Transition

Photo of the week: Welcome to Mfuwe International Airport

Highlight of the week: We reach the Valley.

Lowlight of the week: We get tangoed. The orange man interferes with our travel plans.

Maximum temperature: UK 29 degrees Celsius; Zambia 28 degrees Celsius

Rainfall: UK lots; Zambia nil

Paediatrics is a unique specialty. We are the only specialty which can guarantee that we will never see our patients again once they come of age. But the age of transfer is a moot point. Something I have battled with for most of my career. When does a child become an adult? Ideally, we should start to treat our patients differently from the age of 12. The focus shifts from the parent to the young person. Transition is the buzz word. Smooth transition the holy grail. That depends on advance planning, support and sheer will power.

I have just survived transition. Moved from a position of comfort and certainty. Not quite into the unknown. But certainty is now beyond my reach. Our life in the UK is relatively easy. A beautiful house. A certain rhythm beats. Our lives are sweet. Control in reach. When things go wrong, we can sort them out. Get them fixed. Friends and culture never far away. Holidays punctuate our domestic bliss. But the idyll has now been shattered. Our transition has been daunting. Not a well-worn path. Fraught.

Our advance planning for transition started 4 months ago when we booked our flights. Our first 3 weeks in South Luangwa are mapped out. Luckily, the doctor house is free. Andre, the incumbent doc, has family staying and has rented a bigger house. This means that we can move into the doc house straight away. We have a day to make home. And then 3 weeks of travelling north and south. Keith has us booked into 5 camps so far. Another 2 are in the pipeline. Word has spread of our occupational health screening programme. We look forward to visiting some new camps. And a couple of old ones. Our course through to the rather adult world of South Luangwa seems navigable. We follow a mixture of best laid plans and instinct. Transition is the game.

We start to gather our belongings to pack 4 weeks back. Our tea-point – don’t ask! - starting to fill with all sorts of exciting things. Medical equipment. Drugs. Supplies. And some essential food items. The first suitcase fills quickly. Weighing in at 32 kilos. Three other cases lie half-packed. And then realisation dawns: space is not a vacuum after all. We’re gonna need a bigger bag.

Saved by Mister Amazon, we breathe again. Incredibly the new bag has breathing space, despite holding the permitted 32 kilos. We christen the new bag: The black hole. The existence of black holes creates more existential debate: How is it possible that we seem to take more luggage to Zambia each year? Theoretical physics would have us believe that we should need less matter in the near-Earth orbit that arcs from Manchester to Mfuwe. We leave kit out there. Take less clothes. Try to travel light.

But Keith abhors a vacuum. He fills the black hole with nuts, seeds, Parmesan and dark chocolate. I sneak in some secret whisky. We approach a critical mass. We fear nuclear fission. But con-fusion drives our transition. Will mass be ejected or attracted? Our baggage limit is precariously close to the threshold.

We have a busy final week. Lining up our ducks in a row: A long line peppers the sky:

• A last trip to York;
  • We find clothes that we can’t live without;
    • We score a late reservation at Skosh to get fed up - LOL. My google review: A smash hit. Tapas with knobs on;
      • We battle and fail to replace my iPhone battery;
        • Last suppers and overnighters with our pals;
          • We bid Kwetu, friends and family adieu.

Just now, our garden is almost Eden. Summer is coming. We will miss Britain’s finest hour. Eden fruitful at the time of plenty. But at least we won’t be in Yorkshire, praying for rain, whilst our Cyprus trees steadily turn brown. Our trees seem to be heading South. To a better place perhaps? So we might as well head South too.

Let’s return to the paediatric transition process for now: long term conditions in children are the exception not the rule. But when the finger points, kids can’t duck. Their conditions follow them like clouds over Eeyore. We capably support them through childhood. But then their future gets hazy. We plan with them to transition. We aim to hand them on to capable adult hospital care. We introduce them to the adult team. Support them with a specialist nurse to manage their transfer. But specialist transition care nurses are like hen’s teeth. When one goes sick the house of cards collapses. Chaos seems the pre-ordained course of adolescence. And adulthood these days seems one step beyond. Instead of transition the family get transfer. Into a blackhole. Disaster.

And that same entropy visited us this week. It’s Monday. We are T minus 24 hours. Departure looms. Our bags are almost packed. Three of them zipped up. Weighed. But we are destined to exceed the threshold. We beg an extra 15kg for our internal Zambian hop.

We manage our stress with lists. But stress is chasing us this week. We wake to news of bombs dropping on Iran. The world reels at the news. BA stop flights to Doha. But Qatar Airlines battle on. Our countdown drill ticks away. Or at least we tick jobs off our lists: Cars in garage. Batteries disconnected. SORNs complete. 20 tasks remain.

We are housebound, except by bike or shank’s pony. But these particular ponys are unwilling to move, until our tasks can be counted on one hand. Unprovoked, WhatsApp pings to life. Mum: Do you have a plan B? Yes. Complicated, but feasible. Two minutes pass. Mum again pipes up: When will you enact plan B? Turn on the news!

Armageddon seems imminent. Iran have bombed US airbases in Qatar. Qatari airspace is closed. A bit inconvenient – our understatement. Qatar Airlines our chosen poison. Manchester-Doha-Lusaka-Mfuwe. We scout for news. The internet is awash with stories. Predictions. Ideas. But in reality, nobody knows. We go to sleep at midnight, just as Qatari airspace is re-opened. That feels good. But chaos lurks. Planes in the wrong place. Crew needing a rest. And yet, online check-in fails to halt our blind optimism. The Qatar Airline’s app says our flight will go. On time. Dawn the next chance for Qatar to call the whole thing off. We sleep. Fitfully.

Oh the ups and downs of transition. Dawn cracks and the chorus welcomes an apparently blemish free day. It’s the end of summer.  Cool. Wet. Cloudy. We put the house to bed. Our taxi swallows 153 kilos of inanimate mass. We settle into our airport ride. It’s looking good. I talk to our flight booking agent. He agrees it looks good. The taxi spits us out at Manchester airport 2 hours later to face the music. But, then the music stops. And there are no chairs to sit on. Once again, we fall into a blackhole. No flight today. Unless we are happy to sort ourselves out in Doha. With over 1000 other stranded travellers. We toy again with plan B. Heathrow-Nairobi-Lusaka-Mfuwe. The internet says yes. But the flight booking team say no. Connections don’t exist. The price has suddenly tripled. Airlines making money as the world implodes.

Plan C is born. The same route as plan A. We join Qatar’s rebooking queue. Two hours of my life that I won’t get back. At the front: they promise deliverance. With only a 36-hour delay, despite the war. We invest in a hotel for the night. A gym workout. An Italian dinner. Sleep. Late breakfast. More gym. Lunch. Airport.

We track our incoming flight. It leaves Doha 30 minutes late. But arrives 30 minutes early. Tight connections in Doha and Lusaka. Still no guarantees of arriving in Mfuwe anytime soon. But my new-found pessimism is met with a positive outcome. Mfuwe without much ado.

So, back to our transition process. We start early. The path is mapped out. Expert support at hand. We have a plan to guide us. But we expect to adapt as we go. We need to be adept at adaptation, since Murphy will likely toy with us. His Law the rule, not the exception.

Our travel history is littered with delays: Airplanes breaking down mid-flight. Emergency landings. Weather issues. This time we navigate the complexities of international warfare. A first for us. We stay calm and positive. I have resolved that it will always feel difficult. I now understand the anxieties my patients and families feel as their time in paediatrics comes to a close. However much we explain the process and smooth the journey, leaving a comfortable niche is hard. It’s always challenging but sometimes rewarding. We are going onto bigger and better things. Elephants and hippos and giraffes. Oh my.

Skosh. Tapas with knobs on

Oh My