quickly developed. Our labour divided. Me on tests. Keith sharing decisions. Fine-tuned over the 3 months. Always preceded by a show and tell for the assembled masses. All camp staff. Education. Explanation. Questions. Answers. Everyone knows someone affected by stroke. Colleagues. Friends. Relatives. Neighbours. Common and devastating. All are left with regret. All with a feeling of impotence in its wake. Financial hardship. Loss. But to a man, nobody knew that we could prevent strokes. And few people knew there is a link with high blood pressure, diabetes, smoking and overweight. We had struck a chord.

Our recruitment drive, now straightforward. But our time was short. Remember, this project is our side hustle. Our fourth job. When are you coming to visit my camp? Echoed around the Valley. We quickly learnt to say no. Although we wanted to see everyone, we had too little time, and too compact a range. Limited to the geographical limits of the Valley doctor’s role. Thirty minutes from the gate. But we also said yes. In fact, we said yes too often. As soon as my Diploma in Tropical Medicine and Hygiene was in the bag, we swapped our focus. All of our downtime for a whole month revolved around the programme. We toiled. Afternoons and weekends. Mornings and evenings. But the no’s still outnumber the yes’s.

The show and tell results in a patient line of customers. Not patients. But potential future patients. Our programme lands on fertile ground. Nobody who joins our show and tell opts out. A rare chance to see a doctor. Paperwork first. A consent form, since we offer a change to the status quo. A medical record book. We schedule appointments and work around working duties.

Measurements: Height. Weight. Waist circumference. Blood pressure. Tests: A urine dip. A finger-prick blood cholesterol test. The occasional finger-prick blood glucose. We lug around 25 kg of donated kit. For 2024 Dene Healthcare match last year’s generous donation with 300 more cholesterol test kits and then a whole bunch of other essential diagnostic tools and paraphernalia.

I book our worried well in at 15 minute intervals. But for my tasks, 10 minutes suffices. Then the one true Valley doctor limbers up, ready for action. For there can only be one. Doctor Keith, with his mystical powers, and his mythical website. The doctor will see you now…. Dr Keith and his ward enter the numbers into the computer. A few clicks. A few whirrs. A wheel rotates. Sometimes endlessly. The screen refreshes. And a mini Dr Keith, speaking English, jumps off the screen to share our patients journey with them. Personalised medical fortune telling. In Africa.

2023 sees mini Dr Keith waxing lyrical in English. But for 2024 Dr Keith has a new mini guest star. Perhaps Morgan Freeman has joined the team? Charles is not only a doppelgänger for Morgan Freeman, he is a retired headteacher and a pillar of the community. His new role as poster boy of our Nyanja website puts him onto the small screen. Hollywood and Morgan quake. The Mfuwe community is at our mercy.

But I digress. Back in ’23 the staff wait to see Dr Keith. Keith looks into each person’s crystal ball. And then shares with them: their odds of an untimely future appointment with their maker. He clumsily uses English. His Nyanja rudimentary. His website flawed. Fine in Sunderland and in Yorkshire. But hopelessly English. Keith enters personal numbers. Produces personal results. Offers personal choices. Shares personal options. Drawbacks. Guides and supports. They find priorities. What is doable. What works. Shared decision-making mediated with a Mac in the bush.

Our safari staff choose personal options. Healthy eating. Less salt. Activity. And even medication. But are these choices realistic or even sustainable? A single wave of the magic wand is unlikely to be enough. So, we seek to ensure that their access to medication is unwavering. Be that from clinic or pharmacy. And we offer remote support between continents. Direct access. Email. WhatsApp. Backed up by local clinicians, who now have a plan, and they now have support.

We have had some kind donations from folk who supported our project. Four grand goes a long way in South Luangwa. We have used some of it to guarantee supplies of medicines to hypertensives and diabetics. Of course, pro bono doctors are even more cost effective. But our sustainable master plan needs up-front investment and Keith has already spent our nest egg. Translations and videos. Locally sourced. A modest investment. And now video editing and website construction. Chepetsani takes shape, but the coffers are empty. I attempt to rein Keith in, but he has grandeur in mind.

Our Valley doctor job begins in July. But the project will continue. Afternoons and weekends. We hope for a further 100 recruits. And our 142 from 2023 need reviews. We have local staff to train. Continuity is key. The district health office, and the powers that be, stand behind us. Our aim is to make this sustainable. It should not be just a 2 person show. Shared decision-making our goal. A responsible and sustainable approach to health in the Valley. To reduce the number of people suffering from devastating strokes and heart attacks.

This project has been supported from generous donations from individuals and from Dene Healthcare. The work on the English website has been funded by Keith and me. We seek sponsorship and support for Chepetsani and the Reduce my chance of stroke programme.

Donating to “Reduce Stroke”

Dear supporter,

Thank you very much for considering donating to reducing the chance of heart attacks and strokes in South Luangwa. Project Luangwa has agreed to receive donations for this program and this can be done by bank transfer to UK bank (details below). If you are making a donation to this project, please add the notation Reduce Stroke to the payment, in order to help us track it. If you would also like to send an email to ian.macallan@projectluangwa.org then this will also be very helpful.

Thanks again for your kind support.

Metro UK Bank Account Details

Metro Bank PLC

 Account number: 21201928

 Account Name: Project Luangwa

 Sort code:  23-05-80

 Swift code:  MYMBGB2L

IBAN: GB88MYMB23058021201928

Bank Address:

Metro Bank Plc,

One Southampton Row,

London

WC1B 5HA

Recipient Address in UK:

Project Luangwa

George Fentham Meeting Room

 Marsh Lane

 Solihull

 United Kingdom

 B92 0AH

150kg of luggage. Jonathan kindly packs us in for the ride to the airport. 

Our first animal sighting. He was clearly pleased to see us. 

Home again