Back to School

A dazzle of zebra puts the dogs off

Highlight of the week: Perry has a Sunday off and Kiki’s car happens to be available. Ian and Alicia’s last game drive is leopard heaven.

Lowlight of the week: Ian and Alicia leave us to man the fort.

Maximum temperature: 35 degrees Celsius

Rainfall: One light overnight shower

It’s 08:30. We arrive at clinic. Bright and eager. Clean school uniforms. Freshly pressed. Name tags embroidered on our scrubs rather than sewn into our underwear. Shoes polished. Socks pulled up. Bags neatly packed. A full set of kit at the ready. Not exactly compasses and protractors, but close enough. It’s our first day back at school. We have had a long break from all of this. Our school chums haven’t seen us for 6 months. We are pumped. Have we still got what it takes? Are we imposters? What’s it going to be like in the fifth year? Will we be teacher’s pets or mischievous makers?

The clinic looks different somehow. Fresher. Brighter. Transformed by a lick of green paint. No longer dirty and uninviting. Our Valley green after all the rain. Our clinic also green, symbolising renewal. Many new faces. New leadership. Young and vigorous new shoots of life.

Our first day at Kakumbi clinic begins with hugs. Held hands. Smiles and greetings. Greetings deepen. Testing our embryonic Nyanja. Embryology not my strong suit. Too many dimensions and complications involved. And of course real Nyanja is rarely spoken here. Kunda the local tribal banter. Nyanja meant to be the common link, but pure Nyanja rarely spoken by anyone this side of the Malawian border.

Our scrubs announce our own names. But our co-workers are not always so easy to pin down. There are no name badges pinned on their chests. And we choose not to check their underwear. Their previously known names blend in our aged minds. Their hair pieces transform them beyond all recognition. We use names judiciously and the honorific of muzanga (friend) is awarded freely. To great delight. A sneaky word to one side with obliging informants saves face. We are back in the throng.

I sit with Sister Spiwe in my favourite, light, bright room. I suggest that we see children together. School exercise books are soon stacked on our table. I smile broadly. Secretly delighted that the computers are down. Our records should be computerised by now. But off-site data means no data in a world without broadband. The Ministry of health funds 30GB of data per month. A bundle that barely lasts a week. So we are blind to the past, whilst exercise books at least record the present. We rely on patients’ hazy stories and honesty. But this is short sighted. We need data to prove that pathology is rife in the Valley. No data – no drugs. A paper trail going nowhere. Nothing to join the dots.

Keith sits in the also-ran screening room. A dingy place with no lights. With a shuttered window. But discretion prevents the shutters from opening. The waiting room with interested ears lies beyond. Playschool options are limited to the round and the arched windows. Emmanuel and Keith trawl through the bigger people whilst Spiwe and I start to look for needles in our haystack of self-limiting illnesses.

For Spiwe and I pathology is thin. A smattering of viral respiratory infections. Two kids with  big sore tonsils. A single child with malaria. A child unwilling to walk after a fall. A girl burnt by hot porridge - hand swollen and sore. All straight forward. Nothing too taxing. There is a lull in proceedings. It’s not so busy today.

Emmanuel is wearing the last pair of examination gloves in the treatment room. Keen not to add insult to injury. He is tending to a mere flesh wound. Stoic Jobry sits on the examination couch. Pleased not to be standing on his one remaining leg. His missing foot remains in a crocodile’s belly in the Luangwa. But at least the croc is sporting an injury himself. A quant, used by Jobry’s mate, pole-axed the croc last week and interrupted the intended death-roll. Now, it may well be a fisherman’s tale, well told by this particular fisherman. But a 5 metre croc is a worthy adversary. Jobry’s folly was to walk in the murky shallows. Tick-Tock becomes Snap-Crack. The leviathan takes its prey. Without even saying grace.

Jobry opts to avoid anonymity. Delighted to be alive. He wants to share his fisherman’s tale more widely. To show his scars and scabs. His image and his stump accompany his story. He will not mourn his well digested foot. He’d rather celebrate the rest of his body and the heroic tale of his fearless colleague. Keith marvels at his positivity and gives him clindamycin to ward away the crocodile’s hidden assassins. A mouth full of bacteria from a bygone age seek to munch further into Jobry’s leg beyond the reach of the croc’s savage teeth.

As the morning draws to a close, we conspire to make a sharp exit. But a commotion outside draws our attention. A baby, Justine, is brought in. Limp. Eyes closed. Unresponsive. The story is confusing. Nurse Emmanuel cannot find the words in English to help me. The child has swallowed something noxious. Given to her by a mischievous little friend. I finally deduce that benzene is Justine’s forbidden pleasure. A type of fuel. Unpalatable. But with an intriguing smell Justine must have had at least a taste. She has a smell of fuel on her dress. A quick assessment. Breathing is fine. Heart rate normal. Oxygen levels 92%. Her conscious level is depressed, but she is not comatose. A blood sugar is normal. No other tests possible. She rouses slightly. We plan to observe her for 4 hours. Watch her breathing. Encourage her to feed when she wakes up. We pray that she doesn’t vomit. Her lungs won’t like rocket fuel.

Whilst my attention is on Justine, Keith seems to have done a runner. But in truth, he has been distracted by the sharp end of his stroke programme. Tryson is seizing. He had a stroke 2 years ago, but thanks to our BP clinic, his blood pressure has been at target for the last year. Tryson has also been taking stroke programme atorvastatin and aspirin to protect his fragile arteries. Tryson’s wife might have borrowed extra precious time with her husband, with an extra turn of the big hourglass. But the sands of time appear to be running out now. Sister Spiwe is worried that we need to bring Tryson’s blood pressure down. Keith opts to control the fits. Fits play havoc with automatic BP machines. Tryson’s BP is flattened by a jab of diazepam in the leg. Keith smiles ruefully. He discards the powdered nifedipine. He won’t need to bring Tryson’s blood pressure down after all. Tryson’s life is hanging in the balance. 76 is a respectable innings. But it’s culturally tough to allow the umpire to pronounce the end of an innings in a primary care unit and we reluctantly transfer Tryson to our District General Hospital. Velos hospital however has no third umpire. No functional CT scan. And no interventional radiologist. Life teeters in the balance. The bails wobbling on top of the precarious wicket.

Further shouts and cries outside. Grace a 35 year old lady is in agony. She fell over this morning and dropped a metre. Onto her right knee. Immediate pain. Her leg out at an angle. Something looked skew-whiff. A neighbour helped her and somehow made the leg straight. She arrives on the back of a motorbike. And is carried into the ward. Screaming loudly. Keith is playing wicket keeper for Tryson. So I double my age range in an instant. An assessment reveals a large swollen knee. Boggy and soft. With an effusion. The bones seem ok and she can straighten the knee. I give her paracetamol and ibuprofen. Advise rest. A possible patella dislocation. And likely soft tissue injury to the knee. I advise 48 hours of rest and analgesia. Then a trip to the physiotherapy department after the weekend. To properly check out the ligaments and gristle.

Lunch summons us and we choose not to resist. Tribal café. A chicken wrap takes Keith’s fancy. I opt for avocado on sourdough. We are in deepest darkest Africa eating goodies that African’s can’t quite fathom. Most locals prefer nshima with relish. We pale creatures eschew the joys of Zambian haute cuisine, preferring to keep our glucose numbers in single figures. Emily’s chocolate cake taunts us. But we steel ourselves and head back to work.

We have unfinished business. An expected safari side client has apparently rallied and fails to show. More importantly my young girl with fuel in her belly has roused and is deemed fit to head home. Grace is taking tentative steps, fuelled by ibuprofen and the District’s only ambulance has arrived to take Tryson to either wake or sleep forever.

We leave at 15:00. Our wards empty. We scan the dribs and drabs of left-overs in the outpatient queue. An eyeball triage lets us go. Keith remembers that he owes me some sort of indulgence after 33 years of marital bliss. That cake of Emily’s will complement our reheated leftovers. And make everything seem just fine. Our first day back at school in the bag. 

Our commute. Sometimes we can't help being late. 

Fresh and ready to go

Jobry stoically has his dressing changed. 

Lucy hides under our car as she stalks an impala

A lilac breasted roller surveys the land