Snap. Crackle. Pop

Photo of the week. On world leopard day we are greeted by Lucy's cub

Highlight of the week: Ginny's sourdough pizza from Ian' starter.

Lowlight of the week: Sleep is stolen from us. Business is booming.

Maximum temperature: 34 degrees Celsius

Rainfall: Not a drop

Snap, crackle, pop. Wholesome noises. Evocative. Summoning up my childhood. But a subtle change to snap, crack, pop and my stomach wrenches. But more of this later….

It’s April 2021. We retire. Sage advice from a dear friend directs our thoughts. Bruce, a step ahead of us, opines that we might seek balance in retirement. Our jam packed diaries need filleting. One entry per day the way forward. Be it a plumber or cutting the lawn. Overachievement the enemy. A foe worth fighting. An overzealous Yang. Surrender to the Yin. Passivity in life, suggests Bruce. Let balance into your lives.

Time marches on. Five years pass. Our diaries are either empty, or full. Yin and Yang compete. It’s April 2026. Somehow Bruce’s maxim is put to one side for the day. We have two diary entries today. Dropping staff off at the peripheral clinic and meeting with our bosses. One more than two. The light dominating the dark. The balance is threatened.

Kakumbi clinic our first stop. Staff and kit fill Mzungu. Doors ajar to avoid greenhouse heating. Kennan, a clinical officer, seizes his chance. He is going off shift, after a steady night on-call. Doctor Keith. I have a patient for you. From last night. Please would you take a look at him? The baton is passed. A promise from Keith to cast an eye. In ten minutes, after community clinic drop off.

Five members of staff. A wooden frame for height measurement – an instrument of torture. Vaccines and scales. Nyamununga tree clinic is set up. Diary entry number one is scored through. It’s 08:15.

Back at Kakumbi, Keith talks to *Arthur about his semi-conscious friend *Sidney. Arthur is a bit vague about the nitty gritty. Sidney has been like this before. Confused and responding to an overactive imagination. Kennan gave him a jab of diazepam last night and now Sidney is away with the fairies. There is no smell of booze, but Sidney loves kachasu. Intoxication his default state. Sidney reeks of urine and his self-care leaves a lot to be desired. Kachasu supplies ran out 3 days ago and Sidney has been on edge ever since. Last night he seemed mad. Arthur chooses the clinic over the witch doctor. Knowing that they fixed him a year ago. Light wins over dark.

Despite the diazepam Sidney is stiff. Things aren’t completely clear. We arrange to test the testables. To treat the treatables. His blood glucose is fine. The lab team is enlisted for malaria, syphilis, sleeping sickness and HIV tests. A plan for thiamine and baclofen is hatched and we peel off to address diary entry number two. Mzungu heads off to collect boss number one and boss number two. Priya and Choti our Luangwa Safari Association Medfund masters.

Our diaries nudge us gently to meet with our District Medical Officer and the doctor in charge of the district general hospital, Velos. Boss number 3 and boss number 4 if you like. Our agenda not solid, and open to sway one way or another. But balance the only essential element. Our meeting venue is the District Hospital. Far in the bush. Near the airport.

We reach the hospital 30 minutes later. Smiles and welcomes. On time. Less traditional African and more clinical and practical. Our minds meet. A little pull. A little give. Ideas blend in a productive meeting. We agree to share skills in a realistic fashion. Two large group meetings in each month, unless the course of unpredicted events intervene. Priorities are discussed and we exit sharply. Ticking off our second diary entry efficiently as we go.

Meanwhile, back at Kakumbi: we have tests brewing. All the lab tests say No. But time is our key test. Sidney is up and about. Wandering around picking up imagined items on the concrete floor. His limbs are all fully functional. His brain however, is still well below par. We seek input from Arthur and scratch our heads. DTs seem the best fit and Keith offers something to keep the possibility of fits at bay. He fishes out some drugs from the back of Mzungu and we explain a dosing regimen to Arthur. Sidney will have some hard choices to make when he sees Keith again on Monday.

Arthur by now has been in clinic for 16 solid hours. Caring. Forgetting to care for himself. The room is hot. An unforgiving concrete environment. Thirst and hunger have been deferred. We forget the health of carers at our peril. Peril waits patiently.

We turn our backs briefly and step outside. Away from the heat and stuffiness of the ward.

A whoosh of air, as a rigid body swings through 90 degrees. Snap, crack, pop. Immovable concrete stops a human form from further descent. An equal and opposite force. Sudden and unforgiving. Jaw hits concrete. Concrete wins. A sickening snap. The crack offends our ear drums. A pop as blood spurts forth from mouth, chin and ear. In an instant, carer becomes patient 

Arthur is fitting. Tonic as he fell like a log. Then clonic. Several beats. Blood is gushing from a badly cut lip and a chin wound. Grabbing gloves from pockets, we support his airway. Talk to him in calm voices, to tell him that he will be fine. A pool of blood on concrete provides a sample to check his glucose level. He comes around quickly, but his first urge is to head to the bathroom. Keith man-handles him as he heads to a room full of unforgiving bathroom fittings and another concrete floor. Saulos, really our number 1 boss, the clinic in charge, magically appears in an immaculate white uniform. He too guards Arthur’s body from further insult. Whilst calmly cleaning blood from Arthur and the clinic whilst remaining unmarked himself. We shepherd Arthur back to a bed and start to survey the damage. Arthur takes a litre of oral rehydration solution. In a scene reminiscent of Ice Cold in Alex. Opening his mouth to permit access for fluid and light. The inside of his lip is badly cut, but stitches are unlikely to help here. Keith rashly takes comfort that the mandible might be OK. Despite the loud crack that insulted his ear drums earlier.

The cut under the chin draws Keith’s focus. If nothing else this can be fixed. Within 5 minutes four sutures patch up at least one part of our wounded Samaritan. Blood seeping from his right ear gives cause for concern and we decide that X-ray vision might be needed. On the plus side there is no spinal fluid coming from the ear. Arthur’s brain seems to have been protected. His jaw taking the brunt of the impact. The lack of both nausea and headache reassuring. Expecting pain we give paracetamol and ibuprofen.

Meanwhile, the carers of the carer are wilting too. Thirsty. Hungry. Hangry. The ability to make rational decisions is dwindling. The only viable decision is to eat and drink. Care for the carers. We head off to lunch, with a promise of immediate return. Resuscitation in mind.

Saulos, being the boss, thinks of the bigger picture. Without carers our small inpatient bays are nothing. Food and drink vital fuel for rehab. Carers the catalysts, providing impetus for patients to rally. Family and friends our salvation. Saulos calls the cavalry. And Arthur’s Dad appears out of thin air. A second call discovers that the ambulance is heading the wrong way and won’t be available for 6 hours. Meanwhile, Saulos is also busy in his hypertension clinic. His 2 year old baby. Keith the surrogate father.

Within 30 minutes Keith is back. A quick word in Arthur’s good ear establishes that Arthur’s brain is just fine. Keith’s brain is now also back on form. Rebooted with food and fluid. His request for Arthur to open his mouth seems to fall on deaf ears. But despite the clot in his right ear, Arthur is neither deaf nor dumb. Sixty minutes after that sickening crack a fractured mandible declares itself. The hinges of Arthur’s jaw horribly swollen and seized up.

The process of Arthur’s transfer to Velos hospital is shrouded in a haze. Our District Hospital - built to serve an international airport that will hopefully never need its services - is in a far flung field. This distant location, without a transportation system to speak of controls the flow of accidents and emergencies to Velos. And yet Arthur arrives. His dodgy X-rays arrive on the Doc phone this evening. Blurred images bounce to Germany. Blurred facial bones that blend into facial bones, needing intercontinental expert input. Ralph, bless him, is always on-call! His reply super-quick. The jaw is broken. A condyle needing an expert fix.

Keith has a mere 3 months of ear, nose and throat training under his belt. That means that he got a full month, back in 1991, to learn how to fix each ailing part. Ralph suggests an expert, so Keith hands on the baton. At first a proper expert seems to be on hand. Satiel, a highly skilled ENT surgeon, based at Velos, answers Keith’s WhatsApp instantly. Agreeing on surgical intervention.

But Satiel is actually out of the loop. On distant and extended leave and unable to offer personal help. But at least he knows a friend. A chap in Chipata with the skill to pin Arthur back together. Arthur is sent even further down the road.

We take the blow on the chin. Arthur should get the care he needs, but much further down the road. Meanwhile, Arthur can’t eat, since his mouth won’t allow him to separate his clenched teeth. A prolonged pre-surgical fast is forced upon him, not by anaesthetic guidance, but by physical obstruction. The burden on his family is massive. Long journeys make the carers role a huge headache.

What’s the craic? Ask Phil and Christina at sundowners. Crack a word too triggering for us both. We flash back and relive the trauma of the day. At least we are not nil by mouth this evening. We sit by the Luangwa opening our jaws freely. Able to eat tasty treats and wash them down with a passionfruit G&T and above all able to jaw-jaw. We debrief at the end of an overfilled day. We regret not providing some sort of safety net for our kind Samaritan carer. Could we have recognised the physical stresses imposed on a single carer and have prevented Arthur’s full face dive onto unyielding concrete? We had no way of knowing that poor Arthur was prone to seizures.

Our guilt will at least ensure that Arthur’s aftercare is second to none. Keeping his fits at bay part of the plan.

*Names have been changed to protect anonymity. Permission has been granted to publish this story.

Bush-cam photo of the week. A thirsty monitor lizard

Baboons offering to help with the cooking

Sour dough pizza

A debrief by the Luangwa as the sun sets and the moon rises