Glass half full

Photo of the week 1: A beautiful malachite kingfishwe

Photo of the week 2: Kafue delivers a calm young male leopard for our eyes only

Photo of the week 3: Triplet boys in Kafue

Highlight of the week: We finally get away on holiday to enjoy Kafue park. The park delivers on all fronts. We overcome the tsetse fly challenge

Lowlight of the week: Our time in zambia draws to a close

Maximum temperature: 31 degrees Celsius

Rainfall: A smattering last night in Kafue National Park

Don’t just do something. Wait a bit. Sage advice for volunteers.

Back to 1994. We are a little wet behind the ears. Our VSO induction programme dries our ears. And prepares us for our first overseas tour of duty. Zanzibar. The message is simple: Don’t expect to fix what you don’t understand. The mantra.

So we wait. We listen. We bite our tongues. Eighteen months on Unguja Island. Eighteen months of watching. Learning. Understanding. Then the gestation is complete. Our first baby is born:

Unawma na nini? What’s wrong with you? A training manual for primary healthcare workers. The printing presses at Save the Children in Zanzibar town attend the birth of Diagnosis and Treatment.

Fast forward thirty-two years: Another eighteen months of service in another Z country. Zambia this time. More experience. More watch and wait a bit. No rush to jump. Getting to grips with primary healthcare in Zambia has us wrestling with new complexities. New simplicities. We explore. We cooperate. We incubate some more. We make a plan.

Now our baby is ready to graduate. Diagnosis and Treatment has grown up. It is online. Free. Accessible across Zambia and Malawi. Shaped by experts. Tempered by experience. And increasingly brought to life through video. The videos are capturing attention. Challenging old habits. Nudging new ones. Even changing the way we practise medicine. These days, some patients now leave our Kakumbi clinic without a prescription. Even when the drug cupboards hold stock.

As proud parents, we beam. Our baby has left home. And is making its way into the world. 

DiagnosisandTreatment.org is ready for you. Ready to support clinicians across Zambia and Malawi. Ready to live in their pockets. On their phones. On their screens. Ready when they need it. Ready to guide. To support. To lend a virtual hand when the real one is not close by.

A small gift to Zambia from Virtual Doctors. Built from experience. Shared freely. And ready to make a difference.

Five tours of duty in Zambia. Eighteen months in total. And, officially, the longest-serving Valley doctors. Our dates for 2027 are already in the diary. June to October. Another hot season awaits. Another chapter in the Valley. Year on year, we see change. Some of it for the better. Some of it less welcome. But optimism remains.The Valley keeps moving. So do we. We will be back.

Keith and I are fortunate. We are both glass-half-full people. Perhaps it is the benefit of age. Or simply optimism. We have learnt to look beyond the immediate drama. To see the bigger picture. When one of us dips, the other usually lifts us both. It is rare for us to be down at the same time.

There are plenty of people here who seem permanently stuck in the glass-half-empty camp. Too often, they are found in bars. Emptying their glasses further. Filling their stomachs. Clouding their minds. Slowly spiralling downwards.

But elsewhere, the Valley offers another view. A sundowner. The sun sinking slowly into the horizon. A glass of wine catching the last golden light. Ice melts. The level rises. An impossible little trick of perspective. Perhaps that is the secret. Sometimes the glass really does become fuller as the sun goes down. The mood changes. Possibilities open. And tomorrow suddenly looks a little brighter.

Each year we arrive at the clinic to fond greetings. We are welcomed as friends. As colleagues. It feels like coming home. This year, the clinic itself has had a makeover. Fresh paint. Better lighting. A brighter place to work. Plenty of experienced staff.

But the old problems remain. Medicine shelves are half empty. Some are completely bare. Essential drugs are out of stock. Supplies run out. And sometimes never arrive. We see good prescribing. And bad. Antibiotics still being used for coughs and colds. History-taking is often brief. Examination skills can be limited. We take a deep breath. And start again. Not with grand plans. Not with miracles. Baby steps.

At our leaving do this year, one of the clinical officers speaks up. He tells us something that moves me. He used to fear sick children. So he avoided them. Steered towards the adults instead. The bigger patients. The seemingly easier cases. He thanks me for teaching him paediatrics. For building his skills. But more importantly, for helping him lose his fear. That’s a huge compliment. Perhaps the greatest gift we can give is confidence. Not just knowledge. The confidence to step forward. To have a go. To examine the child. To make a plan. I hope he is still at Kakumbi next year. Because confidence, like clinical knowledge, needs practice. I yearn to see that flourish.

It’s June 2024. We arrive back in the Valley three weeks before our official start date. Keith has been messaging far and wide. It is time to spread the word about stroke prevention. We head north. Further than we are normally allowed to travel when we are on duty. We meet the camp staff. Explain the plan. Set our objectives. Everyone over forty gets the full MOT. Height. Weight. Waist. Blood pressure. Diabetes. Cholesterol. A chance to uncover the silent risks before they become something more serious. Those under forty get a simpler check. Blood pressure. Waist. Simple. Quick. Painless. Baby steps towards preventing strokes.

Jona joins the queue. Twenty-six years old. Cheeky. Laughing. Playful. He sits down and offers his arm. Blood pressure cuff on. The numbers climb. And climb. Slowly, they fall. But not far enough. They settle stubbornly at 180/100. I quieten Jona down. Please relax. Look at the view. Sit still. Stop talking. I start the machine again. Up they go. Then down. 178/98. Hmm. One more time. 182/96.

I reach for an exercise book. This needs a little more investigation. His waist is a little too big. He smokes five cigarettes a day. He drinks more alcohol than is good for him. The pieces are beginning to stack up. I send him down the line. An appointment with Keith is needed.

Keith tackles the issues. Lifestyle changes are encouraged. But blood pressure this high in a young man deserves more than just encouragement. Further investigation is warranted. Medication too. Keith makes his recommendations. Jona goes on his way. But something else happens. The queue gets longer. Much longer. Jona has spread the word. Young men arrive. One after another. Arms outstretched. They look almost disappointed when I take their blood pressure and I don't reach for the exercise book. No full MOT for them. Their blood pressures are all fine.

Fast forward to July 2025. We are back up North. Back at the same camp. And once again, Jona is near the front of the queue. I check his numbers. 160/90. Better. But not good. His waist is a little smaller. He is taking his medication. Sometimes. When he remembers. When it hasn't run out. Otherwise, not much has changed.

Keith is called in again. This time we send Jona some Nyanja videos. Reduce salt. Stop smoking. Sit less. Move more. He is encouraged. Nudged. And sent on his way.

Then July 2026 arrives. We look North. But Jona is missing. I am worried. Then I discover he is working at one of the bush camps even further north. As luck would have it, we are heading there. I make a mental note: Find Jona.

We arrive in North Luangwa. A smiling face meets me, as I step off the boat. Nice to see you again Dr Ginny. It is Jona.

Keith and I set up our bush clinic. Before long, Jona is in the queue. He sits down confidently. Offers his arm. The cuff inflates. The numbers climb. Then fall. 124/84. I stare at the machine. Puzzled. What medication are you taking? He smiles. None. Two more readings. Identical. 124/84.

Where has the hypertension gone? Jona already knows. The first year, I didn't do anything. I thought I was OK. He pauses. The second year, Dr Keith told me that smoking could make me die early. And that I could have problems having sex. That got my attention. So I stopped smoking.

Then came the salt. I stopped adding salt to my food. Then the alcohol. I gave that up too. And finally, exercise. Now I do weights every day.

For the next two days, whenever I see Jona, he beams at me. A huge smile. I check how sustainable these changes really are. Forever. He tells me.

Jona has become one of our poster boys. Not because we cured him. But because he changed.

The blood pressure was real. The risks were real. But so was his ability to do something about them. 

For every Jona, there will be others who are not quite ready. Not ready to change. Not ready to take control. And that’s OK. People are allowed to make bad decisions. Our job is to make sure they understand that they are making a decision. And that they can choose differently.

So we leave with optimism. It is easy to pick holes. To find fault. To wallow in discontent. To collect the negatives and make them the narrative. We choose a different path. We look forward. We nudge. We support. We celebrate the small gains. The tiny shifts. The quiet victories. That is what keeps us coming back. Year after year.

2026 has been an extraordinary stint for us. Full of challenges. Full of rewards. Full of moments we will carry with us. And now, for a while, we put down our pens. This is our final blog of the season. You can sit back. Rest your eyes. Enjoy the peace and quiet. Thank you for coming with us. For following our adventures. For taking an interest in our lives here in the Valley. 

And a very special thank you to our donors. Without you, our Stroke Prevention Programme would never have got off the ground. Your generosity keeps it moving. Keeps it alive. Keeps us moviyas.

We move forward together. With our district and national colleagues. Shaping the future of primary healthcare in the Valley. In our district. One step at a time. Change must be more than a good idea. It must be sustainable. It must involve people. Listen to them. Work with them. Give them the tools to take ownership. Because the goal is not simply better healthcare. It is better health. Thanzi is the local word for that. The local word. And the National word. Thanzi will be our next big thing. But that’s a story for another day.

For now, we bid you a fond farewell. The Valley will still be here. And, we hope, so will our footprints. Small marks. Small changes. A little influence left behind. Then, in June 2027, we return. We pick up the trail where we left it. Follow our footprints forward. And begin the next chapter.

You cannot change your future, but you can change your habits and surely your habits will change your future. Dr APJ Abdul Kalam

Remote cam photo of the week: Just as we leave Kapani, the elephants are back outside the house

We get away to Chinzombo for one last night. Yoga by the river

The last sundowners by the Luangwa

This lovely family of over 20 elephants greet us on what was our commute to work - But has become our transfer to the airport. 

Lilac breasted rollers 

This guy has been in the wars. A very badly damaged right hip and facial wounds. But now on the road to recovery

Norman Gnu Mates. Been on his own now for 3 years. Name and photo courtesy of Alan