The Cure

Photo of the week

Highlight of the week: Lucy introduces us to her 2 adorable cubs

Lowlight of the week: Electricity issues blight our holiday home for 3 days.

Maximum temperature: 42 degrees Celsius.

Rainfall: More than a smattering. Just enough to quell the dust for a day.

The cure. Not a band from the ‘70s. But an impossible dream for a doctor. Most of us are content to tread the fine line between charlatan and barely good enough. But some doctors dream big. They visualise Pasteur shouting: Get in there; Jenner smugly putting smallpox to bed. Surely we, Valley Docs, can’t aspire to be mentioned in the same breath as these medical giants? But this week we finally found the cure for stroke. Stroke. The scourge of our Zambian home from home. We found a cure for a permanent disability and cause of death. Hold onto your hats. Suspend disbelief. We are about to cure an apoplectic patient.

It’s Wednesday morning. 09:00. Our last proper working day. We are almost done. We arrive at the clinic in good spirits. Demob happy. The clinic looks quiet. Only one patient on the ward. We find Mervis. Today’s clinical officer. And get cracking.

The lady on the ward. What’s going on? I enquire. Mervis fills us in. A 43 year old mother of 4. Ester collapsed this morning. A stroke. Her blood pressure is high. Keith and I silently wince. That unhappy alliance between risk factor and executioner. Exactly what we are trying to prevent. A life-changing event. Another Zambian changed. An active productive member of society, doomed to permanent disability. We assess the damage.

Ester is lying on the bed. Daughter and sister standing by, helpless. Mumbling that Ester can’t walk. Can’t talk. Things don’t look good. Ester’s right arm is lying across her body. Fingers held in an odd position. We tease the story out. When she woke up this morning, she was just fine. Got up. Had breakfast. But then she fell down. We brought her straight to the clinic. Further questions drew a series of blanks. No headache. No chest pain. No fever.

Perhaps Ester might be able to pad out the story? Mwuaka bwanji Ester? We try to engage Ester in the consultation. Lying on her back. Staring up at the ceiling. Speechless. Lights on. Eyes betraying understanding. Ester is unable to vocalise her thoughts. We draw another blank.

This happened last year too. Ester’s daughter volunteers. Our ears prick up. Two strokes under that age of 50? Ester’s sister chimes in about last year’s stroke: It was just the same. Ester was taken to Kamoto. She spent a week there. Treatment. Injections. A full recovery. She was lucky. Those doctors really knew their stuff!

So far we are not a patch on the Kamoto docs. We have no answers. We have pieces of a puzzle that just don’t fit together. Ester is not hot. Her pulse is steady. Breathing fine. Blood pressure barely up. Ester’s face stony. No asymmetry. Yet her eyes follow me. Her right arm and leg stiff. Stock still. Her reflexes fine.

There is a rabbit away. Ester’s stroke should make her limbs floppy on one side. Stiffness might follow a stroke, but not for days. And Ester’s face seems to have got off scot-free. Her having normal reflexes is also left field. Not part of an acute brain attack presentation. My mind is spinning. How does the stroke from last year fit in here? The spinning settles. A jackpot seems close.

Just one test. A bit controversial admittedly. I saw Hugh Laurie do it once on House. Never before performed by a jobbing paediatrician. I reach over and lift Ester’s affected arm. I hold it above her face. I let it go. The arm stays up in the air. It does not come crashing down. Ester spares herself a slap in the face. She has failed the test. No other test is needed.

Ester has not had a stroke. Whatever is happening is functional. A conversion disorder. Triggered by acute stress. She is not making it up. But she is not structurally unwell either. A couple of well-aimed questions fill us in. Ester had a fight at home this morning. Fell out with her husband. Then her event paralysed her and all ill feeling was forgot. Functional illness needs no tests. In fact, on the whole, tests fan the flames of your average functional illness. But Keith steps in here. He majors in functional illness. But usually the way that you talk to people about their illness is key. And Keith’s command of Nyanja is sadly lacking. He scrabbles around for a way to allow Ester to get better.

Keith mentions that a trip to the new district hospital would be needed for a scan. The family look at their feet. This is already beyond the family budget. And a brain scan would be 950 Kwacha. A princely sum that would leave the family destitute. All the more reason to avoid investigation. Keith draws on his Tanzanian pharmacopoeia. Injections in Africa are perceived as magic in our experience. Better than witch-doctory. He spies a way to take all of the tension out of Ester’s family, with smoke and mirrors. If Ester doesn’t rally soon her family will be in dire straits. Keith plays his next card. He kneels next to Ester and explains softly that he is going to give a treatment that will help to relax her tight muscles. It will also help with her obvious mental anguish. It will be given as an injection to help it to work faster He conspires to give Ester a big shot of hocus pocus. But only a small dose of diazepam. The question of a possible trip to the big hospital and an expensive investigation is left hanging in the air. Rather like her arm.

Permission granted, we leave Ester to get better.

Almost an hour passes before a wide eyed nurse summons Keith back to the ward. Doctor Keith, I really think you need to see your patient again. Keith braces himself. Schrödinger cat is either dead or alive. He saunters back to the ward. Careful not to betray his uncertainty with a dash.

He is greeted by a smiling Ester. Sat on the edge of the bed. Chatting cordially with her family. Her arm and leg no longer held like spare parts. She jumps to her feet to greet and thank Keith. He does a token GP neurological examination. Ester’s wiring is as good as new. She is evasive about the nitty gritty of the morning. Her distress. Her faulty limbs. Her speechlessness. Consigned to the past. Ester declines to seek further medical support. But instead agrees to seek out her pastor’s counsel. Aware that there are mystical forces behind today’s events.

News of Ester’s miraculous recovery spreads quickly amongst our clinicians. I re-join the throng. Happy faces thank the witch-like doctors. A powerful injection has cured a dreaded ill.

Our smiles belie our elation. We came to Zambia to prevent stroke. Not to cure it. Of course a functional stroke needs no clot buster. No statin. No lengthy physical therapy.  No social support. A functional stroke is a different beast. Not prevented by good blood pressure control or lifestyle. Not linked to glycaemic control or early diagnosis. But one less stroke is one less stroke and we happily take credit. Our stroke prevention and cure programme rocks.

Putting cures to one side, prevention is our main focus. We have recruited 414 people to our stroke prevention programme. 267 newbies this year. We have visited 24 different camps and businesses. We have emphasised lifestyle options. Mediated via short Nyanja video clips.  Provided medication. Support. What’s more, Keith has developed a new hypertension and diabetes service at the Kakumbi clinic. After 10 weeks of support and guidance, the new service is now running independent of us. Every Tuesday and Thursday afternoon. So far, 227 people with hypertension, diabetes, or both, are now receiving evidence-based care and low dose medications. Forty percent are already at their target blood pressure. The staff are all singing from the same hymn sheet. They even chant the low salt mantra.

Our lifestyle memes are propagating elsewhere too. Chawesi our Environmental Health lead champions 10 women’s football teams. She smiles quizzically as we meet her, to hand over footballs donated by our longest serving friends Caro and Chris. What do you think about my new waistline Doctor Keith? I’m doing that 16 hour fast thing. There is a familiar pose struck: She stands side on. This is now a better side, don’t you think Doctor Keith? She quips. We get that same gesture, and bid for approval, at each of the camps that we revisit. Heart-warming. Belly shrinking. Stroke avoiding.

Our erstwhile 3 month line of 24/7 duty, now extends to 365.25 days a year. Keith has rashly handed out his WhatsApp line to all of our stroke programme participants and most of our BP and diabetes clinic flock. Your generous donations allow us to pay clinic staff to work extra time. Low dose medications not only please our patients, but they also ensure that meagre government supplies are eked out. Your donations provide a couple of additional low dose medications. This means that we can even bring down super-high blood pressures. Our partnership with the local Konzani pharmacy keeps programme costs down. Low BPs. Low side effects. Low costs. Happy patients. Happy clinicians. Happy donors.

Of course we don’t ignore the strokes that have already gotten past us. Those whose brains have already been attacked are the most at risk of another stroke. Where quality of life is worth the effort, our programme provides a statin and aspirin. Interestingly atrial fibrillation is not a thing here. A bag of donated Direct Oral Anticoagulants has finally found a new home. Karen and Alan’s clinic incinerator has removed them from the playlist.

Wherever we look we find the non-communicable fruits of lifestyles that have been nudged in the wrong direction. Forty percent of over 40s in our Zambian community have high BP. A new epidemic of type 2 diabetes is also sweeping across Africa. Championed by sloth and excess. But education, choice and some low dose drugs can stop the rot. I can see a learned paper coming to a medical journal soon. Your virtual doormat has been warned.

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

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